title: AAA repair: sociodemographic disparities in management and outcomes.
abstract: OBJECTIVE
  To evaluate sociodemographic influences on utilization and outcomes of endovascular abdominal aortic repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA).
  
  
  METHODS
  Secondary data analysis of the State Inpatient Databases for New Jersey.
  
  
  RESULTS
  Between 2001 and 2006, a total of 6227 adult subjects (mean [SD] age, 73.3 [8.3] years; 77.6% male) underwent AAA repair (3167 EVAR and 3060 open surgery [OS]). Patients receiving EVAR were older than those undergoing OS (mean [SD] age, 74.2 [8.0] vs 72.4 [8.6] years) (P < .001). Men were 1.60 (95% confidence interval [CI], 1.39-1.77) times more likely to receive EVAR than women. White subjects had the same odds of undergoing EVAR as black subjects, and white subjects had 1.60 (95% CI, 1.29-2.06) times higher odds of receiving EVAR than Hispanics. Subjects with Medicare coverage were 3.90 (96% CI, 2.28-6.59) times more likely to receive EVAR than uninsured subjects. Logistic regression analysis demonstrated that older age, male sex, and Medicare coverage were significantly associated with increased utilization of EVAR and that uninsured subjects and Hispanics are less likely to receive EVAR. Octogenarians and black subjects (odds ratios: 3.69 CI: 2.31-5.91, and 2.59 CI: 1.47-4.54 respectively) had significantly greater likelihood of death after elective AAA repair.
  
  
  CONCLUSIONS
  For AAA repair, significant sociodemographic disparities exist in the use of endovascular technology and in mortality. The risk of death after elective AAA repair was significantly greater for black subjects. Further analysis is warranted to delineate inequalities of vascular care for AAA and to assist in formulating policy to address these disparities.
authors.affiliation: Division of Vascular Surgery, The Surgical Outcomes Research Group, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08903-0019, USA. tvogel@excite.com
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.forename: Joel C
authors.initials: JC
authors.lastname: Cantor
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Paul B
authors.initials: PB
authors.lastname: Haser
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare; D009515:New Jersey; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D044465:White People