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Survival disparity following abdominal aortic aneurysm repair highlights inequality in ethnic and socio-economic status

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Summary:

These New Zealand researchers sought to determine how SES and ethnicity impact upon patient survival after abdominal aortic aneurysm (AAA) repair. They analysed data from 6,239 patients (median age, 75 years) undergoing open and endovascular AAA repair during a 14.5-year period (from 1 June 2000 to 31 December 2014). According to the ethnicity information on the health records, the majority (n=5,654) of patients identified as New Zealand Europeans; 421 identified as New Zealand Māori, 97 identified as belonging to a Pacific ethnic group, and 67 identified as an Asian ethnic group. The median survival follow-up period was 5 years. In analyses that adjusted for confounders, those who identified as New Zealand Māori had the lowest survival compared with all other ethnic groups (HR 1.46; 95% CI, 1.23 to 1.72). When the researchers linked SES (on a score of 10, where 1 is least deprived and 10 is most deprived) to census data, they found that living in areas of high social deprivation ≥7 was an independent predictor of short- and medium-term overall mortality, as compared with living in deprivation deciles 1 or 2 (low SES).

Comment:
This paper ties in nicely with a AAA screening programme supported by Maori in Waitemata DHB (The Waitemata Abdominal Aortic Aneurysm Screening Pilot), confirming that inequities can occur at all sites along the disease pathway from prevention, investigation and through to treatment.
Reference: Eur J Vasc Endovasc Surg. 2017 Oct 10. [Epub ahead of print]
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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