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\begin{document}

\title{Impact of Ethnicity and Race on Outcomes after Thoracic Endovascular
Aortic Repair}



\author[1]{Carlos Diaz-Castrillon}%
\author[1]{Derek Serna-Gallegos}%
\author[1]{Edgar Aranda-Michel}%
\author[1]{James Brown}%
\author[1]{Sarah Yousef}%
\author[2]{Floyd Thoma}%
\author[2]{Yisi Wang}%
\author[1]{Ibrahim Sultan}%
\affil[1]{University of Pittsburgh Department of Cardiothoracic Surgery}%
\affil[2]{UPMC Heart and Vascular Institute}%


\vspace{-1em}



  
  \date{May 29, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
\emph{Introduction} Thoracic endovascular aortic repair (TEVAR) became
the standard of care for treating type B aortic dissections and
descending thoracic aortic aneurysms. We aimed to describe the
racial/ethnic differences in TEVAR utilization and outcomes.
\emph{Methods} The National Inpatient Sample was reviewed for all TEVARs
performed between 2010 and 2017 for Type B aortic dissection and
descending thoracic aortic aneurysm (DTAA). We compared groups
stratifying by their racial/ethnicity background in whites, black,
Hispanic, and others. A mixed-effects logistic regression was performed
to assess the relationship between race/ethnicity and the primary
outcome, in-hospital mortality. \emph{Results} A total of 25,260
admissions for TEVAR during 2010--2017 were identified. Of those,
52.74\% (n= 13,322) were performed for aneurysm and 47.2\% (n= 11,938)
were performed for type B dissection. 68.1\% were white, 19.6\% were
black, 5.7\% Hispanic, and 6.5\% were classified as others. White
patients were the oldest (median age 71 years; \textless{}0.001), with
TEVAR being performed electively more often for aortic aneurysm (58.8\%
vs. 34\% vs. 48.3\% vs. 48.2\%; p\textless{}0.001). In contrast, TEVAR
was more likely urgent or emergent for type B dissection in black
patients (65.6\% vs 41.1\% vs 51.6\% vs 51.7\%; p\textless{}0.001).
Finally, the black population showed a relative increase in the
incidence rate of TEVAR over time. The adjusted multivariable model
showed that race/ethnicity was not associated with in-hospital
mortality. \emph{Conclusion} Although there is a differential
distribution of thoracic indication and comorbidities between
race/ethnicity in TEVAR, racial disparities do not appear to be
associated with in-hospital mortality after adjusting for covariates.%
\end{abstract}%



\sloppy


\textbf{Impact of Ethnicity and Race on Outcomes after Thoracic
Endovascular Aortic Repair}

Carlos E. Diaz-Castrillon, MD\textsuperscript{1}; Derek Serna-Gallegos,
MD\textsuperscript{1,2}; Edgar Aranda-Michel, PhD\textsuperscript{1};

James A. Brown, MD, MS\textsuperscript{1}; Sarah Yousef,
MD\textsuperscript{1}; Floyd Thoma, BS\textsuperscript{2}; Yisi Wang,
MPH\textsuperscript{2};

and Ibrahim Sultan, MD\textsuperscript{1,2}

(1) Division of Cardiac Surgery, Department of Cardiothoracic Surgery,
University of Pittsburgh

(2) Heart and Vascular Institute, University of Pittsburgh Medical
Center

\textbf{Conflicts of Interest} : IS receives institutional research
support from Abbott, Boston Scientific, Medtronic and Atricure. None of
these are related to this manuscript.

\textbf{Source of Funding} : None.

\textbf{Keywords} : Aorta, Acute aortic dissection, Aortic aneurysm,
Thoracic endovascular aortic repair, Racial disparities, Socioeconomic
determinants of health

\textbf{Running Head} : Ethnicity, race, and TEVAR

\textbf{Manuscript word count} : 4439

\textbf{Clinical trial registration} : not applicable

\textbf{IRB:} STUDY18120143 approved and consent waived April 17, 2019

\textbf{Corresponding author} :

Ibrahim Sultan, MD

Division of Cardiac Surgery, Department of Cardiothoracic Surgery

University of Pittsburgh

UPMC Center for Thoracic Aortic Disease, Heart and Vascular Institute

University of Pittsburgh Medical Center

5200 Centre Ave, Suite 715

Pittsburgh, PA 15232

Tel: (412) 623-6193

Fax: (412) 623-3717

sultani@upmc.edu

\textbf{ABSTRACT}

Introduction

Thoracic endovascular aortic repair (TEVAR) became the standard of care
for treating type B aortic dissections and descending thoracic aortic
aneurysms. We aimed to describe the racial/ethnic differences in TEVAR
utilization and outcomes.

