Limb outcomes worse for Black, Hispanic patients with PAD than white patients
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Black and Hispanic patients with peripheral artery disease experience worse limb outcomes compared with white patients, even when presenting at a similar stage of clinical severity, data show.
“Differences in comorbid conditions at presentation by race and ethnicity are not sole drivers of disparate outcomes,” Corey A. Kalbaugh, PhD, assistant professor and epidemiologist in the department of public health sciences at Clemson University, told Healio. “Rather, consider the impact of system‐level policies that differentially, and negatively, impact Black and Hispanic patients. We should attempt to understand and address the root causes of disparate outcomes experienced by racial and ethnic minority groups.”
Kalbaugh and colleagues calculated 1-year risk for major adverse limb events, major amputation and death for 88,599 patients undergoing elective revascularization for claudication or chronic limb-threatening ischemia, using Vascular Quality Initiative data from 2011 to 2018. The mean age of patients was 69 years; 37% were women. Researchers estimated HRs according to race and ethnicity using Cox or Fine and Gray subdistribution models for major adverse limb events and major amputation, treating death as a competing event.
The findings were published in the Journal of the American Heart Association.
Within the cohort, major amputation and death occurred among 12.8% of white patients, 16.5% of Black patients and 17.2% of Hispanic patients.
Compared with white patients, Black patients were more likely to experience poor limb outcomes, including major adverse limb events (HR = 1.17; 95% CI, 1.12-1.22) and amputation (HR = 1.52; 95% CI, 1.39-1.65). Similarly, Hispanic patients were also more likely to experience major adverse limb events (HR = 1.22; 95% CI, 1.14-1.31) and amputation (HR = 1.45; 95% CI, 1.28-1.64).
However, all-cause mortality risk was lower in Black patients (HR = 0.85; 95% CI, 0.79-0.91) and Hispanic patients (HR = 0.71; 95% CI, 0.63-0.79) compared with white patients.
Worse limb outcomes were observed among Black and Hispanic patients in analyses stratified by claudication and chronic limb-threatening ischemia.
“This increased risk remained after adjustment for many risk factors for poor outcomes at time of revascularization, failing to support the theory that poor outcomes are solely a function of disease severity at the time of revascularization,” the researchers wrote. “Additional investigation aimed at eliminating disparate limb outcomes is needed and should focus on markers of optimal care delivery.”
For more information:
Corey A. Kalbaugh, PhD, can be reached at coreyk@clemson.edu; Twitter: @corey_kalbaugh.
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