AAA Repair: Sociodemographic Disparities in Management and Outcomes
AAA Repair: Sociodemographic Disparities in Management and Outcomes
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DOI：
10.1177/1538574408321786
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发表时间：
2008-12-01
影响因子：
0.9
通讯作者：
Graham, Alan M.
中科院分区：
文献类型：
--
作者：
Vogel, Todd R.;Cantor, Joel C.;Graham, Alan M.
目的：评估社会人口统计学对腹主动脉腔内修复术 (EVAR) 治疗腹主动脉瘤 (AAA) 的使用和结果的影响。方法：新泽西州住院患者数据库的二次数据分析结果：2001 年至 2006 年间，共有 6227 名成年受试者（平均 [SD] 年龄，73.3 [8.3] 岁；77.6% 男性）接受了 AAA 修复术（3167 EVAR 和 3060 开放手术 [OS]）。接受 EVAR 的患者比接受 OS 的患者年龄更大（平均 [SD] 年龄，74.2 [8.0] vs 72.4 [8.6] 岁）（P < 0.001）。男性接受 EVAR 的可能性是女性的 1.60（95% 置信区间 [CI]，1.39-1.77）倍。白人受试者接受 EVAR 的几率与黑人受试者相同，白人受试者接受 EVAR 的几率比西班牙裔受试者高 1.60 (95% CI, 1.29-2.06) 倍。有医疗保险覆盖的受试者接受 EVAR 的可能性是未参保受试者的 3.90 (96% CI, 2.28-6.59) 倍。 Logistic 回归分析表明，年龄较大、男性和医疗保险覆盖范围与 EVAR 使用率的增加显着相关，而未参保受试者和西班牙裔接受 EVAR 的可能性较小。八旬老人和黑人受试者（比值比：分别为 3.69 CI：2.31-5.91 和 2.59 CI：1.47-4.54）在选择性 AAA 修复后死亡的可能性明显更大。结论：对于 AAA 修复，血管内技术的使用和死亡率存在显着的社会人口统计学差异。黑人受试者选择性 AAA 修复后的死亡风险明显更高。需要进一步分析来描述 AAA 血管护理的不平等，并协助制定政策来解决这些差异。
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 JerseyResults: 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.