The role of personal characteristics in diagnosis and management of AAS has not been extensively studied. AAS tends to occur in older people, due to association with uncontrolled hypertension, but can occur in younger people with connective tissue diseases. The few studies of sex-related differences suggest that AAS tends to occur in women at an older age but with little evidence of differences in treatment or outcomes.128 Studies of ethnicity suggest that African Americans are more likely than other ethnicities to present with type B aortic dissection129 and are more likely to present at a younger age and with risk factors, but treatment and outcomes are similar.130
None of the studies included in the systematic review reported ethnicity characteristics for the study population. Mean or median age was reported in 7/13 studies18,31–33,35,52,53 of ADD-RS (ranging from 5533 to 70 years)32 and 8/25 studies18,31,35,59,64,71,73,74 of D-dimer (ranging from 5373 to 68 years59). The percentage of male or female patients was reported in 11/13 studies18,31–35,52,53,55–57 of ADD-RS (ranging from 32%32 to 53%33 females) and 18/25 studies18,31,32,34,35,59,61–65,67,70–74,76 of D-dimer (ranging from 23%67 to 57%74 females). The studies, therefore, suggest that women may be under-represented. Age was not reported by sex, so we are unable to determine whether under-representation of women may reflect exclusion of older people from studies. Inadequate reporting means that we are unable to determine whether people of different ethnicities are appropriately represented in the studies.
We recommend that future studies should record the ethnicity of participants to determine whether the study population is representative of the wider population and allow exploration of whether there are differences in diagnostic accuracy between people of different ethnicity. Future studies should also provide complete reporting of age and sex characteristics, along with details of any relevant exclusion criteria and characteristics of those excluded, so readers can determine whether specific patient groups are under-represented and gain a more granular understanding of the research.
We requested equality monitoring data from our PPI group members to determine whether the group reflected the characteristics of the wider population. We only received 5 replies from the 16 PPI group members, with responses indicating some diversity in gender (3 females, 2 males) and ethnicity (2 Black or Black British Caribbean, 3 White people).
We also requested equality monitoring data from our research team and received 10 replies from the 14 research team members. The replies indicated that the team included more males than females (three females, seven males) and some diversity in ethnicity (three Asian or Asian British Indian, five White, two Chinese people).