Authors (including presenting author) :
Ng HL(1), Fujikawa T(1), Kwok WT(1), Ho YK(1), Chow CY(1), Chan WY(1), Lim K(1), Chang TC(1), Siu CH(1), Wong HL(1)
Affiliation :
(1)Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital
Keyword 1: :
thoracic aortic aneurysm and dissection
Keyword 2: :
sex disparity
Keyword 5: :
gender difference
Introduction :
The prevalence of thoracic aortic aneurysm and dissection (TAAD) has traditionally exhibited a male predominance, with limited understanding of the incidence patterns and temporal trends in Hong Kong, particularly regarding sex-specific differences.
Objectives :
The objective is to describe sex-specific incidence, temporal trends and 30-Day mortality of TAAD with particular emphasis on sex differences in Prince of Wales Hospital (PWH).
Methodology :
This study is a retrospective data analysis of cardiac-related discharge data from the Dendrite Clinical System for 2015–2024. The study cohort included all individuals aged 18 years and above who underwent surgical intervention for TAAD. The 30-day mortality rates were calculated using both raw values and standardized for logistic EuroSCORE predictors, such as operative urgency. Univariate and multivariable logistic regression analyses were performed to compare surgical data between male and female patients. All statistical analyses were conducted using R (RStudio, version 2024.04.0).
Result & Outcome :
Among the 822 participants included in the study, 77.5% (637/822) were male. Moreover, there was an increasing incidence of TAAD in female aged 60 years and above, with a significantly higher odds ratio compared to males [67.6% vs. 52.7%, odds ratio (OR) 1.87, 95% confidence interval (CI) 1.33-2.65; P < 0.001]. In female, the proportion of incidence increased by 29.91% from the 5-year period 2015–2019 to 2020–2024 [19.09% vs. 24.80%, odds ratio (OR) 1.40, 95% confidence interval (CI) 1.0–1.98; marginally P = 0.055]. Female had higher 30-Day mortality than male following acute repair during 2015-2019, showing a statistically significant association between sex difference and mortality [15.87% vs. 7.49%, odds ratio (OR) 2.33, 95% confidence interval (CI) 1.0-5.17; P = 0.037]. However, female had lower 30-Day mortality than male following acute repair during 2020-2024 [4.92% vs. 6.22%, odds ratio (OR) 0.78, 95% confidence interval (CI) 0.28-1.85; P = 0.60]. Both female and male groups experienced a decrease in 30-day mortality rates from the 5-year period 2015–2019 to 2020–2024 [Female: -69.0%, odds ratio (OR) 0.27, 95% confidence interval (CI) 0.09-0.78; P = 0.012 vs Male: -17.0%, odds ratio (OR) 0.82, 95% confidence interval (CI) 0.44–1.54; P = 0.527]. However, multivariable logistic regression analysis did not reveal a significant association between female sex and higher mortality, with an odds ratio of 1.43 (0.70–2.80) (P = 0.31). Conclusions: Over the past decade, hospital incidence rates for TAAD treatment increased in both sexes. This study shows a male predominance in TAAD, but an increasing incidence in females aged 60 and above. Overall, the 30-Day mortality decreased in both sexes across the two time periods. The 30-Day mortality rate was significantly higher in female than it was in male during 2015-2019, but a reverse trend was found during 2020-2024. The sustained sex-specific disparities in incidence and mortality require further studies.
