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Distressed communities index scores are not associated with differential TAAA presentation, Follow-up, and Management
Melissa Chen Xu, BS
1, Devi Schwartz, BS
1, Justin Do, BS
1, Jeremy Zack, BS
1, Babak Abai, MD
2, Dawn Salvatore
2, Paul Dimuzio, MD
2, Michael Nooromid, MD
2.
1Sidney Kimmel Medical College, Philadelphia, PA, USA,
2Thomas Jefferson University Hospital, Philadelphia, PA, USA.
OBJECTIVES: Thoracoabdominal Aortic Aneurysms (TAAAs) are extensive aortic pathologies, requiring close medical management and observation. It is unclear what impacts follow-up adherence in TAAA patients. This study aims to determine the impact of severe socioeconomic distress (SSD) on thoracoabdominal aortic aneurysm (TAAA) presentation, follow up attendance, and treatment.
METHODS: A single institution retrospective chart review was conducted, identifying 158 TAAA patients using ICD-10 codes. The Distressed Community Index (DCI) was used to approximate patient socioeconomic status via patient zipcode input. Patients were categorized as having severe socioeconomic distress (DCI ≥ 75/100) or not (DCI <75). Fisher’s Exact Test (FET) was used to compare demographics, diagnostic acuity, follow-up attendance, and long-term clinical outcomes.
RESULTS: Of 158 TAAA patients, 43 were classified as having SSD. Patients with SSD were significantly more likely to be non-white (58.1% vs 29.6%, p=0.0015) and active smokers (26% vs 0%, p=0.0000002). Distribution of initial diagnosis location was similar in both groups. Patients with and without SSD were equally likely to initially present in the ED (48.8% vs 47.8%, p=1), and were also equally likely to initially present outpatient (44.2% vs 42.6%, p=0.86). Patients with SSD had a nonsignificant greater proportion of symptomatic presentations (41% vs 28.7%, p=0.18). Post diagnosis, comparing patients with SSD and without SSD respectively, there was no difference in immediate follow up rates (83.7% vs 83.5%, p=1) or 1 year follow up rates (69.8% vs 58.2%, p=0.20) ass seen in Table 1. In terms of treatment modality, patients with SSD had a higher but not significant odds ratio of having surgery on their TAAA (OR 1.18 [95% CI 0.58-2.38], p=0.72).
CONCLUSIONS: Patients with SSD did not have significant differences in location of initial presentation, follow-up rates, and surgical intervention rates compared to patients without SSD. Current literature indicates an inverse relationship between socioeconomic status and overall outcomes. This study suggests that the targetable gap in care for outcome improvement lies before diagnosis--in screening and early detection. Moreover, this study also encourages physicians to reconsider certain implicit biases, which tend to generalize socioeconomically distressed patients as non-adherent to follow-up.
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