Uninsured South Florida vascular surgery patients are less likely to receive optimal medical management than their insured counterparts

Yeh, D. Dante; Jones, Monique De Four; Schulman, Carl I.; Karmacharya, Jagajan; Velázquez, Omaida C.

doi:10.1016/j.jvs.2010.01.035

Cited by 10 publications

(5 citation statements)

References 38 publications

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“…Prior studies of disparities in PAD have focused on utilization rates of lower extremity revascularization by SES or reported rates of optimal medical therapy by insurance status 5–9 This present study confirms findings similar to other cardiac disease states in that the use of secondary prevention treatments for PAD was lower among those of low SES. This finding highlights an important gap in the quality of care for patients with PAD, especially since the cost of aspirin and generic statins is low and should not pose significant barriers to patient access to these evidence-based therapies.…”

Section: Discussionsupporting

confidence: 84%

“…While there have been numerous studies investigating disparities in the care of cardiac patients, 2–4 disparities research in peripheral arterial disease (PAD) has been limited, 5–9 even though PAD affects over 7 million Americans 10 and disproportionately affects those of lower socioeconomic status (SES). 11,12 Equitable access to inexpensive guideline-recommended secondary preventive therapies has the potential to improve cardiovascular outcomes in this vulnerable population, but whether treatment rates differ across income groups remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Disparities in the Use of Cardioprotective Medications Among Patients With Peripheral Artery Disease

Subherwal

Patel

Tang

et al. 2013

Journal of the American College of Cardiology

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Objective Examine disparities in use of cardioprotective medications in treatment of peripheral artery disease (PAD) by socioeconomic status (SES). Background PAD is associated with increased cardiovascular risk and is more prevalent among those of lower SES. However, the use of guideline-recommended secondary preventive measures for the treatment of PAD across diverse income subgroups and the influence of practice site on potential treatment disparities by SES are unknown. Methods Within the National Cardiovascular Disease Registry (NCDR®) PINNACLE Registry®, 62,690 patients with PAD were categorized into quintiles of SES, as defined by the median income of each patient’s zip code. The association between SES and secondary prevention treatment with antiplatelet and statin medications was evaluated using sequential hierarchical modified Poison models, adjusting first for practice site and then for clinical variables. Results Compared with the highest SES quintile (median income >$60,868), PAD patients in the lowest SES quintile (median income <$34,486) were treated less often with statins (72.5 % vs. 85.8%; RR 0.84 [0.83–0.86]; P<0.001) and antiplatelet therapy (79.0% vs. 84.6 %; RR 0.93 [95% CI: 0.91–0.94]; P<0.001). These differences were markedly attenuated after controlling for practice site variation: statins (adjusted RR: 0.97 [0.95–0.99]; P=0.003) and antiplatelet therapy (adjusted RR 0.98 [0.97–1.00]; P=0.012). Additional adjustment for patients’ clinical characteristics had minimal impact with slight further attenuation: statins (adjusted RR: 1.00 [0.99–1.01]; p=0.772) and antiplatelet therapy (adjusted RR: 1.00 [0.99–1.01]; p=0.878). Conclusion Among PAD patients, the practice site at which patients received care largely explained the observed SES differences in treatment with guidelines-recommended secondary prevention medications. Future efforts to reduce treatment disparities in these vulnerable populations should target systems improvement at practices serving high proportions of patients with low SES.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Socioeconomic Disparities in the Use of Cardioprotective Medications Among Patients With Peripheral Artery Disease

Subherwal

Patel

Tang

et al. 2013

Journal of the American College of Cardiology

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“…Dual eligibility for Medicaid, an indicator of lower SES, is also associated with an increased all-cause mortality rate in patients with PAD after controlling for other factors [ 128 ]. One study of health behaviors in South Florida reported that, when compared with vascular surgery patients with insurance, uninsured patients were less likely to receive optimal medical management for PAD, highlighting room for improvement in the medical management of uninsured patients with PAD [ 129 ]. Interestingly, a retrospective cohort study found that the 2006 Massachusetts Health Care Reform resulted in a substantial diminishment in prior racial and socioeconomic disparities with regard to amputation, revascularization, and severity of disease in patients with PAD [ 130 ], suggesting that expansion of insurance at the state level is a possible solution to combatting the inequities in outcomes of patients with PAD.…”

Section: Resultsmentioning

confidence: 99%

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

Demsas

Joiner

Telma

et al. 2022

Seminars in Vascular Surgery

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“…This finding is consistent with numerous other studies that have demonstrated suboptimal medical management of patients with cardiovascular and peripheral vascular disease. 17–20 This points to a potential area of improvement in the health care system in general – in the optimization of preventive care in this patient group. This will potentially change the natural history of this disease, both with respect to incidence and survival.…”

Section: Discussionmentioning

confidence: 96%

Demographic and echocardiographic predictors of anatomic site and outcomes of surgical interventions for cardiogenic limb emboli

et al. 2016

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We sought to determine if symptomatic cardiogenic limb emboli have a random distribution or if there are demographic or echocardiographic factors that predict site of embolization, limb salvage and mortality. Upper (UE) and lower extremity (LE) emboli were evaluated over a 16-year period (1996-2012). Demographic (age, gender, smoking, medical comorbidities) and echocardiographic data were analyzed to determine predictors of embolic site. All symptomatic patients underwent surgical revascularization. Limb salvage and mortality were compared with Kaplan-Meier analysis. A total of 161 patients with symptomatic cardiogenic emboli were identified: 56 UE and 105 LE. The female-to-male ratio for UE emboli (70%:30%) was significantly higher than for LE emboli (47%:53%, p=0.008). No other demographic factors were statistically different. Upper extremity patients were more likely to have atrial fibrillation (50% vs 29.8%, p=0.028), while LE patients had a higher percentage of aortic or mitral valvular disease or intracardiac thrombus (71.4% vs 52.5%, p=0.038). The 30-day limb salvage was higher for UE compared to LE (100% vs 88%, p=0.008). There was a trend toward higher 30-day mortality in the LE group (14% vs 5%, p=0.11). Survival at 1, 3, and 5 years were similar (UE: 62.2%, 44.2%, 35.3%; LE: 69.1%, 47.5%, 30.3%; p=ns). Upper extremity emboli are more frequent in women and patients with atrial fibrillation. Lower extremity emboli are more frequent in the presence of valvular disease or intracardiac thrombus, and are associated with increased 30-day limb loss and mortality. These findings suggest gender- and cardiac-specific differences in patterns of blood flow leading to preferential sites of peripheral embolization.

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Uninsured South Florida vascular surgery patients are less likely to receive optimal medical management than their insured counterparts

Cited by 10 publications

References 38 publications

Socioeconomic Disparities in the Use of Cardioprotective Medications Among Patients With Peripheral Artery Disease

Socioeconomic Disparities in the Use of Cardioprotective Medications Among Patients With Peripheral Artery Disease

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

Demographic and echocardiographic predictors of anatomic site and outcomes of surgical interventions for cardiogenic limb emboli

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