JTCVS open · 2025
Neighborhood socioeconomic status predicts long-term outcomes after acute type A aortic dissection repair in a propensity-matched cohort.
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Catalano Michael A, Gillinov Lauren, Lawrence Kendall M, Toubat Omar, Goel Nicholas J, Patrick William L, Sperry Alexandra E, Brown Chase R, Szeto Wilson Y, Desai Nimesh
Аннотация
OBJECTIVE: Socioeconomic status is associated with outcomes after various cardiac surgical procedures, including repair of acute type A aortic dissection; however, existing data are limited to short-term follow-up and incomplete markers of disparity. We sought to apply a comprehensive, validated score of neighborhood-level socioeconomic status to explore the impact of resource deprivation on long-term outcomes of patients undergoing acute type A aortic dissection repair.
METHODS: A retrospective review of our institution's database of type A aortic dissections was conducted to identify patients undergoing acute type A aortic dissection repair from 1993 to 2022. Socioeconomic status was quantified using the Area Deprivation Index, a weighted score that incorporates 17 markers of disparities to determine overall deprivation at the neighborhood block level. Patients were divided into 4 quartiles based on Area Deprivation Index, with Q1 representing the most deprived and Q4 representing the least deprived. Fifteen-year survival was compared between the first and fourth quartiles in a propensity-matched survival analysis and a multivariable Cox proportional hazards model.
RESULTS: Of 1199 patients with addresses available for Area Deprivation Index linking who underwent acute type A aortic dissection repair, 294 patients were in Q1 and 306 patients were in Q4. Patients in the lowest quartile were younger, more likely to be female, and less likely to be White. After propensity matching, Kaplan-Meier survival analysis revealed significantly reduced 15-year survival among patients in Q1 (P = .025). Cox proportional hazards assessment confirmed the national Area Deprivation Index percentile as a continuous variable as a predictor of mortality (hazard ratio, 1.006; P = .002).
CONCLUSIONS: Socioeconomic status is associated with long-term mortality after acute type A aortic dissection repair, despite no difference in initial presentation or early postoperative outcomes.
METHODS: A retrospective review of our institution's database of type A aortic dissections was conducted to identify patients undergoing acute type A aortic dissection repair from 1993 to 2022. Socioeconomic status was quantified using the Area Deprivation Index, a weighted score that incorporates 17 markers of disparities to determine overall deprivation at the neighborhood block level. Patients were divided into 4 quartiles based on Area Deprivation Index, with Q1 representing the most deprived and Q4 representing the least deprived. Fifteen-year survival was compared between the first and fourth quartiles in a propensity-matched survival analysis and a multivariable Cox proportional hazards model.
RESULTS: Of 1199 patients with addresses available for Area Deprivation Index linking who underwent acute type A aortic dissection repair, 294 patients were in Q1 and 306 patients were in Q4. Patients in the lowest quartile were younger, more likely to be female, and less likely to be White. After propensity matching, Kaplan-Meier survival analysis revealed significantly reduced 15-year survival among patients in Q1 (P = .025). Cox proportional hazards assessment confirmed the national Area Deprivation Index percentile as a continuous variable as a predictor of mortality (hazard ratio, 1.006; P = .002).
CONCLUSIONS: Socioeconomic status is associated with long-term mortality after acute type A aortic dissection repair, despite no difference in initial presentation or early postoperative outcomes.