Skip to main content
2023 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Live Stream
Live Stream
Registration Required
Registration Required
Contains DEI content
Contains DEI content
Back

S5: Plenary Session 5

RS16 - The Impact of Neighborhood Social Disadvantage on Presentation and Management of Hemodialysis Access Surgery Patients

Friday, June 16, 2023
8:53 AM – 9:00 AM ET
Contains DEI content
Objectives: The impact of social determinants of health (SDH) on the presentation, management, and outcomes of patients requiring hemodialysis (HD) access surgery have not been well characterized. The Area Deprivation Index (ADI) is a validated measure of aggregate community-level SDH disparities experienced by members within a community. Herein, we examined the effect of ADI on health outcomes for first-time HD access patients.

Methods: We identified patients who underwent first-time HD access surgery in the Vascular Quality Initiative (VQI) between August 2011 to May 2022. Patient zip codes were correlated with an ADI quintile (Q1-Q5, least to most disadvantaged). Patients without ADI were excluded. Perioperative and long-term outcomes considering ADI were analyzed.

Results: There were 43,292 patients analyzed. The average age was 63 years, 43% were female, 60% were of white race, 10% were of Hispanic ethnicity, and 85% received autogenous arteriovenous (AV) access. Patient distribution by ADI quintile (Q) was as follows: Q1 (16%), Q2 (18%), Q3 (21%), Q4 (23%), and Q5 (22%). On multivariable analysis, the most disadvantaged quintile (Q5) was associated with decreased autogenous access creations (OR .85, 95% CI .77-.94, P=.002), fewer preoperative vein imaging (OR .62, 95% CI .50-.77, P<.001), lower access maturation (OR .82, 95% CI .71-.94, P=.005), and lower 1-year survival (OR .80, 95% CI .71-.90, P<.001) compared to Q1. Q5 was not associated with significantly higher 1-year intervention rates (Table 1).

Conclusions: The most socially disadvantaged (Q5) AV access creation patients were more likely to experience disparities at the time of pre-operative AV access creation, access type, as well as well as at 1-year outcomes. Improvement in preoperative planning and long-term follow-up may be an opportunity for advancing health equity in this population.