Sex Related Disparities in Intervention Rates and Type of Intervention in Patients with Aortic and Peripheral Arterial Diseases in the National Inpatient Sample Database
| Autor: | Linda M. Harris, Samantha D. Minc, Sydney E. Browder, Katharine L. McGinigle, Sherene Shalhub, Paula D. Strassle |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual Population Prevalence 030204 cardiovascular system & hematology Risk Assessment Article 03 medical and health sciences symbols.namesake Peripheral Arterial Disease 0302 clinical medicine Sex Factors Risk Factors Internal medicine Carotid artery disease medicine Humans Carotid Stenosis 030212 general & internal medicine Poisson regression Healthcare Disparities education Healthcare Cost and Utilization Project Aged Retrospective Studies Aged 80 and over education.field_of_study Inpatients business.industry Vascular disease Endovascular Procedures Vascular surgery Middle Aged medicine.disease Abdominal aortic aneurysm United States Treatment Outcome symbols Surgery Female Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Aortic Aneurysm Abdominal |
| Zdroj: | J Vasc Surg |
| Popis: | Objective The first annual Women's Vascular Summit highlighted sex- and gender-related knowledge gaps in vascular disease diagnosis and treatment. This finding suggests an opportunity for further research to improve care and outcomes in people who identify as women, specifically. The purpose of this study was to a large national dataset to identify all operations performed for abdominal aortic aneurysm (AAA), carotid artery stenosis (CAS), and peripheral arterial disease (PAD) in the United States, and to provide data on sex-related disparities in treatment. Methods All hospitalizations of adult patients (≥18 years old) diagnosed with AAA, CAS, or PAD who underwent vascular surgery from 2000 to 2016 were identified in the Healthcare Cost and Utilization Project National Inpatient Sample. Sex-stratified U.S. Census data and sex-specific population disease prevalence estimates from the National Institute of Health and Agency for Healthcare Research and Quality were used to calculate the number of U.S. adults with AAA, CAS, and PAD. Sex-stratified rates of surgery and incidence rate ratios were estimated using Poisson regression. Among those undergoing surgery, multivariable logistic regression was used to assess differences in endovascular vs open approach. Results Over 16 years, there were 1,021,684 hospitalizations for vascular surgery: 13% AAA (21% female, 79% male), 40% CAS (42% female, 58% male), and 47% PAD (42% female, 58% male). Females were older than males at time of surgery (median age, 71.3 years vs 69.7 years) and less likely to have private insurance (18% vs 23%); minimal differences were seen across race/ethnicity, comorbidities, and hospital characteristics. After accounting for disease prevalence, females were still 25% less likely to undergo surgery for AAA and 30% less likely to undergo surgery for PAD compared with males with the same disease. These results were consistent over time. After adjustment, females, compared with males, were less likely to receive an endovascular procedure compared with open for AAA or CAS, and more likely to receive one for PAD. Conclusions From 2000 to 2016 in the United States, females were less likely to undergo intervention for AAA and PAD than males. This finding is particularly significant for PAD, because the prevalence is the same for both sexes, indicating that females are likely undertreated for PAD. Additionally, females were less likely to undergo endovascular surgery for AAA and more likely to undergo endovascular surgery for PAD than males. These findings suggest that improvement in AAA and PAD identification and management in females may improve outcomes. |
| Databáze: | OpenAIRE |
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