Racial and ethnic disparities in abdominal aortic aneurysm evaluation and treatment rates in Texas

Bubble plot showing intact and ruptured abdominal aortic aneurysm procedure rates by racial and ethnic category across Texas regions
Figure 1. Scatterplot showing the close association between the rate of procedures for intact (nonruptured) abdominal aortic aneurysms and the rate of procedures for ruptured abdominal aortic aneurysms for persons categorized as White (blue circles and line), Hispanic (green circles and line), and Black (red circles and line).

Publication details

Work type Peer-reviewed original research article
Citation Barshes NR, Bidare D, Kougias P, Mills JL Sr, LeMaire SA. Racial and ethnic disparities in abdominal aortic aneurysm evaluation and treatment rates in Texas. J Vasc Surg. 2022;76(1):141-148.e1.
Authors Neal R. Barshes; Deeksha Bidare; Panos Kougias; Joseph L. Mills Sr; and Scott A. LeMaire
Publication Journal of Vascular Surgery
Publication date July 2022
DOI 10.1016/j.jvs.2021.12.072
PubMed identification (PMID) number 350-63-611
Intended audience Vascular surgeons and other clinicians involved in abdominal aortic aneurysm screening and treatment, as well as public-health researchers and health-policy leaders working to reduce disparities in preventive care

Summary

This study combined epidemiologic and geospatial analyses of inpatient and outpatient care for intact and ruptured abdominal aortic aneurysms at Texas hospitals and clinics from 2006 through 2014. Area-level data were supplemented with six additional sources to estimate repair rates, AAA-related clinic and ultrasound visits, travel distance to providers, and the location and number of unrecognized aneurysms.

Most AAA repairs occurred among White men aged 65 to 84 years living in large metropolitan areas. Regional rates of ruptured and intact AAA repair were strongly correlated (R2=0.47). Persons categorized as Black had lower rates of AAA-related clinic visits and ultrasound examinations, and several regions had disproportionately high ratios of ruptured to intact AAA repair, mainly affecting Black Texans.

Contribution and significance

The analysis used race- and ethnicity-specific ratios of emergency repair for ruptured AAAs to elective repair for intact AAAs within geographic areas to identify disparities that statewide averages could obscure.

This approach also generated practical information for directing screening toward groups and locations where AAAs were more likely to remain unrecognized. The outpatient data provided a potential explanation for the observed disparity: persons categorized as Black were much less frequently seen for AAA-related clinic care and screening ultrasound than persons categorized as White.

The findings support multiple focused screening strategies rather than a single population-wide approach, with particular attention to improving access to AAA evaluation among Black Texans.

Related materials

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