Racial/Ethnic Disparities in Amputation and Revascularization

Abstract

This study investigates whether ethnic minorities presenting with critical limb ischemia (CLI) are more likely to undergo major limb amputation compared to white patients. The Nationwide Inpatient Sample (NIS) database was used to identify all patients admitted with CLI; lower extremity revascularization; and major lower extremity amputation from 1998 to 2005. The NIS identified 240 139 patients presenting with CLI--68.2% white, 19.5% black, 9.0% Hispanic, and 1.24% Asian. In all, 83 328 patients underwent revascularization--73.7% white, 15.9% black, 7.4% Hispanic, and 1.1% Asian. The majority of the interventions were open. In all, 111 548 patients underwent a major lower extremity amputation--61% white, 25.4% black, 10.1% Hispanic, and 1.1% Asian. The mean Charlson comorbidity scores for amputation were 2.1 for whites, 2.0 for blacks, 2.3 for Hispanics, and 2.5 for Asians (for all data, P < .05). Blacks make up a disproportionately higher proportion of patients admitted for CLI and undergoing amputation, with a lower proportion undergoing revascularization.

Illiteracy and diabetic foot complications

“…The presence of fissures, ulcers (having a lifetime risk of about 25%), or refractory infections may result in foot amputation; it has been estimated that a lower limb is lost every 30 s as consequence of diabetes [1]. Known risk factors for amputation include advanced age, increased duration of diabetes, male gender, certain ethnicities, poor glycemic control, and lack of preventive care [9][10][11][12][13].…”

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

“…Interestingly, the disparities persisted after adjustment for age, sex, and social class (considers income and employment). In a similar study, Hughes et al [25] studied a population of 240,139 patients from the Nationwide Inpatient Sample (NIS) database who presented with critical limb ischemia. Black patients made up 20 % of the total patient sample, however represented 25 % of the total lower extremity amputations performed.…”

Racial and Health Insurance Disparities of Inpatient Spine Augmentation for Osteoporotic Vertebral Fractures from 2005 to 2010

“…Overall, these findings suggest that significant health insurance status disparities exist in the use of spine augmentation procedures, findings consistent with the already reported disparities in access to health care by minorities and the uninsured. 5,[10][11][12][13][14][15] These current findings are potentially clinically relevant because prior studies have shown that patients receiving spine augmentation procedures demonstrate improved survival and quality of life compared with patients receiving nonoperative treatment. 16,17 In a study of the 2006 Medicare Provider Analysis and Review File data base, Chen et al 16 demonstrated that patients who underwent vertebroplasty and kyphoplasty had significantly higher 3-year survival rates compared with patients receiving nonoperative management.…”