Characterizing the geographic distribution of vascular surgeons in the United States

Potluri, Vamsi K.; Bilello, Josh L.; Patel, Shaunak; Yarra, Silpa; Sykes, Mellick T.; Silva, Michael

doi:10.1016/j.jvs.2022.09.015

Cited by 12 publications

(2 citation statements)

References 17 publications

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“…The rates of amputation in the US are unequally distributed, disproportionately affecting patients from racial and ethnic minority groups, patients with lower socioeconomic status and increased comorbidities, and residents of specific geographic locations . Of particular interest are the metropolitan areas of the US, where groups who are disproportionately affected by amputation predominantly reside and where, despite having the highest concentration of hospitals and specialty and primary care practitioners, patients continue to experience the highest amputation rates in the country on an absolute numbers basis …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Of particular interest are the metropolitan areas of the US, where groups who are disproportionately affected by amputation predominantly reside and where, despite having the highest concentration of hospitals and specialty and primary care practitioners, patients continue to experience the highest amputation rates in the country on an absolute numbers basis. [7][8][9] The discordance between the availability of specialized medical care and elevated rates of amputation within these regions suggests the influence of factors beyond quality of care driving amputation rates. 10 Social determinants of health (SDOH) provide a framework to evaluate the economic and social variables that contribute to the health of individuals and communities.…”

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confidence: 99%

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Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties

Kassavin,

Mota,

Ostertag-Hill

et al. 2024

JAMA Surg

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ImportanceSocial Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described.ObjectiveTo evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US.Design, Setting, and ParticipantsIn this population-based cross-sectional study of the 100 most populous US counties, hospital discharge rates for lower extremity amputation in 2017 were assessed using the Healthcare Cost and Utilization Project State Inpatient Database. Those data were matched with publicly available demographic, hospital, and SDOH data. Data were analyzed July 3, 2022, to March 5, 2023.Main outcome and MeasuresAmputation rates were assessed across all counties. Counties were divided into quartiles based on amputation rates, and baseline characteristics were described. Unadjusted linear regression and multivariable regression analyses were performed to assess associations between county-level amputation and SDOH and demographic factors.ResultsAmputation discharge data were available for 76 of the 100 most populous counties in the United States. Within these counties, 15.3% were African American, 8.6% were Asian, 24.0% were Hispanic, and 49.6% were non-Hispanic White; 13.4% of patients were 65 years or older. Amputation rates varied widely, from 5.5 per 100 000 in quartile 1 to 14.5 per 100 000 in quartile 4. Residents of quartile 4 (vs 1) counties were more likely to be African American (27.0% vs 7.9%, P &lt; .001), have diabetes (10.6% vs 7.9%, P &lt; .001), smoke (16.5% vs 12.5%, P &lt; .001), be unemployed (5.8% vs 4.6%, P = .01), be in poverty (15.8% vs 10.0%, P &lt; .001), be in a single-parent household (41.9% vs 28.6%, P &lt; .001), experience food insecurity (16.6% vs 12.9%, P = .04), or be physically inactive (23.1% vs 17.1%, P &lt; .001). In unadjusted linear regression, higher amputation rates were associated with the prevalence of several health problems, including mental distress (β, 5.25 [95% CI, 3.66-6.85]; P &lt; .001), diabetes (β, 1.73 [95% CI, 1.33-2.15], P &lt; .001), and physical distress (β, 1.23 [95% CI, 0.86-1.61]; P &lt; .001) and SDOHs, including unemployment (β, 1.16 [95% CI, 0.59-1.73]; P = .03), physical inactivity (β, 0.74 [95% CI, 0.57-0.90]; P &lt; .001), smoking, (β, 0.69 [95% CI, 0.46-0.92]; P = .002), higher homicide rate (β, 0.61 [95% CI, 0.45-0.77]; P &lt; .001), food insecurity (β, 0.51 [95% CI, 0.30-0.72]; P = .04), and poverty (β, 0.46 [95% CI, 0.32-0.60]; P &lt; .001). Multivariable regression analysis found that county-level rates of physical distress (β, 0.84 [95% CI, 0.16-1.53]; P = .03), Black and White racial segregation (β, 0.12 [95% CI, 0.06-0.17]; P &lt; .001), and population percentage of African American race (β, 0.06 [95% CI, 0.00-0.12]; P = .03) were associated with amputation rate.Conclusions and RelevanceSocial determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%