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Chad T. Wilson, MD; Elliott Fisher, MD; H. Gilbert Welch, MD

Arch Surg. 2008;143(5):506-510.

Hypothesis  Although investigators have reported that abdominal aortic aneurysm (AAA) repair is performed less frequently in black subjects than in white subjects, these findings may be explained by a lower prevalence of AAA disease among black subjects. We examine this assumption by determining the relative rate (RR) of elective AAA repair in black men vs white men after accounting for differences in disease prevalence.

Design  We used Medicare data from January 2001 to December 2003 to identify men 65 years and older undergoing elective or urgent AAA repair. We calculated the age-adjusted RR of repair in black men vs white men. We then used findings from the Aneurysm Detection and Management Veterans Affairs Cooperative Study to determine the ratio of screen-detected AAA prevalence among black men vs white men. Finally, we calculated prevalence-adjusted RRs of repair.

Setting  Medicare data study.

Participants  Men 65 years and older undergoing elective or urgent AAA repair.

Main Outcome Measure  Prevalence-adjusted RR of AAA repair in black men vs white men.

Results  The annual rate of elective AAA repair in black men was less than one-third that in white men (42.5 vs 147.8 per 100 000; RR, 0.29; 95% confidence interval [CI], 0.27-0.31). The disparity in urgent AAA repair was smaller, with black men undergoing repair at roughly half the rate of white men (26.1 vs 50.5 per 100 000; RR, 0.52; 95% CI, 0.48-0.56). The screen-detected disease prevalence of AAA among black men was less than half that among white men. Adjusting for this difference in prevalence diminished but did not erase the disparity in elective AAA repair (RR, 0.73; 95% CI, 0.68-0.77) and suggested that black men face a higher rate of urgent AAA repair (RR, 1.30; 95% CI, 1.21-1.41).

Conclusions  Black men undergo elective AAA repair at a lower rate than white men even after accounting for their decreased disease burden. However, the prevalence-adjusted rate of urgent repair is higher among black men. Whether the lower frequency of elective procedures is responsible for the higher frequency of urgent procedures warrants further investigation.

Author Affiliations: VA Outcomes Group 111B, Department of Veterans Affairs Medical Center, White River Junction, Vermont. Dr Wilson is now with the Department of General Surgery, Massachusetts General Hospital, Boston.

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