The Effects of Socioeconomics on the Outcomes of Aortic Dissection Surgery
Abstract
Type A aortic dissection is an acute cardiovascular condition with a greater than 60% early mortality rate if left untreated and a 20% mortality rate with urgent surgical correction. Socioeconomic status (SES) is one of the determinants of treatment apportionment for thoracic aortic disease within the United States; however, it is not known whether SES influences early outcomes after definitive surgical repair of acute Type A aortic dissection. The purpose of this study was to assess if social and economic variables play a significant role in determining the eventual results of aortic dissection surgery. This study was guided by the cumulative advantage/disadvantage theory, and a cross-sectional study design was used. Data for the study were obtained from the Society of Thoracic Surgeons (STS) database for the years 2008 to 2012. The independent variable was SES group and the primary dependent variables were 30-day mortality and incidence of stroke at 30 days. In multivariate logistic regression controlling for age and clinical risk factors, membership in the lowest SES group did not represent a significant increase in risk for 30-day mortality (OR 0.756, 95% CI[0.34 - 1.67]) or stroke (OR 2.46, 95% CI[0.98â6.13]). The results of this study suggest that care delivery for patients undergoing surgery for an acute Type A aortic dissection is being delivered in an equitable way to patients of low and high SES. The positive social change implication of this study is such that resources should be focused on early interventions to reduce the risk of Type A dissection, regardless of SES. This study will pave the way to implement policies, to ensure that all people, regardless of SES, benefit from the healthcare system, bridging the gap to quality care between the high SES and the low SES.