Methods

The National Inpatient Sample was reviewed for all TEVARs performed
between 2010 and 2017 for Type B aortic dissection and descending
thoracic aortic aneurysm (DTAA). We compared groups stratifying by their
racial/ethnicity background in whites, black, Hispanic, and others. A
mixed-effects logistic regression was performed to assess the
relationship between race/ethnicity and the primary outcome, in-hospital
mortality.

Results

A total of 25,260 admissions for TEVAR during 2010--2017 were
identified. Of those, 52.74\% (n= 13,322) were performed for aneurysm
and 47.2\% (n= 11,938) were performed for type B dissection. 68.1\% were
white, 19.6\% were black, 5.7\% Hispanic, and 6.5\% were classified as
others. White patients were the oldest (median age 71 years;
\textless{}0.001), with TEVAR being performed electively more often for
aortic aneurysm (58.8\% vs. 34\% vs. 48.3\% vs. 48.2\%;
p\textless{}0.001). In contrast, TEVAR was more likely urgent or
emergent for type B dissection in black patients (65.6\% vs 41.1\% vs
51.6\% vs 51.7\%; p\textless{}0.001). Finally, the black population
showed a relative increase in the incidence rate of TEVAR over time. The
adjusted multivariable model showed that race/ethnicity was not
associated with in-hospital mortality.

Conclusion

Although there is a differential distribution of thoracic indication and
comorbidities between race/ethnicity in TEVAR, racial disparities do not
appear to be associated with in-hospital mortality after adjusting for
covariates.

\textbf{Abstract word count} : 250

\textbf{INTRODUCTION}

Ever since its first description in 1994 by Dake and colleagues,
thoracic endovascular aortic repair (TEVAR) has become the standard of
care for the treatment of various pathologies involving the descending
thoracic aorta (DTA), including aneurysm, acute dissection, intramural
hematoma, and aortic rupture . Aided by technological advances and
increasing operator familiarity with endovascular approaches, TEVAR has
been associated with improved short-term outcomes compared to open
surgical repair, including operative mortality, spinal cord ischemia,
acute kidney injury, and cardiac and pulmonary complications

Nevertheless, access to surgical procedures and their benefits is often
inequitable due to structural disparities at the health systems level .
For example, racial disparities have persisted in the utilization of 9
major surgical procedures, including coronary angioplasty, spinal
fusion, carotid endarterectomy, appendectomy, colorectal resection,
coronary artery bypass grafting, total hip arthroplasty, total knee
arthroplasty, and worsened for one-third of them from 2012-2017 period .
Likewise, the Transcatheter Valve Therapy (TVT) Registry suggests
minorities have been underrepresented among the recipients of
transcatheter aortic valve replacement (TAVR) .

However, the incursion of TEVAR technology into medical practice
suggested a process of ''democratizing technology.'' Historically, black
patients were more likely to undergo open repair for thoracic aortic
aneurysms (TAA) at low-volume hospitals with higher operative mortality
than white patients (13). This paradigm was challenged by two reports,
including data from 1999 to 2008, were we could observed a setting-off
of traditional racial disparities with TEVAR utilization . Given that
more than a decade has already passed, our objective is to reevaluate if
TEVAR continues to be a procedure where access to surgical services is
not affected by racial differences using a contemporary database.

\textbf{METHODS}

\emph{Data source}

We obtained data from the Nationwide Inpatient Sample (NIS) Database
from 2010 to 2017. The Agency for Healthcare Research and Quality
sponsors the NIS as part of the Healthcare Cost and Utilization Project.
The NIS is the largest publicly available all-payer inpatient healthcare
database designed to produce national estimates of inpatient
utilization, access, cost, quality, and outcomes. Unweighted, it
contains data from more than 7 million hospital stays each year.
Weighted, it estimates more than 35 million hospitalizations nationally.
The data include diagnosis and procedure codes from the International
Classification of Diseases, Ninth and Tenth Revision, Clinical
Modification (ICD-9-CM and ICD-10-CM), and Clinical Classifications
Software diagnosis and procedure classifications. The Institutional
Review Board at the University of Pittsburgh evaluated this study and
deemed it not to qualify as human subject research. The research team
completed relevant HCUP training modules and signed the NIS Data Use
Agreement.

