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Cited by 66Peripheral Artery Disease ManagementVascular Procedures and ComplicationsHealth disparities and outcomes

Racial Disparities in Outcomes of Endovascular Procedures for Peripheral Arterial Disease: An Evaluation of California Hospitals, 2005–2009

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Loja, Melissa N., Brunson, Ann, Li, Chin-Shang, Carson, John G., White, Richard H., Romano, Patrick S., Hedayati, Nasim·2015·Annals of Vascular Surgery
DOI 10.1016/j.avsg.2015.01.006PMC PMC4990079
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Abstract

Background Racial/ethnic disparities in treatment outcomes of peripheral arterial disease (PAD) are well documented. Compared to non-Hispanic (NH) whites, blacks and Hispanics are more likely to undergo amputation and less likely to undergo bypass surgery for limb salvage. Endovascular procedures are being increasingly performed as first line of therapy for PAD. In this study, we examined the outcomes of endovascular PAD treatments based on race/ethnicity in a contemporary large population-based study. Methods We used Patient Discharge Data (PDD) from California’s Office of Statewide Health Planning and Development (OSHPD) to identify all patients over the age of 35 who underwent a lower extremity arterial intervention from 2005 to 2009. A look-back period of five years was used to exclude all patients with prior lower extremity arterial revascularization procedures or major amputation. Cox proportional hazards regression was used to compare amputation-free survival and time to death within 365 days. Logistic regression was used for comparison of 1-month myocardial infarction (MI), 1-month major amputation, 1-month all-cause mortality, 12-month major amputation, 12-month reintervention, and 12-month all-cause mortality rates among NH white, black, and Hispanic patients. These analyses were adjusted for age, gender, insurance status, severity of PAD, comorbidities, history of coronary artery angioplasty or bypass surgery, or history of carotid endarterectomy. Results Between 2005 and 2009, a total of 41,507 individuals underwent PAD interventions, 25,635 (61.7%) of whom underwent endovascular procedures. There were 17,433 (68%) NH whites, 4,417 (17.2%) Hispanics, 1,979 (7.7%) blacks, 1,163 (4.5%) Asian/Native Hawaiians, and 643 (2.5%) others in this group. There was a statistically significant difference in the amputation-free survival within 365 days among the NH white, Hispanic and black groups (P < 0.0001); the hazard ratio for amputation within 365 days was 1.69 in Hispanics (95% CI 1.51–1.90; P <0.0001) and 1.68 in blacks (95% CI 1.44–1.96; P <0.001) compared to NH whites following endovascular procedures after adjusting for age, gender, insurance status, comorbidities, severity of PAD, history of coronary artery angioplasty or bypass surgery, or history of carotid endarterectomy. After adjusting for the aforementioned confounders, the first reintervention within 12 months was also significantly associated with race/ethnicity (P=0.002). Odds ratio for reintervention was 1.17 in blacks (95% CI 1.06–1.30, P=0.002) and 1.084 in Hispanics (95% CI 1.00–1.16, P=0.04) compared to NH whites. Conclusions In this contemporary large population-based study, we demonstrated that even among matched cohorts Hispanics and blacks have worse amputation-free survival than NH whites following endovascular therapy. Our study also found that Hispanics and blacks are more likely to undergo lower extremity arterial reinterventions than NH whites. Further research is crucial in understanding if higher reintervention rates in Hispanics and blacks are due to more severe disease and/or poor access to proper follow-up care and optimal medical management.

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  • After treatment, Black Americans are more likely to die in the 30-day perioperative period following endovascular procedures compared with non-Hispanic White patients.

    “After treatment, Black Americans are more likely to die in the 30-day perioperative period following endovascular procedures compared with NHW.116”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [116]

    The Results (Perioperative Outcomes) report lower 30-day mortality for Black patients than for non-Hispanic White patients: 1.1% versus 1.6%, with an adjusted odds ratio of 0.43. The Discussion says Black patients were more likely to die, but that statement conflicts with the paper’s reported results. (LLM, conf=0.88)

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  • Black Americans who undergo surgical or endovascular revascularization have disproportionately higher total hospitalization costs and lower rates of successful limb salvage compared with their non-Hispanic White peers.

    “Black Americans who do undergo surgical or endovascular revascularization have disproportionately higher total hospitalization costs and lower rates of successful limb salvage compared with their NHW peers.[114][115][116]”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [116]

    The Results section (Longitudinal Outcomes: Amputation and Mortality; page not provided) reports higher major-amputation rates for Black patients than for non-Hispanic White patients after endovascular procedures, and worse amputation-free survival after open procedures. The paper does not report the claimed difference in total hospitalization costs; its Methods section (page not provided) lists the outcomes evaluated without including costs. (LLM, conf=0.87)

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Authors
Loja, M. N., Brunson, A., Li, C.-S., Carson, J. G., White, R. H., Romano, P. S., & Hedayati, N.
Affiliations
University of California Davis Medical Center (US)
Corresponding author
Hedayati, Nasim
ORCID
Venue
Annals of Vascular Surgery
Publisher
Elsevier BV
Published
2015-07
Volume
29
Issue
5
Pages
950-959
ISSN
0890-5096 (ISSN-L)
DOI
10.1016/j.avsg.2015.01.006
PMC
PMC4990079
OpenAlex
W2022911635
Semantic Scholar
33be81353484d7183c944904e9721e7aada3ad48
Cited by
66
References
23
Citations by year
2026: 2 · 2025: 2 · 2024: 5 · 2023: 11 · 2022: 6 · 2021: 12 · 2020: 6 · 2019: 5 · 2018: 7 · 2017: 4 · 2016: 6
FWCI
5.71
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Annals of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Center for Healthcare Policy and Research
  • National Center for Advancing Translational Sciences
  • National Institutes of Health (UL1 TR000002)
Topics
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
  • Social Sciences › Health › Health disparities and outcomes
Keywords
peripheral arterial disease, endovascular revascularization, racial disparities, ethnic disparities, amputation, amputation-free survival, all-cause mortality, reintervention, Hispanic patients, Black patients, California hospitals, health care quality disparities, hospital discharge data, United States
MeSH terms
Adult, Aged, Aged, 80 and over, Amputation, Surgical, Black or African American, California, Female, Hispanic or Latino, Humans, Male, Middle Aged, Risk Factors, Time Factors, Chi-Square Distribution, Logistic Models, Proportional Hazards Models, Odds Ratio, Databases, Factual, Treatment Outcome, Disease-Free Survival, Limb Salvage, Lower Extremity, White People, Health Status Disparities, Healthcare Disparities, Endovascular Procedures, Peripheral Arterial Disease

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