Racial and Ethnic Disparities in Peripheral Artery Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1913-1926 ◽  
Author(s):  
Eddie L. Hackler ◽  
Naomi M. Hamburg ◽  
Khendi T. White Solaru
Keyword(s):  
Peripheral Artery Disease ◽  
Black Americans ◽  
Ethnic Disparities ◽  
Lower Extremity Amputation ◽  
Treatment Modalities ◽  
Racial And Ethnic Disparities ◽  
Peripheral Artery ◽  
Nonpharmacological Treatment ◽  
Artery Disease ◽  
Extremity Amputation

Peripheral artery disease is an obstructive, atherosclerotic disease of the lower extremities causing significant morbidity and mortality. Black Americans are disproportionately affected by this disease while they are also less likely to be diagnosed and promptly treated. The consequences of this disparity can be grim as Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease. The risk factors of peripheral artery disease and how they differentially affect certain groups are discussed in addition to a review of pharmacological and nonpharmacological treatment modalities. The purpose of this review is to highlight health care inequities and provide a review and resource of available recommendations for clinical management of all patients with peripheral artery disease.

High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease

2013 ◽  
Vol 165 (5) ◽  
pp. 809-815.e1 ◽  
Author(s):  
W. Schuyler Jones ◽  
Manesh R. Patel ◽  
David Dai ◽  
Sreekanth Vemulapalli ◽  
Sumeet Subherwal ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
High Mortality ◽  
Lower Extremity Amputation ◽  
Peripheral Artery ◽  
Mortality Risks ◽  
Medicare Patients ◽  
Artery Disease ◽  
Extremity Amputation

scholarly journals Proteinuria and Risk of Lower-Extremity Amputation in Patients With Peripheral Artery Disease

Diabetes Care ◽  
2019 ◽  
Vol 42 (9) ◽  
pp. e146-e147
Author(s):  
Jung-Im Shin ◽  
Morgan E. Grams ◽  
Josef Coresh ◽  
Alex R. Chang ◽  
Kunihiro Matsushita
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Lower Extremity Amputation ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Extremity Amputation

scholarly journals Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease

2019 ◽  
Vol 191 (35) ◽  
pp. E955-E961 ◽  
Author(s):  
Mohamad A. Hussain ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Atul Sivaswamy ◽  
Thomas L. Forbes ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Population Based ◽  
Secular Trends ◽  
Lower Extremity Amputation ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Extremity Amputation

Abstract 075: Heterogeneity in Treatment Effect in Patients With Peripheral Artery Disease: Insights From the CLEVER Trial

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Yashashwi Pokharel ◽  
Phillip Jones ◽  
Garth Graham ◽  
John Spertus ◽  
Kim Smolderen
Keyword(s):  
Peripheral Artery Disease ◽  
Significant Interaction ◽  
Treatment Time ◽  
Demographic Factors ◽  
Arterial Stenosis ◽  
Treatment Modalities ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Maximum Likelihood Methods ◽  
Artery Disease

