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. 2023 Feb 10:14:46-76.
doi: 10.1016/j.xjon.2023.02.002. eCollection 2023 Jun.

Racial disparities in surgical treatment of type A acute aortic dissection

Adhana Asfaw  1 , Yuming Ning  2 , Adrianna Bergstein  1 , Hiroo Takayama  3 , Paul Kurlansky  2   3
Affiliations

Racial disparities in surgical treatment of type A acute aortic dissection

Adhana Asfaw et al. JTCVS Open. .

Abstract

Objective: To determine whether there are racial disparities associated with mortality, cost, and length of hospital stay after surgical repair of type A acute aortic dissection (TAAAD).

Methods: Patient data from 2015 to 2018 were collected using the National Inpatient Sample. In-hospital mortality was the primary outcome. Multivariable logistical modeling was used to identify factors independently associated with mortality.

Results: Among 3952 admissions, 2520 (63%) were White, 848 (21%) were Black/African American, 310 (8%) were Hispanic, 146 (4%) were Asian and Pacific Islander (API), and 128 (3%) were classified as Other. Black/African American and Hispanic admissions presented with TAAAD at a median age of 54 years and 55 years, respectively, whereas White and API admissions presented at a median age of 64 years and 63 years, respectively (P < .0001). Additionally, there were higher percentages of Black/African American (54%; n = 450) and Hispanic (32%; n = 94) admissions living in ZIP codes with the lowest median household income quartile. Despite these differences on presentation, when adjusting for age and comorbidity, there was no independent association between race and in-hospital mortality and no significant interactions between race and income on in-hospital mortality.

Conclusions: Black and Hispanic admissions present with TAAAD a decade earlier than White and API admissions. Additionally, Black and Hispanic TAAAD admissions are more likely to come from lower-income households. After adjusting for relevant cofactors, there was no independent association between race and in-hospital mortality after surgical treatment of TAAAD.

Keywords: aortic dissection; racial disparities; type A aortic dissection.

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Figures

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Graphical abstract
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No independent association found between race and TAAAD mortality.
Figure 1
Figure 1
Type A acute aortic dissection cohort selection was done using the National Inpatient Sample database for 2015 to 2018. Nonelective admissions were included if there was a thoracic or thoracoabdominal dissection diagnosis code and a surgical procedure code on the ascending aorta for a final cohort of 4204 admissions. This cohort was then stratified by the race variable. API, Asian and Pacific Islander.
Figure 2
Figure 2
Type A acute aortic dissection (TAAAD) cohort by race. The final cohort of TAAAD admissions included 2520 White admissions, 848 Black admissions, 310 Hispanic admissions, 146 Asian and Pacific Islander (API) admissions, and 128 admissions classified as Other.
Figure 3
Figure 3
Multivariable regression model of in-hospital mortality. Forest plot representation of a multivariable regression model of in-hospital mortality, showing the Elixhauser Comorbidity Index, age, and race. Both the Elixhauser Comorbidity Index (odds ratio [OR], 1.046; 95% confidence interval [CI], 1.001-1.093) and age (OR, 1.029; 95% CI, 1.017-1.041) were independently associated with type A acute aortic dissection in-hospital mortality. However, race was not found to be independently associated with mortality. ∗P ≤ .05, ∗∗P ≤ .01, ∗∗∗P ≤ .001. API, Asian and Pacific Islander.
Figure 4
Figure 4
Graphic abstract.
Figure E1
Figure E1
Cubic spline of the Elixhauser comorbidity index.
See this image and copyright information in PMC

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