\emph{Study Population}

We identified all adult hospitalizations (aged \textgreater{}18 years)
that were associated with a diagnosis code of dissection or aneurysm of
the thoracic aorta without rupture (ICD-9-CM 441.00, 441.01, 441.03,
441.9, and ICD-10-CM I71.00, I71.01, I71.03, I71.2, I71.5). Then, we
proceed to identify admissions associated with a TEVAR procedure. To
exclude patients undergoing TEVAR in the aortic arch surgical
reconstruction setting, patients with codes indicating Type A
dissection, cardioplegia, valve repair, or an operation on vessels of
the heart were excluded (see \textbf{Supplemental Table 1} ). Patients
were stratified by race and ethnicity. \textbf{Figure 1} is a CONSORT
diagram depicting the patient population and groups of analysis.

\emph{Statistical methods and analysis}

The cohort was stratified by their racial/ethnicity background in whites
or Caucasians, black or African American, Hispanic, and others to assess
baseline characteristics and outcomes comparatively. Sampling weights
provided by the NIS were used for national estimations. TEVAR incidence
rates were calculated for White, Black, and Hispanic patients using
race-specific US Census population data for each year
(\textbf{Supplementary Table 2} ). Univariate comparison between groups
was performed with Pearson Chi\textsuperscript{2} test for categorical
variables. Continuous data, including patient age, hospital length of
stay, and total charges, were compared using the Kruskal-Wallis or ANOVA
after testing for normality using the Shapiro--Wilk test. Bonferroni
correction and Tukey's multiple comparison adjustment prevented Type I
error. We have four groups which mean six pairwise; the significance
value of p used was less than 0.05/6=0.008 to reject the null
hypothesis. The primary outcome was in-hospital mortality. Secondary
outcomes included complications identified through ICD codes
(\textbf{Supplementary Table 3} ) and resources utilization, such as
length of stay and hospital charges. A mixed-effects multivariable
logistic regression assessed the relationship between race and the
primary outcome, using hospitals as the random effect to account for
interhospital variability. Adjusting covariates were selected through a
correlation matrix. R (4.0.0 'Arbor Day') was utilized for the analysis.



\textbf{RESULTS}

\emph{Baseline demographic and clinical variables}

Selection of the study cohort is described in \textbf{figure 1} . In
2010--2017, a total of 25,260 hospital admissions having coded a TEVAR
procedure were estimated, of which 52.7\% (n= 13,322) and 47.2\% (n=
11,938) were secondary to an DTAA and type B dissection, respectively.
The median age of the cohort was 69 years (IQR 59-77), with 40.7\% (n=
10,297) being female and 55\% (n= 13,901) catalogued as elective
admissions. Most of the included admissions had hypertension as a
comorbidity (85.7\%, n= 21,663), followed by dyslipidemia (46.9\%, n=
11,856) and coronary artery disease (31.4\%, n= 7,948). Furthermore,
54.8\% (n= 13,859) of the admission were from patients whose median
household incomes fell under the 50\textsuperscript{th} percentile
(30.2\% in the \textless{}25\textsuperscript{th} and 24.6\% in the
25-50\textsuperscript{th} percentile). Regarding hospital
characteristics, 83.3\% (n= 21,041) and 74.2\% (n= 3,758) of TEVARs were
performed in Urban non-teaching and in large bed size hospitals,
respectively.