Background: The CLEVER trial (Claudication: Exercise versus Endoluminal Revascularization) showed significant improvement in peripheral artery disease (PAD)-specific health status (Peripheral Artery Questionnaire, PAQ) at 6 and 18 months for both supervised exercise (SE) and stent therapy (ST) compared with optimal medical care (OMC) in PAD patients. However, it is unknown whether there is variation in treatment by age, gender or race, or if recovery is similar across these groups over time. Methods: A total of 111 patients from 22 sites with hemodynamically significant aortoiliac arterial stenosis were randomized to SE, ST, or OMC. Using maximum likelihood methods for longitudinal analyses, we analyzed change from baseline in PAQ summary scores at 6 and 18 months and tested interactions between demographic factors (≥65 vs. <65 years; women vs. men; non-Caucasians vs. Caucasians) and treatment, time, and treatment by time. When significant, we further examined effects by different treatment modalities (OMC, SE and ST). Results: The mean age of the study population was 64.4 years (53.1% <65 years), 37.8% were women and 32.4% were non-Caucasians (26.1% African Americans and 6.3% other race). There was a significant interaction by race and treatment (p=0.006, overall difference in PAQ summary scores in non-Caucasians minus Caucasians -4.0 [-11.6, 3.6], p=0.30), but there was no significant interaction between other demographic factors and treatment, time, or treatment and time. In Caucasians, PAQ summary scores improved only with ST; in non-Caucasians, improvement was similar with ST or SE (Figure). Estimates of difference in PAQ scores between SE or ST and OMC showed similar results (Table). Conclusion: There was a significant interaction between treatment and race, with only ST showing significant improvement in PAQ scores in Caucasians, whereas both ST and SE showed significant improvements in PAQ among non-Caucasians. Further studies should validate and explore the mechanisms of different racial responses to PAD treatment.

scholarly journals Regional health care services and rates of lower extremity amputation related to diabetes and peripheral artery disease: an ecological study

CMAJ Open ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. E659-E666
Author(s):  
Charles de Mestral ◽  
Mohamad A. Hussain ◽  
Peter C. Austin ◽  
Thomas L. Forbes ◽  
Atul Sivaswamy ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Ecological Study ◽  
Lower Extremity Amputation ◽  
Peripheral Artery ◽  
Regional Health ◽  
Care Services ◽  
Regional Health Care ◽  
Artery Disease ◽  
Extremity Amputation

scholarly journals Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas

2021 ◽  
Vol 10 (17) ◽  
Author(s):  
Alexander C. Fanaroff ◽  
Lin Yang ◽  
Ashwin S. Nathan ◽  
Sameed Ahmed M. Khatana ◽  
Howard Julien ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Lower Extremity ◽  
Metropolitan Areas ◽  
Major Amputation ◽  
Lower Extremity Amputation ◽  
Amputation Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Zip Code ◽  
Extremity Amputation

Background Rates of major lower extremity amputation in patients with peripheral artery disease are higher in rural communities with markers of low socioeconomic status, but most Americans live in metropolitan areas. Whether amputation rates vary within US metropolitan areas is unclear, as are characteristics of high amputation rate urban communities. Methods and Results We estimated rates of major lower extremity amputation per 100 000 Medicare beneficiaries between 2010 and 2018 at the ZIP code level among ZIP codes with ≥100 beneficiaries. We described demographic characteristics of high and low amputation ZIP codes, and the association between major amputation rate and 3 ZIP code–level markers of socioeconomic status—the proportion of patients with dual eligibility for Medicaid, median household income, and Distressed Communities Index score—for metropolitan, micropolitan, and rural ZIP code cohorts. Between 2010 and 2018, 188 995 Medicare fee‐for‐service patients living in 31 391 ZIP codes with ≥100 beneficiaries had a major lower extremity amputation. The median (interquartile range) ZIP code–level number of amputations per 100 000 beneficiaries was 262 (75–469). Though nonmetropolitan ZIP codes had higher rates of major amputation than metropolitan areas, 78.2% of patients undergoing major amputation lived in metropolitan areas. Compared with ZIP codes with lower amputation rates, top quartile amputation rate ZIP codes had a greater proportion of Black residents (4.4% versus 17.5%, P <0.001). In metropolitan areas, after adjusting for clinical comorbidities and demographics, every $10 000 lower median household income was associated with a 4.4% (95% CI, 3.9–4.8) higher amputation rate, and a 10‐point higher Distressed Communities Index score was associated with a 3.8% (95% CI, 3.4%–4.2%) higher amputation rate; there was no association between the proportion of patients eligible for Medicaid and amputation rate. These findings were comparable to the associations identified across all ZIP codes. Conclusions In metropolitan areas, where most individuals undergoing lower extremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lower extremity amputation. Development of community‐based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.

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