A systematic review to examine the impact of socioeconomic status on revascularization for peripheral arterial disease, carotid artery surgery, and aortic aneurysm repair outcomes in the United States

Objective: This systematic review aims to study the available literature on the impact of SES on the surgical outcomes of peripheral artery disease (PAD), carotid artery disease, and aortic aneurysms in the United States. The review also aims to report the diverse tools used to compute SES within the vascular surgery literature. Methods: A systematic review of English literature was conducted using the PubMed and Scopus literature databases from inception to November 2023. The review was designed on the PRISMA guidelines. It included studies reporting socioeconomic factors, income, social determinants of health, social class, and health status disparities in patients undergoing vascular surgical procedures. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies – of Interventions tool. There were 1133 studies initially selected; only 19 passed the complete inclusion criteria for final assessment and reporting. Results: A total of 19 studies were examined that assessed the relationship between socioeconomic status and vascular surgery outcomes. All analyses were published between 2018 and 2023 and included a broad spectrum of patients undergoing multiple vascular procedures. A total of 10 publications addressed the role of these factors in patients with PAD, three analyzed the impact of these factors in patients with carotid artery disease, and six explored the role of these factors in patients with aortic repairs. No high risk of bias was reported for any selected study, and most studies (15/19) were based on national or large registries. The results of these studies showed widespread reporting measures of SES. The findings reported describe that lower SES is associated with a higher risk of amputation and stroke after revascularization for PAD and carotid artery surgery. Among the patients undergoing aortic repair, lower SES was more likely to present with ruptured aneurysms or symptomatic at the time of surgery. Conclusions: Multiple metrics are used to assess SES in the vascular surgery literature. All studies associated lower SES with poorer outcomes or higher acuity of symptoms at the time of revascularization for PAD, carotid artery disease, and aortic repair. This finding highlights the need to consider SES in improving surgical outcomes and decreasing health care disparities.