Black men more likely than white men to have emergency aneurysm repairs

Black men are more likely than white men to have a serious blood vessel condition repaired during emergency surgery rather than in an elective operation prompted by screening, a new study reports.

The gap persists even after accounting for the lower rate of abdominal aortic aneurysms among black men, raising the possibility that fewer elective procedures lead to more emergency operations.

Dr. Chad T. Wilson, now of Massachusetts General Hospital, writes in the Archives of Surgery about his analysis of Medicare and Veterans Affairs data from 2001 through 2003 for approximately 66,000 men, 23,000 of whom had repairs to correct abdominal aortic aneurysms.

AAAs are bulges in the large vessel that carries blood to the abdomen, pelvis, and legs. Physical examination or ultrasound screening tests can spot the problem in men who have risk factors, such as smoking, high blood pressure, and abdominal pain.

"Because they are not getting repaired electively, they are more likely to erupt and have a more urgent repair. That would be one conclusion to draw," Wilson said in an interview about the study he conducted while at the Veterans Affairs Medical Center in White River Junction, Vt. "What [the study] clearly shows is that there is something there that is very surprising and it potentially very concerning.”

Black men had elective AAA repairs at one-third the rate of white men but black men had urgent repairs at a little over half the rate of white men, the authors found. They estimate that the prevalence of AAAs among black men is less than half the rate among white men.

In an invited critique also appearing in the journal, Dr. James H. Black III of Johns Hopkins Hospital said the study's findings may reflect racial bias in how AAAs are diagnosed and treated, and that the bias may be inflicting harm.

"The differences in AAA treatment ... should bother us, as surgeons and citizens," he writes. "Next time you are called to see an African-American patient with abdominal pain who is a former smoker and is hypertensive, just remember to palpate the abdomen..."