Thoracic Aortic Disease in Nova Scotia: Effect of Socioeconomic Status and Remoteness From Tertiary Centre on Disease Outcomes

Abstract

The effect of socioeconomic status and remoteness from the tertiary care centre on outcomes in patients with thoracic aortic disease is unknown. This thesis sought to determine the effect of socioeconomic deprivation and geographic factors on outcomes in patients undergoing thoracic aortic aneurysm (TAA) and type A aortic dissection (TAAD) repair in Nova Scotia. A retrospective cohort study from 2005-2015 of patients presenting to the Maritime Heart Centre for elective or emergency thoracic aortic repair was performed. The Concentration index (C) of inequality and multivariable logistic regression were used to determine the effect of socioeconomic deprivation and geographic variables on in-hospital outcomes, while the C and Cox proportional hazard modeling were used to determine the effect of socioeconomic deprivation and geographic variables on long-term mortality. A total of 476 patients were included. There was no effect of SES or increased remoteness from the tertiary care centre on in-hospital mortality or discharge disposition. Prolonged length of stay, however, was more concentrated in more materially deprived patients, and patients from Eastern Zone were at greatest risk for this outcome, while patients from social deprivation quintiles 2 and 3 were at greatest risk of composite in-hospital complications. With respect to long-term outcomes, patients from Northern Zone and from ≥1 hour travel time from the tertiary centre were at increased risk for long-term mortality. Based on these results, barriers to discharge and causes of increased in-hospital composite complications among more deprived patients should be explored. Furthermore, gaps in care following surgery should be identified and mitigated through expansion of follow-up services to address inequalities in long-term mortality.