OBJECTIVE: Descending thoracic aortic diseases may be treated with either open thoracic aortic repair or thoracic endovascular aortic repair (TEVAR). Previous studies have demonstrated that race and socioeconomic status (SES) affect access to care and treatment allocation in vascular surgery. We hypothesized that racial minorities and lower SES patients have decreased propensity to have their thoracic aortic disease treated with TEVAR. METHODS: Weighted discharge records for patients who underwent either open thoracic aortic repair or TEVAR between 2005 and 2008 were evaluated using the Nationwide Inpatient Sample. Patient records were stratified by therapeutic intervention (open repair vs TEVAR). Differences in baseline comorbidities, race, and SES were compared. To account for the effects of comorbidities and other factors, hierarchical logistic regression modeling was used to determine the likelihood for TEVAR performance based on differences in patients' race and SES. RESULTS: A total of 60,784 thoracic repairs were analyzed, the majority (79.4%) of which were open repairs. The most common race was white (78.2%), followed by black (9.1%), Hispanic (5.7%), Asian or Pacific Islander (2.9%), and Native American (0.7%). Patients were divided into quartiles according to SES with 20.6% of patients in the lowest SES quartile, 24.3% in the second quartile, 26.4% in the third quartile, and 28.8% in the highest SES quartile. Indications for treatment were similar for both treatment groups. After adjusting for multiple patient and hospital factors, race and SES were significantly associated with treatment modality for thoracic aortic disease. Black, Hispanic, and Native American populations had increased adjusted odds ratios of TEVAR performance compared with white patients. Similarly, lower SES correlated with increased use of TEVAR. CONCLUSIONS: Contrary to our initial hypothesis, racial minorities (Black, Hispanic, and Native American) and patients with lower median household incomes have a greater association with the performance for TEVAR after accounting for patient comorbid disease, indication for treatment, payer status, and hospital volume. These results indicate that traditional racial disparities do not persist in TEVAR allocation.
RCT Entities:
OBJECTIVE: Descending thoracic aortic diseases may be treated with either open thoracic aortic repair or thoracic endovascular aortic repair (TEVAR). Previous studies have demonstrated that race and socioeconomic status (SES) affect access to care and treatment allocation in vascular surgery. We hypothesized that racial minorities and lower SES patients have decreased propensity to have their thoracic aortic disease treated with TEVAR. METHODS: Weighted discharge records for patients who underwent either open thoracic aortic repair or TEVAR between 2005 and 2008 were evaluated using the Nationwide Inpatient Sample. Patient records were stratified by therapeutic intervention (open repair vs TEVAR). Differences in baseline comorbidities, race, and SES were compared. To account for the effects of comorbidities and other factors, hierarchical logistic regression modeling was used to determine the likelihood for TEVAR performance based on differences in patients' race and SES. RESULTS: A total of 60,784 thoracic repairs were analyzed, the majority (79.4%) of which were open repairs. The most common race was white (78.2%), followed by black (9.1%), Hispanic (5.7%), Asian or Pacific Islander (2.9%), and Native American (0.7%). Patients were divided into quartiles according to SES with 20.6% of patients in the lowest SES quartile, 24.3% in the second quartile, 26.4% in the third quartile, and 28.8% in the highest SES quartile. Indications for treatment were similar for both treatment groups. After adjusting for multiple patient and hospital factors, race and SES were significantly associated with treatment modality for thoracic aortic disease. Black, Hispanic, and Native American populations had increased adjusted odds ratios of TEVAR performance compared with white patients. Similarly, lower SES correlated with increased use of TEVAR. CONCLUSIONS: Contrary to our initial hypothesis, racial minorities (Black, Hispanic, and Native American) and patients with lower median household incomes have a greater association with the performance for TEVAR after accounting for patient comorbid disease, indication for treatment, payer status, and hospital volume. These results indicate that traditional racial disparities do not persist in TEVAR allocation.
Authors: Raja R Gopaldas; Tam K Dao; Scott A LeMaire; Joseph Huh; Joseph S Coselli Journal: J Thorac Cardiovasc Surg Date: 2011-09-09 Impact factor: 5.209
Authors: George J Arnaoutakis; John A Hundt; Ashish S Shah; Duke E Cameron; James H Black Journal: Vasc Endovascular Surg Date: 2010-09-09 Impact factor: 1.089
Authors: Raja R Gopaldas; Joseph Huh; Tam K Dao; Scott A LeMaire; Danny Chu; Faisal G Bakaeen; Joseph S Coselli Journal: J Thorac Cardiovasc Surg Date: 2010-11 Impact factor: 5.209
Authors: Davy Cheng; Janet Martin; Hani Shennib; Joel Dunning; Claudio Muneretto; Stephan Schueler; Ludwig Von Segesser; Paul Sergeant; Marko Turina Journal: J Am Coll Cardiol Date: 2010-03-09 Impact factor: 24.094
Authors: Bradley S Quon; Kevin Psoter; Nicole Mayer-Hamblett; Moira L Aitken; Christopher I Li; Christopher H Goss Journal: Am J Respir Crit Care Med Date: 2012-09-13 Impact factor: 21.405
Authors: Philip P Goodney; Benjamin S Brooke; Jessica Wallaert; Lori Travis; F Lee Lucas; David C Goodman; Jack L Cronenwett; David H Stone Journal: J Vasc Surg Date: 2012-11-22 Impact factor: 4.268