Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

Abstract

Background: To assess racial/ethnic differences in disease severity, hospital outcomes, length of stay and healthcare costs among hospitalized patients with peripheral artery disease (PAD).Methods: This study used data from the National Inpatient Sample (NIS) to explore the racial/ethnic disparities in PAD-related hospitalizations including presence of PAD with chronic limb threatened ischemia (CLI), amputation, in-hospital mortality, length of hospital stays and estimated medical costs. Race-ethnicity groups included non-Hispanic White, Black, Hispanic, Asian or Pacific Islander, Native American, and others (multiple races). Regression analyses adjusted for age, gender, Charlson Comorbidity Index, primary payer, patient location, bed size of the admission hospital, geographic region of the hospital, and rural/urban location of the hospital.Results: A total of 341,480 PAD hospitalizations were identified. Compared with non-Hispanic Whites, Native Americans had the highest odds of PAD with CLI (OR = 1.77, 95% CI: 1.61, 1.95); Black (OR = 1.71, 95% CI: 1.66, 1.76) and Hispanic (OR = 1.36, 95% CI: 1.31,1.41) patients had higher odds of amputation; Asian or Pacific Islanders had a higher mortality (OR = 1.20, 95% CI: 1.01,1.43), whereas Black (OR = 0.81, 95% CI: 0.76, 0.87) patients has a lower mortality; Asian or Pacific Islanders incurred higher overall inpatient costs (Margin = 30093.01, 95% CI: 28827.55, 31358.48) and most prolonged length of stay (IRR = 0.14, 95% CI: 0.09, 0.18).Conclusions: Our study identified elevated odds of amputation among Hispanic patients hospitalized with PAD as well as higher hospital mortality and medical expenses among Asian or Pacific Islander PAD inpatients. These two demographic groups were previously thought to have a lower risk for PAD and represent important populations for further investigation.

Lower extremity amputation protocol: a pilot enhanced recovery pathway for vascular amputees

“…Notably, half of the patients in the study are Hispanic, a known underserved ethnicity that has been demonstrated to have elevated risk of diabetes and higher odds of amputation when hospitalized with PAD compared to the non-Hispanic races. [28][29][30] Chen et al noted in a crosssectional analysis of over 300,000 inpatient hospitalizations for PAD that the average age of the Hispanic population was 57 and presented with advanced stages, which is consistent with our findings. This suggests that perhaps the Hispanic population might be affected at a younger age, J o u r n a l P r e -p r o o f 13 in addition to being under-diagnosed and under-treated.…”

“…This suggests that perhaps the Hispanic population might be affected at a younger age, J o u r n a l P r e -p r o o f 13 in addition to being under-diagnosed and under-treated. 28 Achieving improved outcomes in underserved populations emphasizes the importance of implementing a standardized postamputation protocol across all patient populations to help decrease healthcare disparities.…”

Disparities in peripheral artery disease care: A review and call for action

“…Although there is increased risk of cardiovascular disease in Southeast Asian populations, there is limited research that clarifies disparities in PAD treatment or outcomes. One study using data from the NIS found that Asian or Pacific Islander patients had higher odds of in-hospital mortality (OR, 1.20; 95% CI, 1.01–1.43) compared with Black (OR, 0.81; 95% CI, 0.76–0.87) and Hispanic (OR, 0.84; 95% CI, 0.77–0.92) patients admitted for PAD [ 79 ]. Asian patients also had increased length of hospital stay, which was also observed in Black and Hispanic patients compared with American Indian and non-Hispanic White patients.…”

“…Asian patients also had increased length of hospital stay, which was also observed in Black and Hispanic patients compared with American Indian and non-Hispanic White patients. Finally, average medical expenditures were greatest in Asian and Pacific Islander patients, and this group carried a greater economic burden than all other demographic groups included in this study [ 79 ]. Overall, studies better characterizing prevalence, treatment, and outcomes of PAD care that can address different Asian populations (eg, South Asian, East Asian, and Pacific Islander) are clearly needed.…”

Orthopedic Surgery Referral Pattern Analysis per Demographic Factors Among Patients Diagnosed With Severe Peripheral Artery Disease in Terms of Partial or Total Limb Amputation

“…African Americans were found to be two to three times more afflicted with PAD as opposed to their white counterparts [10]. It was also found that African American and Hispanic patients suffer from CLI and received major amputations at a greater proportion than their non-Hispanic white PAD patients [11].…”