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. 2025 Jul 15;152(2):92-100.
doi: 10.1161/CIRCULATIONAHA.124.072018. Epub 2025 Apr 7.

Racial Disparities in Long-Term Outcomes After Endovascular Aortic Aneurysm Repair in Black and White Medicare Beneficiaries

Abena Appah-Sampong  1   2 , Christina Marcaccio  3   4 , Siling Li  3 , Yang Song  3 , Mohamad A Hussain  1   2 , Robert Yeh  4 , Marc L Schermerhorn  4 , Eric A Secemsky  3
Affiliations

Racial Disparities in Long-Term Outcomes After Endovascular Aortic Aneurysm Repair in Black and White Medicare Beneficiaries

Abena Appah-Sampong et al. Circulation. .

Abstract

Background: Despite reported racial disparities between Black and White adults in short-term outcomes after abdominal aortic aneurysmal intervention, there is a paucity of literature aimed at understanding long-term disparities. The present study aims to characterize racial disparities in long-term outcomes, perioperative outcomes, and health care use after endovascular aortic aneurysm repair.

Methods: We conducted a retrospective cohort study from 2011 to 2019 with outcome assessment through 2020. Using a 100% sample of national Medicare data, we identified beneficiaries ≥66 years of age who underwent intact infrarenal endovascular aortic aneurysm repair. The primary outcome was a composite of endovascular or open aortic reintervention, late aneurysm rupture, and all-cause mortality. Secondary outcomes included other reinterventions, perioperative outcomes, and annual rates of health care use.

Results: A cohort of 107 636 Black (3.9%) and White (96.1%) beneficiaries was identified. The cumulative incidence of the primary outcome was 72.9% (95% CI, 71.8%-73.9%) in White patients versus 80.0% (95% CI, 76.4-83.0) in Black patients (P<0.0001). The adjusted hazard of the primary outcome was not significantly different between Black and White adults (adjusted hazard ratio [HR] 1.04 [95% CI, 0.99-1.09]); however, when death was treated as a competing risk, a significantly higher hazard for the composite outcome was observed for Black patients (subdistribution HR, 1.56 [95% CI, 1.39-1.76]). Components of the primary outcome were also greater among Black compared with White patients. Black patients had higher rates of medical complications in the perioperative period, including acute renal failure (subdistribution HR, 1.18 [95% CI, 1.01-1.38]), dialysis initiation (subdistribution HR, 2.75 [95% CI, 2.03-3.7]), and deep vein thrombosis (subdistribution HR, 1.54 [95% CI, 1.05-2.26]). Black patients had lower rates of vascular office visits after intervention (adjusted rate ratio, 0.96 [95% CI, 0.93-0.99]) but higher rates of emergency department visits (adjusted rate ratio, 1.05 [95% CI, 1.02-1.09]) and hospital readmissions (adjusted rate ratio, 1.13 [95% CI, 1.08-1.18]).

Conclusions: Black patients demonstrated increased risk of late aortic-related events after endovascular aortic aneurysm repair after accounting for the competing risk of death and controlling for baseline covariates. Further investigation into structural barriers affecting optimal preoperative medical management and barriers to postoperative health care access is necessary to further elucidate underlying mechanisms for the observed disparities.

Keywords: Medicare; aortic aneurysm, abdominal; endovascular aneurysm repair; healthcare disparities.

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Conflict of interest statement

Dr Secemsky reported receiving grants from Philips, Medtronic, Boston Scientific, Cook Medical, and BD during the conduct of the study, as well as receiving grants from AstraZeneca, CSI, and Laminate Medical and personal fees from Philips, Medtronic, Boston Scientific, Cook Medical, BD, CSI, Janssen, VentureMed, Abbott, Bayer, and Inari Medical outside the submitted work. Dr Schermerhorn reported receiving personal fees from Abbott, Cook Medical, Endologix, Medtronic, Philips, and Silk Road Medical outside the submitted work and participating in a scientific advisory board meeting without pay for Medtronic and Philips. Dr Yeh reported receiving grants from BD Bard, Boston Scientific, Cook Medical, Medtronic, and Philips during the conduct of the study, as well as receiving personal fees from Boston Scientific, Medtronic, Shockwave Medical, and Zoll Medical outside the submitted work. Dr Hussain reported receiving grants from Vascular Therapies (ACCESS-2 Trial) and Humacyte, Inc (V-012 Trial) and consulting for Humacyte, Inc.

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