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).