\emph{Racial/Ethnic Groups}

Out of the 25,260 hospital admissions, 68.1\% (n= 17,197) were
whites/Caucasian, 19.6\% (n= 4,959) were black/African American, 5.7\%
(n= 1,462) Hispanic and 6.5\% (n= 1,642) were classified as ``others''
(2.9\% Asian or pacific islanders and 0.4\% native Americans). Overall,
there was a relative marginal increase in the proportion of TEVARs
performed from 2013 onwards. Specifically, the race-adjusted procedural
incidence rate for black population went from 1.14 cases per 100 000
persons in 2012 to 2.03 cases per 100 000 persons in 2015
(\textbf{Figure 2} )

Overall, TEVAR was more frequently secondary to DTAA (58.8\% vs 34\% vs
48.3\% vs 48.2\%; p\textless{}0.001) among white population; they had
more often CAD (34.6\% vs 24.1\% vs 26.8\% vs 24.7\%;
p\textless{}0.001), and COPD (28.7\% vs 15.6\% vs 15.1\% vs 16.5\%;
p\textless{}0.001). In contrast, black population had a younger median
age, presented more frequently with type B dissection (41.1\% vs 65.6\%
vs. 51.6\% vs 51.7\%; p\textless{}0.001), or hypertension as a
comorbidity (83\% vs 92\% vs 85\% vs 84\%; p\textless{}0.001). A higher
proportion of the black population had a median household income below
the percentile 25\textsuperscript{th} (24.2\% vs 52.1\% vs 34.9\% vs
22.6\%; p\textless{}0.001) (\textbf{Table 1} ).

\emph{Outcomes after TEVAR}

Hemorrhage or transfusion-related complications were the most common
complication identified among all TEVAR admissions with 23.1\% (n=
5.850), followed by conduction abnormalities 22.9\% (n= 5,807) and acute
kidney failure with 15.3\% (n= 3,870). The median length of stay was 6
days (IQR 3 -- 10), and the median total hospital charges were \$165,500
(IQR 106,600 -- 260,000). Adjusted pairwise comparison showed the black
population had the highest proportion of acute kidney failure overall
(13.3\% vs. 21.7\% vs. 16.1\% vs. 15.4\%; p\textless{}.008), and
compared to white counterparts, presented more frequently paraplegia
(2.62\% vs 1.66\%; p\textless{}.008). No differences were observed in
the total hospital charges between white, black, and Hispanic
populations (\textbf{Table 2} ).

\emph{Mixed-effects logistic regression for in-hospital mortality}

The overall estimated in-hospital mortality was approximately 4.3\% (n=
1,087), being significantly higher for the Hispanic group after pairwise
comparisons (4.1\% vs. 4.2\% vs. 6.2\% vs. 4.1\%; p\textless{}.001).
However, the adjusted multivariable model showed that race was not an
independent factor associated with in-hospital mortality (\textbf{Table
3} ). Instead, the association with cerebrovascular disease (OR 2.3, CI
95\% 1.6 -- 3.4), a non-elective admission (OR 2.2, CI 95\% 1.5 -- 3.1),
peripheral artery disease (OR 1.6, CI 95\% 1.2 -- 2.2), and chronic
kidney disease (1.45 (1.01 -- 2.07), were all highly associated with
in-hospital mortality.

\textbf{DISCUSSION}

Historically, favorable results treating thoracic aortic pathologies
were restricted to centers of excellence with extensive experience in
open surgical repair , limiting the access of high-quality surgical
services to underrepresented populations . However, the refinement of
endovascular techniques and TEVAR becoming widely available translated
into better perioperative outcomes.

This contemporary study reaffirms that racial or ethnic background is
not associated with in-hospital mortality after TEVAR after adjusting
for hospital-level and patient-level covariates, including median
household income. Instead, we observed comorbidities determining
unfavorable outcomes in the multivariable analysis; white patients were
more likely to be treated electively after thoracic aortic aneurysms,
and black and Hispanic patients were more likely to be treated
non-electively for type B aortic dissection. Most importantly, there
seems to be a relative increase in the proportion of the black
population having access to TEVAR technology over the last years.

Our data corresponds with previous reports. An analysis of the Vascular
Quality Initiative database showed that despite increased comorbidities
and advanced disease, black patients were not associated with an
increased risk of perioperative complications compared to white
populations (OR 0.9; 95\% CI, 0.7-1.1; P = .42) . Additionally, data
from 12,500 Medicare patients showed that the increased risk of
perioperative mortality seen in open repairs for black patients (OR =
2.0, 95\% CI1.5-- 2.5, p\textless{}0.001) was offset when TEVAR was
utilized compared to the white population (OR = 0.9, 95\% CI=0.6--1.5,
p=0.72), a relationship that remained constant across different hospital
volume strata . Rather than being associated with race or ethnicity, all
these studies suggest TEVAR mortality is affected by other factors such
as the underlying pathologic process or clinical acuity. For example,
patients with type B dissection have traditionally had lower in-hospital
mortality rates than aortic aneurysms or repair of ruptured thoracic
aneurysms usually have a higher risk of death than non-ruptured
aneurysms.

