Abstract Body: Introduction: Abdominal aortic aneurysm (AAA) screening and diagnosis in Black, Hispanic/LatinX, Asian/Pacific Islander and Native American people is challenging given the asymptomatic clinical presentation necessitating access to and utilization of the healthcare system. While previous studies report higher AAA risk in patients who identify as White, institutionalized racism and mistrust of the healthcare system limits representation of non-White individuals biasing AAA risk assessments. Large scale analysis of diverse patient cohorts is essential to understand the true incidence of AAA.
Objective: To evaluate the impact of race on diagnosis rates for AAA in a diverse patient population.
Methods: Patients over the age of 65 seen at the Mount Sinai Healthcare System were retrospectively reviewed from 2002 to 2024 to assess diagnosis rates in patients eligible for screening by U.S. Preventative Services Task Force (USPSTF) guidelines and those with aortic ultrasound screening. Multivariate logistic regression with interaction factors between patient reported race/ethnicity, screening eligibility, and aortic ultrasound (US) screening were included to assess the impact of US screening and race on AAA diagnosis.
Results: A total of 1,070,367 patients were evaluated during the study period of which 54.6% self-identified as female, 11.4% Black, 42.9% White, 10.4% Hispanic/LatinX, 4.6% Asian, 0.08% Native American, 0.54 Pacific Islander, and 9.5% as Other Race. The diagnosis rate in men over 65 who smoked was slightly higher than the diagnosis rate for individuals who did not meet USPSTF guidelines (OR=3.087, 97.5% CI = 0.8-10.36, p=.075). Overall, after adjusting for race/ethnicity, eligibility, and US screening, diagnosis was significantly impacted by race (p<.05), screening (p=0.001), and the interaction effect between race and US screening (p=.008). Contrary to the results of previously studies, the significance of race and screening on diagnosis was driven by ~20% higher odds of a positive AAA diagnosis from screening Black or Hispanic/LatinX patients compared to White patients.
Conclusion: AAA incidence in people who identify as Black, Hispanic/LatinX, Asian/Pacific Islanders, and Native Americans is likely much higher than previously reported. With the historic barriers to healthcare access and under representation, active AAA screening programs in these communities could drastically increase diagnosis rates leading to decreased mortality due to ruptured AAA.