title: Racial and ethnic disparities in the treatment of unruptured thoracoabdominal aortic aneurysms in the United States.
abstract: OBJECTIVE
  Previous studies have found increased mortality in minority patients undergoing abdominal aortic aneurysm repair. The goal of this study was to identify racial and ethnic disparities in patients undergoing thoracoabdominal aortic aneurysm repair.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample (2005-2009) using International Classification of Diseases, Ninth Revision, Clinical Modification codes for repair of unruptured thoracoabdominal aneurysms. The primary outcome was death. Secondary outcomes included postoperative complications. We performed multivariate analysis adjusting for age, gender, race, comorbidities (Charlson index), insurance type, and surgeon and hospital operative volumes and characteristics.
  
  
  RESULTS
  Overall, 1541 white, 207 black, and 117 Hispanic patients underwent thoracoabdominal aortic aneurysm repair. White patients tended to be older (P = 0.003), whereas black patients had a higher incidence of diabetes mellitus (P = 0.04). Black and Hispanic patients were less likely to have an elective admission (P < 0.001) and more likely to have repair performed at a hospital with a lower average annual surgical volume (P = 0.04). Postoperative complications were similar among the groups (P = 0.31). On multivariate analysis, increased mortality was independently associated with Hispanic ethnicity (relative ratio [RR], 2.57; 95% confidence interval [CI], 1.25-5.25; P = 0.01), cerebrovascular disease (RR, 1.88; 95% CI, 1.10-3.23; P = 0.02), and age (RR, 1.04; 95% CI, 1.01-1.07; P = 0.004).
  
  
  CONCLUSIONS
  Hispanic ethnicity is independently associated with increased mortality after repair of unruptured thoracoabdominal aneurysms. This finding was independent of preoperative comorbidities, postoperative complications, and surgeon and hospital operative volumes. Further studies are necessary to determine whether this mortality difference persists after the index hospitalization.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Arnaoutakis
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Propper
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perler
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Abularrage
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000191:economics / Q000208:ethnology* / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
keywords: Ethnicity; Outcomes; Race; Thoracoabdominal aneurysm