Additionally, this analysis adds to the body of literature describing
the influence of the comorbidities profile on TEVAR outcomes. For
example, perioperative mortality is significantly higher in patients
with chronic renal disease compared to non-renal failure patients ;
chronic heart failure has been associated with TEVAR-related
adjusted-mortality for both thoracic aneurysm and type B dissection ;
chronic obstructive pulmonary disease has also been independently
associated with increased mortality after adjusting for gender and other
comorbidities (OR 4.31, CI 1.01--16.88; p=0.03) . Finally, increasing
age has been identified to be interdependently associated with
mortality; patients [?]80 years have higher odds for mortality than
younger patients (OR, 2.32; 95\% CI, 1.25 -- 4.31) . In our analysis,
comorbidities such as cerebrovascular disease, peripheral artery
disease, and chronic kidney disease were independently associated with
in-hospital mortality, reflecting the association between
atherosclerosis and mortality . Worth mentioning, hypertension was
associated with increased odds for hospital survival, which can be
explained by hypertension being related to younger patients with Type B
dissection .

Racial or ethnic disparities in health services follow a multifactorial
framework; patient characteristics and preferences, surgical providers'
background, and surgical health services availability determine access
to care . Thoracic endovascular grafting has demonstrated that
technological advancements can effectively bridge access and outcomes
gaps; namely, TEVAR made managing complex aortic pathologies simpler and
safer, encouraging widespread utilization. Data from 2000 to 2012
already showed a progressive increase of thoracic endovascular aortic
repair supplanting open repairs with better results . Furthermore,
earlier reports even suggested that underrepresented populations (Black,
Hispanic, and Native American) and patients with lower median household
incomes had a higher propensity for undergoing TEVAR procedures . We
could observe a relative increase in the TEVAR incidence rate during
2013 -2015 for the black population in this opportunity. This trend
could be related to some national health reforms implemented during the
same period. For example, the Health and Human Services Action Plan to
Reduce Racial and Ethnic Health Disparities (HHS Disparities Action
Plan), The Affordable Care Act insurance, and the Medicaid expansions
have a temporal relationship . Likewise, it can be argued that the
extension of indication criteria might have also positively impacted the
underrepresented population. For example, endovascular treatment of
traumatic aortic lesions could benefit minority-serving trauma centers
where the uninsured population tends to cluster or the tendency to treat
acute type B dissections with TEVAR may have helped the black population
.

\emph{Limitations}

The limitations of this study are inherent to the nature of the
database. Although administrative databases are a great source of
national data, coding systems are prone to oversimplification of
pathologies, registry errors, and missed entries. For example, a patient
with a chronic type B dissection and degenerative dilation can be coded
as an aortic aneurysm in some institutions and as dissection in others.
Furthermore, more comprehensive data to address race disparities
holistically is not possible with administrative databases such as the
NIS database. Another limitation is that decompensated comorbid
conditions or other important clinical factors present at admission
cannot be differentiated from chronic stable ones, leading to
confounding. Also, despite these data demonstrating the short-term
advantages of an endovascular approach regardless of race, the
longer-term effects are uncertain. Significant racial/ethnic disparities
might be essential in explaining clinical outcomes concerning
antihypertensive therapy variability, treatment adherence, and
surveillance programs.

\emph{Conclusion}

This contemporary real-world data reconfirms racial or ethnic background
is not associated with in-hospital mortality after adjusting for
covariates, demonstrating TEVAR has been a successful case where one
aspect of health services disparities has been covered. Instead, the
burden of comorbidities seems to affect clinical outcomes among TEVAR
patients.

