{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T09:21:41Z","timestamp":1783761701930,"version":"3.55.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007184","name":"yale school of medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007184","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>As the role of social determinants in carotid artery stenting (CAS) outcomes remains unclear, we investigated the association between the Distressed Community Index (DCI) (zip-code based) and post-CAS mortality\/stroke outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We analyzed patients undergoing CAS from 2015 to 2019 using the Medicare claims-linked Vascular Quality Initiative database. Patients were grouped based on high (DCI \u2a7e 60) and low (DCI &lt; 60) community distress. We analyzed 36-month mortality using Kaplan\u2013Meier survival curves and hierarchical Cox regression, and 36-month stroke using cumulative incidence function curves and Fine\u2013Gray models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The final cohort included 8717 patients (3032 DCI \u2a7e 60), with a mean DCI score of 46.2 (\u00b1 28.5) and mean age of 74.7 (\u00b1 7.8) years. Most participants were men (64.3%), White (92.7%), and non-Hispanic\/Latino (97.7%). There was no significant difference in the 36-month mortality incidence between high and low community distress groups (25.6% vs 23.5%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.22), and no significant association between high community distress and mortality (unadjusted HR: 1.04; 95% CI 0.90\u20131.21; adjusted HR: 1.02; 95% CI 0.89\u20131.17). The high community distress group experienced an elevated 36-month stroke incidence (26.8% vs 22.4%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.048), but no significant association with stroke was observed (unadjusted sub-HR: 1.12; 95% CI 1.00\u20131.24; adjusted sub-HR: 1.03; 95% CI 0.92\u20131.16).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our cohort showed underrepresentation in terms of sex, race, and ethnicity, with a skewed DCI distribution towards lower community distress. Contrary to what we know about community distress, no independent association between higher community distress and post-CAS stroke\/mortality risk was found. Future work must examine whether accessibility barriers and selective CAS allocation explain our results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x241292545","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T07:15:41Z","timestamp":1731309341000},"page":"27-37","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Lack of diversity in patients undergoing carotid artery stenting: Implications for the Distressed Community Index"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5849-6916","authenticated-orcid":false,"given":"Carmen","family":"Pajarillo","sequence":"first","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4294-5507","authenticated-orcid":false,"given":"Ga\u00eblle","family":"Romain","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-0237","authenticated-orcid":false,"given":"Jacob","family":"Cleman","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Scierka","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Grubman","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Schenck","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"},{"name":"Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (Current)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-4400","authenticated-orcid":false,"given":"Jonathan","family":"Kluger","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6104-6254","authenticated-orcid":false,"given":"Kim G","family":"Smolderen","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"},{"name":"Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA (Current)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4954-5672","authenticated-orcid":false,"given":"Carlos","family":"Mena-Hurtado","sequence":"additional","affiliation":[{"name":"Vascular Medicine Outcomes Program, Cardiovascular Medicine, Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31820d8d78"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.12882"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.544866"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.03.057"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574413510978"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61690-6"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.057756"},{"key":"e_1_3_3_9_2","article-title":"Socioeconomic Distressed Communities Index associated with worse limb-related outcomes after infrainguinal bypass","volume":"70","author":"Hawkins RB","year":"2019","unstructured":"Hawkins RB, Charles EJ, Mehaffey JH, et al. 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