J Korean Med Sci.  2020 Oct;35(40):e360. 10.3346/jkms.2020.35.e360.

Incidence and Mortality Rates of Thoracic Aortic Dissection in Korea – Inferred from the Nationwide Health Insurance Claims

• Lee JH
• Cho Y
• Cho YH
• Kang H
• Lim TH
• Jang HJ
• Ro SK
• Kim H

• KMID: 2507619
• DOI: http://doi.org/10.3346/jkms.2020.35.e360

Abstract

Background
Aortic dissection (AD) is one of the most catastrophic diseases and is associated with high morbidity and mortality. The aim of this study is to investigate the hospital incidence and mortality rates of thoracic AD in Korea using a nationwide database.
Methods
We conducted a nationwide population-based study using the health claims data of the National Health Insurance Service in Korea. From 2005 to 2016, adult patients newly diagnosed with AD were included. All patients were divided into the following four subgroups by treatment: type A surgical repair (TASR), type B surgical repair (TBSR), thoracic endovascular aortic repair (TEVAR), and medical management (MM). The incidence rate, mortality rate, and risk factors of in-hospital mortality were evaluated.
Results
In total, 18,565 patients were newly diagnosed with AD (TASR, n = 4,319 [23.3%]; TBSR, n = 186 [1.0%]; TEVAR, n = 697 [3.8%]; MM, n = 13,363 [72.0%]). The overall AD incidence rate was 3.76 per 100,000 person-years and exhibited a gradual increase during the study period (3.29 to 4.82, P < 0.001). The overall in-hospital mortality rate was 10.84% and remained consistent (P = 0.57). However, the in-hospital mortality rate decreased in the TASR subgroup (18.23 to 11.27%, P = 0.046). An older age, the female sex, hypertension, and chronic kidney disease were independent risk factors for in-hospital mortality.
Conclusion
The incidence of thoracic AD has gradually increased in Korea. The in-hospital mortality in the TASR subgroup decreased over the decade, although the overall mortality of AD patients did not change.

Keyword

Aortic Dissection; Incidence; Mortality; Population-based Study

Figure

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  Fig. 1 Flow diagram of the cohort.AD = aortic dissection, TEVAR = thoracic endovascular aortic repair.

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  Fig. 2 Incidence and in-hospital mortality rates of thoracic aortic dissection patients in Korea from 2005 to 2016.TASR = type A surgical repair, TBSR = type B surgical repair, TEVAR = thoracic endovascular aortic repair, MM = medical management, APC = annual percent change.*Statistically significant (P value < 0.05).

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  Fig. 3 Monthly and seasonal numbers of AD patients from 2005 to 2016. (A) Monthly trend in the number of AD patients. (B) Seasonal trend in the number of AD patients.AD = aortic dissection.

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  Fig. 4 Survival to discharge rate of surgical treatment for type A aortic dissection according to the hospital volume.TASR = type A surgical repair.

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  Fig. 5 Kaplan-Meier curves of aortic dissection patients. (A) Overall; (B) TASR, TBSR, TEVAR, and MM.TASR = type A surgical repair, TBSR = type B surgical repair, TEVAR = thoracic endovascular aortic repair, MM = medical management.

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