\textbf{References:}

\textbf{Table 1.} Weighted patient demographics and hospital
characteristics with univariate comparisons between race groups\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Variable}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Total} \textbf{N= 25,260}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{White/Caucasian N= 17,197}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Black/AA} \textbf{N= 4,959}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Hispanic} \textbf{N= 1,462}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Other} \textbf{N= 1,642}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{P-Value}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Age, median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
69 (59 -77)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
71 (62-78)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
62 (53-72)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
66 (57-76)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
67 (58-77)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Female, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10,297 (40.77\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7,046 (40.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,147 (43.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
543 (37.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
561 (34.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Indication, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Type B dissection\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11,938 (47.26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7,079 (41.16\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,255 (65.64\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
755 (51.63\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
850 (51.74\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Thoracic Aneurysm\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13,322 (52.74\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10,118 (58.84\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,704 (34.36\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
707 (48.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
793 (48.26\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Elective admission, n(\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
13,901 (55.03\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10,169 (59.14\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,142 (43.20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
697 (47.70\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
893 (54.35\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Comorbidities, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Diabetes Mellitus\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5,346 (21.16\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,315 (19.27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,199 (24.18\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
403 (27.57\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
429 (26.12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Dyslipidemia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
11856 (46.94\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
8478 (49.30\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1939 (39.11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
709 (48.50\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
730 (44.44\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Coagulation Disorder\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3125 (12.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2082 (12.11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
644 (12.98\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
171 (11.68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
228 (13.88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.08\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Heart Valve Disorder\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2662 (10.54\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1930 (11.22\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
425 (8.57\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
150 (10.27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
158 (9.59\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Hypertension\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21,663 (85.76\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14,440 (83.97\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4,580 (92.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,255 (85.83\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,388 (84.53\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Coronary Artery Disease\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7948 (31.47\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5954 (34.62\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1195 (24.11\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
392 (26.81\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
407 (24.77\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Congestive Heart Failure\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2633 (10.42\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1687 (9.81\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
668 (13.46\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
120 (8.22\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
158 (9.64\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
CVD\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2706 (10.71\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1893 (11.01\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
483 (9.75\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
166 (11.36\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
164 (10.00\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.05\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
PAD\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5727 (22.67\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4181 (24.31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1000 (20.17\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
270 (18.47\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
276 (16.81\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
COPD\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6220 (24.62\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4949 (28.78\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
778 (15.69\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
222 (15.15\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
271 (16.52\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Chronic Kidney Disease\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4647 (18.40\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2680 (15.58\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1368 (27.59\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
250 (17.12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
349 (21.23\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Hospital Variables, n (\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Rural\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
400 (1.59\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
330 (1.92\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
46 (0.93\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5 (0.34\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
19 (1.18\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Urban Non-Teaching\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,709 (14.68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,715 (15.79\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
453 (9.13\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
264 (18.06\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
277 (16.89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Urban Teaching\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21,041 (83.30\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14,102 (82.01\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4,439 (89.51\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,177 (80.48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,324 (80.60\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Small bed size\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
364 (7.19\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
257 (7.46\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
44 (4.44\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
24 (8.25\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
39 (11.82\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Medium bed size\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
917 (18.12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
620 (17.99\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
168 (16.94\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
68 (23.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
61 (18.48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Large bed size\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,758 (74.27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,560 (74.27\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
776 (78.23\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
196 (67.35\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
226 (68.48\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2.} Weighted clinical outcomes with univariate comparisons
between race groups\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Variables}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Total} \textbf{N= 25,260}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{White/Caucasian N= 17,197}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Black/AA} \textbf{N= 4,959}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Hispanic} \textbf{N= 1,462}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{Other} \textbf{N= 1,642}\strut
\end{minipage} & \begin{minipage}[b]{0.14\columnwidth}\raggedright\strut
\textbf{P-value}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{In-hospital Mortality, n (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{1,087 (4.3\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{717 (4.17\%) \textsuperscript{a}}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{211 (4.26\%) \textsuperscript{a}}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{91 (6.24\%) \textsuperscript{b}}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{68 (4.15\%) \textsuperscript{a}}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
LOS in days, median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (3-10)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5 (3-10)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7 (4-13)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (3- 9)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5 (3-11)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Discharge Location, n (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Home\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
14,486 (57.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9,741 (56.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,828 (57\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
918 (62.7\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,000 (60.8\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
STH/SNF/ICF/HHC\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9,628 (38.1\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6,700 (38.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,905 (34.4\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
448 (30.6\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
574 (34.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{Complications, n (\%)}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Heart Failure\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
706 (2.79\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
461 (2.68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
141 (2.84\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
46 (3.12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
59 (3.58\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.16\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Arrhythmia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5,807 (22.99\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
4,393 (25.54\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
832 (16.79\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
229 (15.68\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
352 (21.44\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Pneumonia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,832 (7.25\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,198 (6.97\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
453 (9.14\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
110 (7.50\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
71 (4.32\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Respiratory Failure\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1502 (5.95\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1002 (5.83\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
334 (6.73\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
81 (5.52\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
85 (5.20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.05\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Acute Kidney Injury\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,870 (15.32\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
2,301 (13.38\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,079 (21.76\%) \textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
236 (16.17\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
254 (15.45\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Paraplegia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
456 (1.81\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
285 (1.66\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
130 (2.62\%) \textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
31 (2.12\%) \textsuperscript{a, b}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (0.61\%) \textsuperscript{c}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Spinal Cord Ischemia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
331 (1.31\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
236 (1.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
60 (1.20\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
20 (1.37\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
15 (0.89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.35\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Bowel Ischemia\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
549 (2.18\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
389 (2.26\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
110 (2.22\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
31 (2.11\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
20 (1.20\%) \textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.04\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Stroke\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
940 (3.72\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
666 (3.87\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
159 (3.21\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
46 (3.12\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
70 (4.24\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
0.06\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Hemorrhage or Transfusion-related\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
5,850 (23.16\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3,775 (21.95\%) \textsuperscript{\textbf{b}}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
1,268 (25.58\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
370 (25.27\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
437 (26.63\%) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Hospital Charges (x \$1000), median (IQR)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
165.5 (106.6-260.0)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
158.3 (103.8-247.2) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
178.5 (116.4-269.2) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
173.9 (111.7-291.6) \textsuperscript{a}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
189.5 (107.2-310.5) \textsuperscript{b}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textless{}.001\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

