Racial disparities in abdominal aortic aneurysm screening

This study aimed to investigate racial disparities in abdominal aortic aneurysm (AAA) screening rates among eligible patients and assess the prevalence of AAA. We used the TriNetX Analytics Network, a national database with deidentified patient data from 98 centers, to conduct this study. The US Preventative Services Task Force guidelines for male smokers aged 65 to 75 years were used to determine screening eligibility. Of the patients that met this guideline, we isolated two cohorts: screened and unscreened patients. Screened patients were defined as those who underwent screening ultrasound examination corresponding with Current Procedural Terminology (CPT) code 76706 or Healthcare Common Procedure Coding System Code G0389 while eligible for screening. Unscreened patients met screening eligibility, but had not undergone ultrasound based on CPT/Healthcare Common Procedure Coding System codes at the time of this analysis. Propensity score matching controlled for age, Deyo-Charlson comorbidities, AAA risk factors, and CPT codes for surgeries, outpatient visits, laboratory orders, and preventative medicine orders. A total of 1,405,901 patients were included in the study, including 73,541 in the screened cohort. Eligible White patients were screened for AAA at a higher rate (4.86%) than patients who were Black (3.72%; P < .01), Asian (3.38%; P < .01), or another race (3.51%; P < .01). Eligible non-Hispanic patients were screened at a higher rate (5.31%) than Hispanic patients (2.70%; P < .01). The prevalence of AAA was higher in unscreened White patients compared with unscreened patients of other races ( P < .01 for all). There was no significant difference in AAA prevalence between screened White, Black, and Other race individuals ( P = .28 and P = .11, respectively). Screened Asian and Hispanic patients had a lower AAA prevalence than their White and Non-Hispanic counterparts (Asian, odds ratio, 0.756; 95% confidence interval, 0.637-0.897; P < .01; Hispanic, odd ratio, 0.729; 95% confidence interval, 0.622-0.854; P < .01). After propensity matching, White and Non-Hispanic patients were over-represented in the screened cohort ( P < .01 for both) and Black individuals were under-represented in the screened cohort ( P < .01). These findings highlight several key points; AAA screening is underused across all racial groups, with significant AAA prevalence observed in unscreened patients, particularly among White patients. Screened populations show reduced disparities between Black and White patients, as well as between Hispanic and Non-Hispanic patients. Thus, improved access to screening for racial and ethnic minorities may decrease disparities in AAA prevalence.