Understanding the racial disparity in the receipt of endovascular abdominal aortic aneurysm repair

Hypothesis: Racial disparity exists in the management of abdominal aortic aneurysms (AAAs) using new health care technology. Design: Retrospective cross-sectional study. Setting: Medicare database (January 1, 2001, to December 31, 2006). Patients: All patients who underwent open or endovascular AAA repair were identified (N=160 785). Main Outcomes Measures: The relationship between race and the type of AAA repair (open vs endovascular), controlling for differences in patient factors and adjusting for the hospitals where patients received care. Results: Accounting for differences in patient comorbidities and neighborhood socioeconomic status, black patients were 33% less likely than nonblack patients to undergo endovascular AAA repair (odds ratio, 0.67; 95% confidence interval, 0.63-0.71). Black patients treated in hospitals with the highest proportions of black patients having AAA repair underwent endovascular AAA repair less often than black patients treated in hospitals with the lowest proportions of black patients having AAA repair (31.0% vs 39.6%, P<.05). Accounting for differences in the hospitals where they received care, black patients continued to have a significantly lower rate of endovascular AAA repair (odds ratio, 0.73; 95% confidence interval, 0.67-0.78). Conclusions: Despite controlling for differences in patient characteristics and the hospitals where they received care, black patients were still less likely to undergo endovascular AAA repair. Efforts aimed at improving this disparity will need to explore the causes of these treatment differences.