Low Socioeconomic Status is Associated With Higher In-Hospital Mortality in Stanford Type A Aortic Dissection Repair: A Population Study of National Inpatient Sample From 2015 to 2020

• Published in: The Journal of surgical research 2024-08, Vol.300, p.409-415
• Main Authors: Li, Renxi, Prastein, Deyanira
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic Dissection - economics; Aortic Dissection - mortality; Aortic Dissection - surgery; Disparity; Female; Healthcare Disparities - economics; Healthcare Disparities - statistics & numerical data; Hospital Mortality; Humans; Income; Low Socioeconomic Status; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Registries - statistics & numerical data; Retrospective Studies; Social Class; Socioeconomic status; Type A aortic dissection; United States - epidemiology
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.04.081

Stanford Type A Aortic Dissection (TAAD) is characterized by a high in-hospital mortality rate and necessitates urgent surgical intervention. While socioeconomic status is known to influence health-care outcomes, its specific association with TAAD remains underexplored. This study aimed to investigate the population-based association between socioeconomic status with TAAD repair outcomes using a national registry. Patients who had TAAD repair were identified in National Inpatient Sample from Q4 2015-2020. National Inpatient Sample stratified estimated median household income of residents within a patient's ZIP code. Patients residing in neighborhoods of incomes in the lowest and highest quartiles were selected as the study cohorts. Multivariable logistic regressions were used to compare in-hospital outcomes, adjusted for demographics, comorbid conditions, hospital characteristics, primary payer status, and transfer status. Compared to patients from high-income neighborhoods, patients in low-income communities had higher risks of mortality (adjusted odds ratio [aOR] 1.45, P = 0.01), acute kidney injury (aOR 1.225, P = 0.03), and infection (aOR 1.474, P = 0.02), as well as longer wait from admission to operation (24.96 ± 2.64 versus 18.00 ± 1.92 h, P = 0.03) and longer length of stay (15.06 ± 0.38 versus 13.80 ± 0.36 d, P = 0.01). In contrast, patients from low-income communities had less risk of hemorrhage/hematoma (aOR 0.691, P