Abstract 15987: Equitably Identifying Majority and Minority Populations at Risk for Abdominal Aortic Aneurysms

Introduction: Abdominal aortic aneurysm (AAA) screening efforts have had two shortcomings: (1) a high number needed to treat; and (2) persons categorized as black are less frequently identified prior to presenting with a ruptured AAA (rAAA). The goal of this analysis was to identify community-level factors that could be used to identify specific majority and minority populations in Texas that could benefit from directed screening efforts. Methods: The study sample was comprised of all patients who underwent surgical or endovascular treatment for intact AAA (iAAA) and rAAA at all non-federal Texas hospitals from 2006-2014, aggregated by county and by metropolitan statistical area (MSA). These were then combined with demographics and other community-level characteristics in multivariate analyses. Results: In total, 22,455 patients who underwent treatment of iAAA or rAAA were included. 47% of the variance in the rate of AAA or AAA repair among Texas counties was explained by just two variables: proportion elderly (p<0.001) and proportion categorized as white (p<0.001). Within MSAs, the incidence of rAAA was directly and strongly correlated with iAAA incidence (R 2 =0.58, p<0.001). The rAAA:iAAA ratio demonstrated populations in several MSAs that had higher than expected rAAA rates, with the four most extreme high-outliers comprised of black populations (Figure). The incidence rates of AAA ultrasound relative to AAA repair were lower for persons categorized as black than for those categorized as white in 10 MSAs (58%) despite a higher proportion (81 vs 70%, p<0.0001) living within 50 miles of providers of Medicare-reimbursed AAA ultrasound screenings. Conclusion: Readily-accessible, publicly-available data can be used to identify geographic areas and populations that could benefit from more intensive screening efforts. Directing ultrasound screening efforts at persons categorized as black in specific geographic areas may help increase equity in AAA care.