Introduction
Thoracic aortic aneurysm (TAA) represents a significant healthcare burden worldwide, with an estimated annual incidence of 5.3 per 100,000 persons/year, and is a significant risk factor for rupture, which has over 90% mortality.1-3 Increased understanding of the natural history of TAA, with an average annual growth rate of 1mm/year, has led to recommendations for surveillance imaging at regular intervals to guide timing of surgical intervention.4, 5 However, whether such periodic, guidelines-based clinical follow-up is implemented in clinical practice across patients of different sociodemographic strata remains unknown.
Several studies have demonstrated an association between cardiovascular health disparities and socioeconomic inequality.6-9Within cardiac surgery, lower socioeconomic status (SES) has been associated with greater mortality and morbidity after valve surgery and coronary artery bypass grafting (CABG).10, 11
In patients with TAA, it has been observed that lower SES and lack of health insurance is associated with greater acuity of presentation and higher mortality after aortic events (dissection and rupture).12 However, it is unknown how SES affects the follow-up care and progression of TAAs prior to this.12-14 Better characterizing this relationship may provide important insights into how socioeconomic inequality ultimately manifests as health outcome disparities for TAA patients. In the present study, we utilized the area deprivation index (ADI) as a measure of SES, which uses national census data to calculate a percentile measure of socioeconomic deprivation within in each census-block group.15 We sought to determine the influence of ADI on whether patients receive appropriate surveillance follow-up after diagnosis of ascending thoracic aortic aneurysm (ATAA).