Racial and sex disparities in inpatient outcomes of patients with ruptured abdominal aortic aneurysms in the United States

ABSTRACT

Introduction

Ruptured abdominal aortic aneurysm (AAA) is a medical emergency that requires immediate surgical intervention. The aim of this analysis was to identify the sex and race specific disparities that exist in outcomes of patients hospitalized with this condition in the United States using the National Inpatient Sample (NIS) in order to identify targets for improvement and support of specific patient populations.

Methods

In this descriptive, retrospective study, we analyzed the patients admitted with a primary diagnosis of ruptured AAA between January 1, 2016, to December 31, 2020, using the National Inpatient Sample (NIS) database. We compared demographics, comorbidities, and in-hospital outcomes in AAA patients, and compared these results between different racial groups and sexes.

Results

A total of 22,395 patients with ruptured AAA were included for analysis. Of these, 16,125 patients (72.0%) were male, and 6,270 were female (28.0%). The majority of patients (18,655 or 83.3%) identified as Caucasian, with the remaining patients identifying as African American (1,555 or 6.9%), Hispanic (1,095 or 4.9%), Asian or Pacific Islander (470 or 2.1%) or Native American (80 or 0.5%). Females had a higher risk of mortality than males (OR 1.7 (1.45-1.96), p<0.001) and were less likely to undergo endovascular aortic repair (EVAR) (OR 0.70 (0.61-0.81), p<0.001) or fenestrated endovascular aortic repair (FEVAR) (OR 0.71 (0.55-0.91), p=0.007). Relative to Caucasian race, patients who identified as African American had a lower risk of inpatient mortality (OR 0.50 (0.37-0.68), p<0.001).

Conclusions

In this retrospective study of the NIS database from 2016 to 2020, females were less likely to undergo endovascular intervention and more likely to die during their initial hospitalization. African American patients had lower rates in-hospital mortality than Caucasian patients, despite a higher burden of comorbidities. Future studies are needed to elucidate the potential factors affecting racial and sex disparities in ruptured AAA outcomes, including screening practices, rupture risk stratification and more personalized guidelines for both elective and emergent intervention.