Racial disparities in presentation and short-term outcomes for patients with acute type B aortic dissection

Objective: Racial disparities in cardiovascular risk factors and disease outcomes have been well documented. A knowledge gap exists regarding the role that health maintenance plays in the development and outcomes of type B aortic dissection (TBAD). In the present study, we evaluated the comparative presentation and short-term outcomes of patients with TBAD across race. Methods: In the present single-center, retrospective study, TBAD patients who had been admitted to the intensive care unit from 2015 to 2020 were identified. Patients who had self-identified as Black (n = 57) or White (n = 123) were included. The demographics, socioeconomic status, and pre-event health maintenance were compared between the two groups. Socioeconomic disadvantage was quantified using the area deprivation index (ADI). Management strategies included nonoperative and surgical repair. The outcomes assessed included 30-day mortality, hospital length of stay, and the APACHE II (acute physiology and chronic health evaluation) score. Results: The present study included 180 consecutive patients with TBAD. TBAD included complicated (n = 42) and uncomplicated (n = 138) cases, of which 79 had had high-risk features. Black patients were younger than were White patients (58.9 vs 67.6 years; P <.01) and were more likely to have end-stage renal disease (8.8% vs 0.8%; P =.01) and to present with anemia (10.5% vs 2.4%; P =.03). The TBAD anatomic features and management were similar in both groups. The rate of surgical intervention during hospitalization was 40% and 46% for the Black and White patients, respectively (P =.4). Black patients were more likely to be taking three or more hypertension agents (42.2% vs 16.4%; P =.005) and were less likely to be adherent to taking the prescribed agents (27.1% vs 6.7%; P <.001). Also, Black patients had fewer primary care physician visits before TBAD (P =.03) and more emergency department usage before TBAD (57.9% vs 26.9%; P <.001). Black patients had also had higher ADI scores (86.0 6 14.6 vs 64.4 6 21.3; P <.001). The median APACHE II score was the same for both Black and White patients (9 [interquartile range (IQR), 6-12] and 9 [IQR, 7-13], respectively; P =.7). The median hospital length of stay was identical for both groups (7 days; IQR, 5-13 days). The readmission rate was 24.5% for Black patients vs 15.5% for White patients (P =.16), with the 30-day mortality similar between the two groups (Black, 7.0%; White, 5.7%; P =.7). Conclusions: Black patients had presented at a younger age but with similar dissection morphology, rate of anatomic high-risk features, and APACHE II scores. The fewer primary care physician visits, greater emergency department usage, and higher ADI scores suggested lower health maintenance for the Black patients. White patients with TBAD were also highly deprived of health maintenance compared with the national percentile, indicating that TBAD is a disease that affects vulnerable populations, regardless of race.