Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006
Presented at the Annual Society of Vascular Surgery Meeting, Denver, Col, Jun 11-14, 2009.
Received 17 September 2009; accepted 21 September 2009. published online 18 January 2010.
Objective
Prior studies have documented racial and ethnic disparities in rates of amputations for peripheral arterial disease (PAD) in the United States. We analyze whether there are underlying differences in the types of treatment provided to patients who are acutely hospitalized for PAD.
Methods
The 1998-2006 Nationwide Inpatient Sample was used to examine patterns of treatment. We considered a hospitalization an acute admission for PAD if (1) the primary diagnosis was PAD, and (2) the patient was admitted urgently or emergently or through an emergency department. Vascular interventions were designated as open bypass, endovascular intervention, or major amputation, defined as disarticulation at the ankle or higher amputation.
Results
From 1998 through 2006, the likelihood of an endovascular procedure being performed during an acute hospitalization for PAD increased from 11.5% to 35.3%, and open vascular procedures decreased from 34.9% to 25.4%. The likelihood of a major amputation during an acute hospitalization for PAD decreased from 29.7% to 20.3%. Black and Hispanic patients were more likely than white patients to undergo amputation and were less likely to have an endovascular or open revascularization.
Conclusion
Use of endovascular procedures has increased and use of open vascular bypass has decreased in the inpatient treatment of acute PAD. Although the overall likelihood of amputation has decreased, racial and ethnic differences persist, with black and Hispanic patients experiencing a higher likelihood of amputation.
aCardioVascular Thoracic Institute, Division of Vascular and Endovascular Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, Calif
cDivision of Colorectal Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, Calif
dDepartment of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, Calif
bDivision of Vascular Surgery, Department of Surgery, University of California, Irvine Medical School, Irvine, Calif
Correspondence: Vincent L. Rowe, MD, CardioVascular Thoracic Institute, Division of Vascular and Endovascular Surgery, Department of Surgery, Keck School of Medicine at USC, 1520 San Pablo, Ste 4300, Los Angeles, CA 90033
Competition of interest: none.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
ABSTRACT