Objectives- To examine the association between several census tract-level socioeconomic factors and the likelihood of rupture among patients undergoing open or endovascular treatment of an abdominal aortic aneurysm (AAA).
Methods- Data from the United States Department of Agriculture (USDA) Food Access Research Atlas was utilized to determine the levels of food insecurity, median income, and poverty rate across census tracts in a major metropolitan area. This census data was then cross referenced with the residence of patients undergoing surgical AAA repair over a twenty-year period (2001-2021) at a tertiary center. Multilevel logistic regression models investigated the association between census tract-level socioeconomic variables and rupture to account for clustering by census tract, adjusting for age, sex, smoking, weight, baseline glomerular filtration rate, and aneurysm size.
Results- 431 Patients (87 females (20%), mean age 72± 9.8 years) were included over a twenty-year period with an average aneurysm size of 6.16± 1.78 cm and 19% (83/431) presentation of rupture. 75% (324/431) of patients treated were identified as living in a food insecure area, and 79% (324/408) of the patients were current or previous smokers. Patients with rupture tended to live in poorer census tracts with a median poverty rate of 17.8% (Quantile 1 - Quantile 3: 10.1%-23.4%) compared to those without rupture 13.4% (Q1–Q3: 7.9%-20.1%), P=0.02. Furthermore, median income across census tracts for those with rupture was ,827 (Q1-Q3 = ,927-,646), compared to those without rupture, ,795(Q1-Q3 = ,026-,228), P=0.05. Living in neighborhoods with low food access did not influence a patient’s likelihood of rupture. Meanwhile, an additional percentage point in census-tract poverty rate was associated with a 5% increase in odds of rupture (OR=1.05, 95%CI = 1.01 – 1.08). Patients living in census tracts with extra ,000 in median income had 10% lower odds of rupture (OR=0.90, 95%CI = 0.81 – <1.00).
Conclusions- Higher census tract-level poverty rate and lower census tract-level median income where our patients reside were associated with higher odds of rupture. Efforts aimed at identifying patients in areas of risk along with improving access to care and increased surveillance or earlier intervention should be further investigated.
