(PC152) The impact of socioeconomic metrics on the outcomes of endovascular treatment of aortic dissection: a mediation analysis

Objectives: Despite increased recognition of socioeconomic deprivation as a determinant of health disparities, its influence on outcomes following endovascular repair of aortic dissections (AD) remains understudied. Thus, we examined the potential effects of socioeconomic deprivation on the outcomes of TEVAR for AD-based pathology.

Methods: Patients who underwent TEVAR for acute or chronic type A and B dissections, PAU, IMH and blunt thoracic aortic injury at a single institution between February 2005 to September 2024 were reviewed retrospectively. Cases of aneurysm without dissection were excluded. Social Deprivation Index (SDI) score was derived using home address (higher SDI scores are associated with greater socioeconomic deprivation). Primary outcomes included 30-day mortality, 30-day reintervention, 1-year reintervention, and 1-year survival. Mediation analysis was performed to quantify the direct and indirect effects of SDI on outcomes, with mediators calculated as a single risk score based on composite factors signifying disease severity: malperfusion/rupture, urgency status, and dissection morphology.

Results: A total of 625 patients with non-aneurysmal acute aortic pathology underwent TEVAR. Socioeconomic demographics were notable for 26.2% female, 53.9% non-White, 90.1% English proficient, 64.8% transferred from other centers and 17.6% with substance abuse history. On multivariate regression analysis, the greatest socioeconomic deprivation quartile was associated with higher 1-year reintervention (OR: 2.86, 95% CI: [1.38, 5.89]). Kaplan-Meier analysis showed significantly increased survival among insured patients compared to non-insured patients (Figure 1) and significantly increased freedom from reintervention among patients in lower SDI quartiles (Figure 2). There was no significant difference in survival and freedom from reintervention when stratified by race, substance abuse history, English proficiency, and transfer status.

Conclusions: This study highlights SDI and insurance status as critical determinants of short- and long-term outcomes after TEVAR for aortic dissection. Notably, uninsured patients experience worse survival rates, underscoring the need for policy interventions to assure timely post-operative follow-up and medical care for this patient cohort. Addressing these disparities through increasing access to care with additional healthcare resources will likely improve long-term outcomes among patients with aortic dissection treated with TEVAR.