title: Socioeconomic disparities affect survival after aortic dissection.
abstract: OBJECTIVE
  The effect of socioeconomic status (SES) on the course of many disease states has been documented in the literature but has not been studied in aortic dissection. This study evaluated the effect of SES on 30-day and long-term survival of patients after aortic dissection.
  
  
  METHODS
  Hospital discharge records were used to identify patients with acute aortic dissection. Patient demographics, insurance status, comorbidities, and 30-day mortality were collected. Home addresses were used to estimate each patient's median household income, and the neighborhood deprivation index, a measure of SES, was determined. Long-term survival was assessed by review of the Social Security Death Index. Associations between demographics, insurance status, comorbidities, and poverty level were investigated to determine their effect on survival.
  
  
  RESULTS
  There were 212 aortic dissections; of which, 118 were type A and 94 were type B. Median follow-up was 7.6 years. The neighborhood deprivation index (hazard ratio, 1.43; 95% confidence interval, 1.16-1.78; P = .001) was associated with reduced long-term survival and was also significantly associated with 30-day mortality (hazard ratio, 1.43; 95% confidence interval, 1.05-1.93; P = .02). The mean neighborhood deprivation index score was higher in patients with type B aortic dissections (0.45 ± 0.93) than in those with type A aortic dissections (0.16 ± 0.96; P = .029).
  
  
  CONCLUSIONS
  Patients with a lower SES had reduced short-term and long-term survival after aortic dissection. Patients with type B dissection live in lower socioeconomic neighborhoods than patients with type A dissection.
authors.affiliation: Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich. Electronic address: lkabbani1@hfhs.org.
authors.forename: Loay S
authors.initials: LS
authors.lastname: Kabbani
authors.affiliation: Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
authors.forename: Sara
authors.initials: S
authors.lastname: Wasilenko
authors.affiliation: Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Nypaver
authors.affiliation: Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Weaver
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Mich.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, Henry Ford Hospital, Detroit, Mich.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdul-Nour
authors.affiliation: Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich.
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.affiliation: Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Shepard
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010351:Patient Discharge; D011203:Poverty; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome