White Race is an Independent Predictor of In-Hospital Mortality in Type B Aortic Dissection
Matthew Aizpuru, BA, Kevin X. Farley, BS, Justin L. Santos, BS, Xiaoying Lou, MD, Eric R. Wagner, MD, Bradley G. Leshnower, MD, William D. Jordan, MD, Robert S. Crawford, MD
Emory University, Atlanta, GA
Objective: Racial differences in type B aortic dissection (TBAD) are not well understood. We aimed to understand differences between African American (AA) and White (Wh) patients with TBAD in a representative sample.
Methods: Data were collected on 97,178 patients with TBAD in the National Inpatient Sample (2010-2015). Univariate analysis (chi-square, t-tests) was conducted to elucidate differences in demographics, risk factors, management, and outcomes. Binomial logistic regression was performed to control for confounders and identify independent predictors of in-hospital mortality.
Results: There were 27,411 AA and 69,767 Wh patients with TBAD. AA patients presented younger (59.9±14.2 years vs. 69.3±14.7 years, p<.001), with higher rates of hypertension (81.2% vs. 77.3%; p<.001), chronic kidney disease (31.9% vs. 17.9%; p<.001), obesity (14.7% vs. 10.7%; p<.001), and diabetes mellitus (21.8% vs. 15.6%; p<0.001). AA patients were more likely to have thoracoabdominal extension of their dissection: abdominal (20.0% vs. 27.3%; p<.001), thoracic (48.0% vs. 47.2%; p<.001), thoracoabdominal (18.0% vs. 13.8%; p<.001), and undefined (14.0% vs. 11.7%; p<.001). Management was not different between AA and Wh patients; medical (81.4% vs. 81.0%; p=.96), EVAR/TEVAR (9.7% vs. 9.2%; p=.096) or open surgery (8.9% vs. 9.8%; p=.096). Wh patients had higher rates of: stroke (4.1% vs 4.7%; p<.001), MI (2.8% vs. 3.8%; p<.001), arrhythmia/arrest (2.7% vs. 3.3%; p<.001), PE (1.9% vs 2.4%; p<.001), non-home discharge (32.5% vs. 40.2%; p<.001), and in-hospital mortality (6.0% vs 11.2%; p<.001). Multivariate analysis demonstrated White race to be an independent predictor of in-hospital mortality (OR = 1.69; p<.001).
Conclusion: Despite presenting with fewer comorbidities, White patients had more complications and higher mortality. These results build on a body of literature suggesting White patients have inferior outcomes in TBAD. Further study is needed to delineate potential pathophysiologic differences and optimal race-specific treatment algorithms.
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