Black Men Less Likely Than White Men To Select Aneurysm Repair

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Main Category: Cardiovascular / Cardiology
Also Included In: Men's health;  Medicare / Medicaid / SCHIP
Article Date: 20 May 2008 - 13:00 PST

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According to an article appearing in the May issue of the Archives of General Surgery, black men are less likely than white men to elect surgery that will repair abdominal aortic aneurysms. Chad T. Wilson, M.D. (formerly of the Department of Veterans Affairs Medical Center, White River Junction, Vt., currently of Massachusetts General Hospital, Boston) and colleagues noted this difference even after controlling for that fact that the disease develops at different rates among races.

Abdominal aortic aneurysms are characterized by the enlargement or ballooning outwards of a segment of the aorta - the major vessel that brings blood to the pelvis, legs and abdomen. Even before symptoms are present, people can choose to repair the condition. If symptoms such as pain develop or an aneurysm bursts, leaks or expands rapidly, the aneurysm will be urgently repaired.

Using Medicare data, the researchers identified men age 65 years and older who received elective or urgent surgery to repair abdominal aortic aneurysms from 2001 to 2003. They were able to estimate how the disease affects racial groups differently by analyzing data from studies of ultrasound screenings - including a Veterans Affairs study consisting of over 65,000 men.

The researchers found that compared to white men, black men elected aneurysm repair less than one-third as often as white men. That is 42.5 of 100,000 black men compared to 147.8 per 100,000 white men underwent elective surgery. Black men also received urgent repair at about 50% the rate of white men - 26.1 vs. 50.5 per 100,000 men. Data from ultrasound screening studies pointed to a racial disparity between the rate of developing abdominal aortic aneurysms - black men have a rate that is less than half the rate of white men. Since this fact may affect a group's likelihood to elect surgery, the researchers adjusted statistically for the rate difference. They found that compared to white men, black men were about 27% less likely to elect repair but 30% more likely to undergo urgent repair for abdominal aortic aneurysms.

Suggesting explanations for this difference, the authors point to differences in socioeconomic status among others. "Although all of the patients in this study are Medicare beneficiaries, there may be substantial racial differences in comprehensiveness of Medicare benefits, supplemental insurance status and the ability to pay for health care expenses not covered by Medicare," the authors write. They also suggest the possibility that black patients are being treated differently than white patients. For example, black patients may not receive screenings since they are not as likely to develop aneurysms. Additionally, doctors may not offer black patients surgery for the same aneurysms (in size and structure) that a white patient may have.

"What seems clear is that the racial disparity in abdominal aortic aneurysm repair rate is not simply because of differences in disease prevalence," conclude the authors. "The fact that black men seem to need more urgent abdominal aortic aneurysm repairs than white men given their disease prevalence suggests that the racial disparity in the use of elective repair merits further investigation."

Racial Disparities in Abdominal Aortic Aneurysm Repair Among Male Medicare Beneficiaries
Chad T. Wilson, MD; Elliott Fisher, MD; H. Gilbert Welch, MD
Archives of Surgery (2008). 143[5]:506-510.
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Written by: Peter M Crosta
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