Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region
Open accessAbstract
Background It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease (PAD) is improving. We examined national trends in care of patients with both PAD and diabetes.Methods A cohort of patients diagnosed with PAD and diabetes between 2007 and 2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR).Results From 2007 to 2011, 2.3 per 1,000 patients underwent a major amputation with the higher rate among black patients (5.5 per 1,000 vs. 1.9 per 1,000; P < 0.001) compared with nonblack. The rate varied widely by HRR (1.2 per 1,000-6.2 per 1,000), with higher variation in amputation rates in black patients (2.1-16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients, and 75.4% among nonblack patients, with the disparity between the 2 groups increasing over time.Conclusions Prevalence of concurrent PAD and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and HRR. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients.
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Black Americans are less likely to be offered and less likely to undergo revascularization in an effort to salvage the limb and avoid amputation.
“Black Americans are also less likely to be offered and less likely to undergo revascularization in an effort to salvage the limb and avoid amputation.107,108,[110][111][112][113]”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [111]
The Discussion states that black patients are less likely than non-black patients to receive revascularization, supporting the claim about undergoing it. The passages do not establish that they are less likely to be offered revascularization; receiving a procedure and being offered one are distinct. (LLM, conf=0.88)
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References 16 · Cited by 115
Research works printed but not linked: 2
- [14]Jones WS Patel MR Dai D Temporal Trends and Geographic Variation of Lower Extremity Amputation in Patients with Peripheral Artery Disease: Results from U.S. Medicare 2000–2008 Journal of the American College of Cardiology 2012 60 2230 6 23103040 PMC3918457
- [16]Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease Dartmouth Atlas of Health care 2014 36516287
- Authors
- Newhall, K., Spangler, E., Dzebisashvili, N., Goodman, D. C., & Goodney, P.
- Affiliations
- Dartmouth–Hitchcock Medical Center (US)
- Dartmouth College (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Corresponding author
- Newhall, Karina
- Venue
- Annals of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 30
- Pages
- 292-298.e1
- ISSN
- 0890-5096 (ISSN-L)
- PMC
- PMC4851557
- OpenAlex
- W2106229632
- Cited by
- 115
- References
- 16
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 26 · 2023: 20 · 2022: 14 · 2021: 10 · 2020: 10 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 4
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R21HS021581)
- U.S. Public Health Service (NHLBI K08HL05676)
- National Institute on Aging (U01AG046830)
- National Heart, Lung, and Blood Institute (K08HL105676)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Keywords
- peripheral arterial disease, diabetes mellitus, major amputation, amputation-free survival, racial disparities, revascularization, endovascular intervention, Medicare claims data, care coordination
- MeSH terms
- Aged, Aged, 80 and over, Amputation, Surgical, Black or African American, Diabetic Angiopathies, Female, Humans, Male, United States, Cohort Studies, Cluster Analysis, Outcome Assessment, Health Care, Endovascular Procedures, Peripheral Arterial Disease
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