Large race disparities persist for Black, Hispanic adults with peripheral vascular disease
Key takeaways:
- Race-related disparities persist after peripheral vascular disease admission.
- Black and Hispanic patients were more likely to undergo amputation than white patients.
Compared with white patients, Black and Hispanic patients with peripheral vascular disease are younger, have more comorbidities, are less likely to undergo revascularization and more likely to undergo amputation, national data show.
In a retrospective analysis of more than 600,000 inpatients with peripheral vascular disease from 2015 to 2019 using the National Inpatient Sample database, researchers also found that Black and Hispanic patients incurred the highest total hospital charge, despite having lower social determinants of health compared with white patients.
“Socioeconomic and geopolitical factors, rather than physiologic or genetic variations, usually contribute to racial and ethnic disparities in health care,” Ahmad Jabri, MD, of the department of cardiovascular disease at Henry Ford Hospital in Detroit, and colleagues wrote in the Journal of American Cardiology. “Therefore, any conversation regarding racial and ethnic CVD outcome disparities must include socioeconomic factors. In our sample, Black and Hispanic patients were more likely to be in the lowest median household income quartile and experienced higher total hospital charges despite still having lower social determinants of health. This could be because of the complexity of care required to address multiple comorbidities. The multiple comorbidities and severity of the disease often result in Black and Hispanic patients who underwent repeated surgical or revascularization interventions for their peripheral vascular disease, extending their length of stay because of elevated risk.”
Jabri and colleagues analyzed hospital discharge data from 622,820 patients admitted with peripheral vascular disease from 2015 to 2019, using the National Inpatient Sample database (63% men). Researchers stratified patients by three race and ethnic categories — Black (20.8%), white (67.1) and Hispanic (12.1%) — and compared baseline characteristics, inpatient outcomes and resource utilization. Residential income provided a quartile classification of the estimated median household income of residents in the ZIP code of the patient. The quartiles were identified on a scale of one to four, with four being the wealthiest.
Black and Hispanic patients were more likely to be younger and of the lowest median income but incur higher inflation-adjusted total hospital costs. Researchers found that Black race predicted higher rates of acute kidney injury, need for blood transfusion and need for vasopressor but lower rates of circulatory shock and mortality.
Additionally, Black and Hispanic patients were less likely to undergo limb-salvaging procedures and more likely to undergo major and minor amputation than white patients. Mortality rates were similar across race categories. Compared with other race groups, Black race was associated with minor amputations (adjusted OR = 1.28; 95% CI 1.22-1.23; P < .001) and major amputations (aOR = 1.68; 95% CI, 1.56-1.81; P < .001). Black race was also associated with lower rates of endovascular revascularization (aOR = 0.77; 95% CI, 0.75-0.8; P < .001) and surgical revascularization (aOR = 0.8; 95% CI, 0.75-0.85; P < .001).
“Black and Hispanic patients continue to experience health disparities in resource utilization and inpatient outcomes in peripheral vascular disease admissions,” the researchers wrote. “Black and Hispanic patients were less likely to undergo limb-salvaging procedures and more likely to undergo amputation than white patients. Further studies are warranted to identify the potential mechanisms for such differences in these racial minorities to guide efforts and resource allocation.”
As Healio previously reported, a scientific statement from the American Heart Association, published in June, stated that Black adults are significantly more likely to develop peripheral artery disease than Hispanic or white adults even when accounting for traditional risk factors, and often present with advanced disease tied to worse outcomes like amputation. The authors wrote that a “confluence of social, economic and health variables” contributes to the disproportionate prevalence of PAD among Black adults, and a holistic view of PAD is necessary to craft the appropriate tiered strategic measures.
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