Variability in care and outcomes in type B aortic dissection: A systematic review and meta-analysis of gender disparities and a preliminary assessment of ethnic disparities

Variabilities in access to care may influence outcomes after acute Type B aortic dissection (TBAD). This systematic review and meta-analysis evaluates gender-based and ethnicity-based differences in outcomes, noting that socioeconomic status data were not available in the included literature. A systematic search of PubMed MEDLINE, Embase and Cochrane library was performed. Studies comparing outcomes in male versus female and Black versus White patients with acute TBAD were included. Statistical analyses evaluated mortality, cardiac events, acute kidney injury (AKI), limb ischemia, respiratory complication, spinal cord complication, stroke, length of hospital stay (LOS), intensive care unit (ICU) length of stay. Fourteen studies compared outcomes for male and female patients (54,840 patients). Male patients demonstrated a higher risk of AKI (RR = 1.46, p < 0.01; 95% CI: 1.37, 1.55), spinal cord complications (RR = 1.32, p = 0.01; 95% CI: 1.07, 1.63), and longer ICU stay (MD = 1.00, p < 0.01; 95% CI: 0.40, 1.61) after TBAD compared to female patients. No statistically significant discrepancies were identified between male and female patients for mortality, cardiac events, limb ischemia, respiratory complications, stroke, LOS. Subgroup analysis in patients who underwent only thoracic endovascular aortic repair (TEVAR), found similar significant discrepancies between male and female patients. Three studies compared outcomes for white and black patients (498 patients). Ethnicity analyses were underpowered, and did not demonstrate any statistically significant discrepancies in mortality and stroke, between White and Black patients. No studies examined outcomes by socioeconomic status. Male patients experienced significantly higher rates of AKI and spinal cord complications, and prolonged ICU stays, compared to female patients. Data on ethnicity were too limited for definitive conclusions, and no socioeconomic status-stratified outcome data were available. This meta-analysis supports prioritizing gender-specific risk mitigation while underscoring the need for adequately powered studies that report data on ethnicity and socioeconomic status to clarify potential disparities.