Disparities in Treatment of Peripheral Artery Disease and Critical Limb Ischemia: A National Perspective

Purpose: Previous literature briefly highlighted the current racial and ethnic disparities in peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment. Herein, we analyze the trend over a 14-year time period to investigate whether the disparities gap in treatment is closing.

Materials and Methods: The National Inpatient Sample was queried between 2005 and 2018 for patients with PAD or CLI. Cochran-Armitage test was conducted to assess trends in the utilization of amputations and revascularizations between races. P values less than 0.05 were considered statistically significant. All estimates were nationalized using discharge weights provided by the Healthcare Cost and Utilization Project.

Results: There was a total of 12,442,005 admissions involving PAD. Of these, 9,536,224 were white, 1,631,198 were Black, 826,297 were Hispanic, and 447,160 were of other race. Among those who received any revascularization, the trend in the proportion of admissions involving white patients decreased by 0.47% per year (P < 0.001), but it increased by 0.35% in Black patients (P < 0.001). There was no change in the proportion of Hispanic or of other race (P = 0.262 and P = 0.198, respectively) patients. Among those who received major amputation, there was no change in the proportion of admissions involving white (P = 0.561), Black (P = 0.236), Hispanic (P = 0.587), and other race (P = 0.277) patients. There was a total of 6,904,057 admissions involving CLI. Of these, 4,649,481 were white, 1,249,535 were Black, 695,238 were Hispanic, and 309,803 were other race. Among those who received any revascularization, the trend in the proportion of admissions involving white patients decreased by 0.51% (P < 0.001), but it increased by 0.30% in Black patients (P = 0.001). Meanwhile, there was an increase in the proportion of Hispanic patients by 0.16% per year (P = 0.020). There was no change in the proportion of those of other race (P = 0.277). Among those who received major amputation, there was no change in the proportion of admissions involving white (P = 0.232), Black (P = 0.170), Hispanic (P = 0.708), and other race (P = 0.140) patients.

Conclusions: Our analysis highlighted disparities in PAD and CLI treatments for nonwhite populations in our nationally representative database. Nonwhite patients are more likely to receive amputations and less likely to receive revascularization than white patients. The gap is slowly closing, however, which may demonstrate that guidelines have been effective in mitigating disparities.