Abstract 1002: Health Insurance Prevalence & Aortic Aneurysm And Dissection Mortality: A Cross-sectional Analysis

The prevalence of health insurance significantly influences the early detection and timely treatment of cardiovascular conditions, which are vital for reducing the risk of morbidity and mortality. In many regions, access to necessary cardiac care, including life-saving interventions and long-term management, hinges on the availability and scope of health insurance. Do disparities in mortality exist in aortic dissection/aneurysm based on the prevalence of health insurance in the USA? We investigated the association between US county-level healthcare coverage prevalence and aortic dissection/aneurysm mortality rates. We queried the CDC Agency for Toxic Substances and Disease Registry to obtain data on the uninsured population, based on 5-year estimates from 2018. To gauge the uninsured population in each US-county, we computed percentile rankings from 0 to 1, with higher values indicating a larger uninsured population. Counties were grouped into 4 quartiles based on these rankings. Mortality data from 1999-2018 was obtained from the CDC WONDER database, using ICD-10 codes: I71 for aortic aneurysm and dissection as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the direct method. Risk ratios (RR) were estimated using univariable Poisson regression. The cumulative AAMR within UP-Q1 and UP-Q4 showed no significant differences in mortality and had a corresponding risk ratio (RR) of 0.94 (P >0.05). Among male populations, there was no difference in AAMR between UP-Q4 (AAMR: 5.48 [95% CI, 5.29 - 5.68]) and UP-Q1 (AAMR: 5.77 [95% CI, 5.64 - 5.90]), with a risk ratio of 0.95 (P >0.05). Similarly, among female populations, AAMR in UP-Q4 (AAMR: 2.66 [95% CI, 2.54-2.79]) was similar to UP-Q1 (AAMR: 2.98 [95% CI, 2.91-3.06]) with a risk ratio of 0.89 (P >0.05). Finally, when comparing UP-Q4 with UP-Q1 across all US-census regions and counties using urbanization criteria, no statistically significant differences were found. This study found that in the US, county-level healthcare coverage prevalence didn't impact aortic dissection/aneurysm mortality rates, unlike in other diseases. Therefore, while lack of coverage hinders care access, it's not the sole social determinant of mortality outcomes.