PMID- 37737257
OWN - NLM
STAT- MEDLINE
DCOM- 20230925
LR  - 20230925
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 96
DP  - 2023 Oct
TI  - Racial Disparities in Treatment Indications and Outcomes for Limb Ischemia.
PG  - 89-97
LID - S0890-5096(23)00243-1 [pii]
LID - 10.1016/j.avsg.2023.04.022 [doi]
AB  - BACKGROUND: Studies suggest that the Affordable Care Act (ACA) of 2014 has 
      improved access to vascular care and vascular outcomes among patients suffering 
      from peripheral arterial disease (PAD). We sought to examine the racial 
      disparities that exist in patients with PAD who have undergone lower extremity 
      bypass (LEB) or a peripheral vascular intervention (PVI) using the Vascular 
      Quality initiative (VQI) database. METHODS: The VQI infrainguinal and PVI 
      datasets were queried for patients receiving elective and urgent LEB or PVI 
      between 2016, 2 years after ACA implementation, and in 2021. Patients undergoing 
      interventions urgently/emergently or for aneurysm were excluded. The primary 
      outcome was major adverse limb event (MALE-defined as any vascular reintervention 
      or above-ankle amputation) free survival at 1 year. Standard statistical methods 
      were utilized as appropriate. RESULTS: A total of 17,455 LEB and 87,475 PVIs were 
      included in this analysis. Black persons present at a younger age when compared 
      to non-Hispanic White persons (NHW) and are more likely to have diabetes, 
      hypertension, end-stage renal disease (ESRD), and higher rates of prior 
      amputation. Black persons are more likely to present with chronic 
      limb-threatening ischemia (CLTI) rather than claudication, and in a more urgent 
      setting. Postoperative outcomes show higher rates of major amputations among 
      racial minorities, specifically Black persons for both LEB (1.8% vs. 0.8% 
      P < 0.001) and PVI (20.8% vs. 16.8% P < 0.001). Black persons are at higher risk 
      of 1-year MALE for LEB (36.7% vs. 29.9% P < 0.001) and PVI (31.0% vs. 21.7%; 
      P < 0.001). Even after adjusting for confounding variables, Black persons have a 
      higher risk of 1-year MALE for LEB, with an adjusted hazard ratio (aHR) of 1.15 
      (95% CI [1.05-1.26], P = 0.003) and PVI (aHR 1.18 95% CI [1.12-1.24], P < 0.001). 
      Other major determinates of 1-year MALE on multivariate Cox regression included 
      CLTI (LEB aHR 1.57 95% CI [1.43-1.72], P < 0.001; PVI aHR 2.29 95% CI 
      [2.20-2.39], P < 0.001) and history of prior amputation (LEB aHR 1.35 95% CI 
      [1.17-1.56], P < 0.001; PVI aHR 1.5 95% CI [1.4-1.6], P < 0.001). CONCLUSIONS: 
      Compared to NHW persons, Black persons present with more advanced vascular 
      disease regardless of the operative indication. Black persons are also at 
      significantly higher risk of 1-year MALE. Despite some advances in more 
      accessible care through the ACA of 2014, our observations suggest that Black 
      persons still have significantly worse outcomes due to variety of variables that 
      need further investigation.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Semaan, Dana B
AU  - Semaan DB
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
FAU - Abdul-Malak, Othman M
AU  - Abdul-Malak OM
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
FAU - Avgerinos, Efthymios D
AU  - Avgerinos ED
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
FAU - Chaer, Rabih A
AU  - Chaer RA
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
FAU - Madigan, Michael C
AU  - Madigan MC
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
FAU - Siracuse, Jeffrey J
AU  - Siracuse JJ
AD  - Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA.
FAU - Eslami, Mohammad H
AU  - Eslami MH
AD  - Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA. 
      Electronic address: eslamimh@upmc.edu.
LA  - eng
PT  - Journal Article
DEP - 20230430
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - United States
MH  - Humans
MH  - *Patient Protection and Affordable Care Act
MH  - Treatment Outcome
MH  - *Peripheral Arterial Disease/diagnosis/surgery
MH  - Chronic Limb-Threatening Ischemia
MH  - Lower Extremity
EDAT- 2023/09/22 12:41
MHDA- 2023/09/25 06:42
CRDT- 2023/09/22 09:29
PHST- 2023/01/12 00:00 [received]
PHST- 2023/04/15 00:00 [revised]
PHST- 2023/04/19 00:00 [accepted]
PHST- 2023/09/25 06:42 [medline]
PHST- 2023/09/22 12:41 [pubmed]
PHST- 2023/09/22 09:29 [entrez]
AID - S0890-5096(23)00243-1 [pii]
AID - 10.1016/j.avsg.2023.04.022 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Oct;96:89-97. doi: 10.1016/j.avsg.2023.04.022. Epub 2023 Apr 
      30.