* Pairwise comparison: same letter means no significant difference i.e.:
a vs a or b vs b or c vs c. If they have different letter, it means the
difference was statistically significant i.e.: a vs b or b vs c.

\emph{Table 3.} Mixed effect logistic regression model for in-hospital
mortality\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
Individual center & & & 0.38 (0.24) & 0.02\tabularnewline
\textbf{Race} & \emph{White as reference} & & &\tabularnewline
Black & 0.86 (0.58-- 1.28) & 0.46 & &\tabularnewline
Hispanic & 1.54 (0.88-- 2.68) & 0.13 & &\tabularnewline
Other & 0.78 (0.41 -- 1.49) & 0.45 & &\tabularnewline
Non-elective admission & 2.23 (1.56 -- 3.18) & \textless{}0.001 &
&\tabularnewline
\textbf{Indication} & \emph{Aneurysm as reference} & & &\tabularnewline
Type B & \emph{0.49 (0.35 -- 0.70)} & \textless{}0.001 &
&\tabularnewline
\textbf{Comorbidities} & & & &\tabularnewline
Dyslipidemia & 0.56 (0.40 -- 0.77) & \textless{}0.001 & &\tabularnewline
Hypertension & 0.50 (0.35 -- 0.73) & \textless{}0.001 & &\tabularnewline
Congestive heart failure & 1.24 (0.82 -- 1.88) & 0.32 & &\tabularnewline
Cerebrovascular disease & 2.39 (1.65 -- 3.46) & \textless{}0.001 &
&\tabularnewline
Peripheral artery disease & 1.62 (1.18 -- 2.23) & 0.001 &
&\tabularnewline
Chronic Kidney Disease 1.45 (1.01 -- 2.07) 0.04 & & & &\tabularnewline
\bottomrule
\end{longtable}



*Non-significant covariates also included in the model: Congestive heart
failure, Coagulopathy, median household income, Type of hospital (rural,
urban non-teaching, urban teaching), Size of hospital (small, medium,
and large bed size).

\textbf{Figures}

\textbf{Figure 1.} Flow chart of Cohort selection\textbf{.} \emph{NE=
National Estimation}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}



\textbf{Figure 2.} Population adjusted TEVAR incidence rate of TEVAR by
year using the U.S. national census.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

\textbf{Figure 3.} Distribution of TEVAR per median household income
stratified by race\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

