Healthcare disparities in vascular surgery: A critical review

Abstract

Health disparities in vascular surgical care have existed for decades. Persons categorized as Black undergo a nearly twofold greater risk-adjusted rate of leg amputations. Persons categorized as Black, Latinx, and women have hemodialysis initiated via autogenous fistula less often than male persons categorized as White. Persons categorized as Black, Latino, Latina, or Latinx, and women are less likely to undergo carotid endarterectomy for symptomatic carotid stenosis and repair of abdominal aortic aneurysms. New approaches are needed to address these disparities. We suggest surgeons use data to identify groups that would most benefit from medical care and then partner with community organizations or individuals to create lasting health benefits. Surgeons alone cannot rectify the structural inequalities present in American society. However, all surgeons should contribute to ensuring that all people have access to highquality vascular surgical care.

Health inequities in dialysis care: A scoping review

“…One study found that men were more likely to have AVF 26 compared to women who had less AVF use, 29,43,67 more central venous catheter use, 25,45 less dialysis access patency, 68 and more fistula maintenance interventions 69 . Men were less likely to start dialysis at home, 39 less likely to withdraw from dialysis, 57 had greater kidney function recovery, 70 and go on palliative care more often 42 .…”

“…marginalized groups to have lower mortality than white patients (Table 2). Historically marginalized groups received arteriovenous fistulas (AVF), [25][26][27][28][29][30] peritoneal dialysis (PD), [31][32][33][34][35][36][37] home hemodialysis, 31,32,[36][37][38][39] hospice, 40,41 and palliative care 42 less frequently than white patients and were more likely to receive arteriovenous grafts (AVG) 43,44 and central venous catheters. 25,44,45 According to Yap et al, race was not a predictor for PD.…”

“…Historically marginalized groups received arteriovenous fistulas (AVF), [25][26][27][28][29][30] peritoneal dialysis (PD), [31][32][33][34][35][36][37] home hemodialysis, 31,32,[36][37][38][39] hospice, 40,41 and palliative care 42 less frequently than white patients and were more likely to receive arteriovenous grafts (AVG) 43,44 and central venous catheters. 25,44,45 According to Yap et al, race was not a predictor for PD. 46 The quality of dialysis centers used by historically marginalized racial and ethnic groups varied by region, 47,48 and it has been found that Black and Hispanic patients were more likely to attend for-profit dialysis facilities.…”

“…66 Women were more likely than men to feel that their dialysis center did not care about them as a person 50 and were less likely to discuss dialysis options with their nephrologist. 54 One study found that men were more likely to have AVF 26 compared to women who had less AVF use, 29,43,67 more central venous catheter use, 25,45 less dialysis access patency, 68 and more fistula maintenance interventions. 69 Men were less likely to start dialysis at home, 39 less likely to withdraw from dialysis, 57 had greater kidney function recovery, 70 and go on palliative care more often.…”

Diversity, Equity, and Inclusion Task Force initiatives within the Society for Vascular Medicine: Current status and future challenges

“…In vascular medicine, persons categorized as Black with peripheral artery disease have a nearly twofold rate of leg amputation, mainly due to underutilization of screening procedures. 13 The decline in deaths Diversity, Equity, and Inclusion Task Force initiatives within the Society for Vascular Medicine: Current status and future challenges Carmel Celestin 1 , Rafael S Cires-Drouet 2 and Olusegun Osinbowale 3 from cardiovascular disease is not seen equitably across racial and ethnic groups despite controlling for socioeconomic status. 14 White patients have higher rates of coronary artery revascularization compared with Black patients.…”