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Cited by 177Peripheral Artery Disease ManagementDiabetic Foot Ulcer Assessment and ManagementVascular Procedures and Complications

Racial disparities in the use of revascularization before leg amputation in Medicare patients

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Holman, Kerianne H., Henke, Peter K., Dimick, Justin B., Birkmeyer, John D.·2011·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2011.02.035PMC PMC3152619
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Abstract

Objective Black patients with peripheral arterial disease undergo amputation at two to four times the rate of white patients. In order to determine whether differences in attempts at limb salvage might contribute to this disparity, we studied the limb care received prior to amputation by black patients compared with whites.Methods Using inpatient Medicare data for the years 2003 through 2006, we identified a retrospective sample of all beneficiaries who underwent major lower extremity amputation. "Limb salvage care" was defined as limb-related admissions and procedures that occurred during the 2 years prior to amputation. We used multiple logistic regression to compare rates of revascularization and other limb care received by black versus white amputees, adjusting for individual patient characteristics. We then controlled for hospital referral region in order to assess whether differences in care might be attributable to the geographic regions in which black and white patients received care. Finally, we examined the timing of revascularization relative to amputation for both races.Results Our sample included 24,600 black and 65,881 white amputees. Compared with whites, black amputees were more likely to be female and had lower socioeconomic status. Average age, rates of diabetes, and levels of comorbidity were similar between races. Black amputees were significantly less likely than whites to have undergone revascularization (23.6% vs 31.6%; P < .0001), any limb-related admission (39.6% vs 44.7%; P < .0001), toe amputation (12.9% vs 13.8%; P < .0005), or wound debridement (11.6% vs 14.2%; P < .0001) prior to amputation. After adjusting for differences in individual patient characteristics, black amputees remained significantly less likely than whites to undergo revascularization (odds ratios [OR], 0.72 [95% confidence interval, .68-.76]), limb-related admission (OR, 0.81 [0.78-0.84]), or wound debridement prior to amputation (OR, 0.80 [0.75-0.85]). Timing of revascularization relative to amputation was similar between races. Observed differences in care were shown to exist within hospital referral regions and were not accounted for by regional differences in where black and white patients received care.Conclusion Black patients are much less likely than whites to undergo attempts at limb salvage prior to amputation. Further studies should explore whether this disparity might be attributable to race-related differences in severity of arterial disease, patient preferences, or physician decision making.

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  • Racial and ethnic disparities in revascularization for patients with PAD have been well documented since the 1990s.

    “Racial and ethnic disparities in revascularization for patients with PAD have been well documented since the 1990s.87,106”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [106]

    The Results and Discussion report that black Medicare patients were less likely than white patients to receive revascularization before amputation. The paper does not establish that these disparities have been documented since the 1990s, and its own comparison does not address ethnic groups beyond black and white patients. Page numbers are unavailable in our copy. (LLM, conf=0.85)

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  • Native Americans with PAD were twice as likely to undergo amputation than non-Hispanic White patients.

    “One study that analyzed inpatient discharge data discovered that Native Americans with PAD were also twice as likely to undergo amputation than NHW.106”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [106]

    The Introduction describes a two- to fourfold amputation-rate difference for Black versus White patients, and the Results examine Black and White Medicare amputees. A search for Native American or American Indian patients found no passage addressing their amputation risk relative to non-Hispanic White patients. (LLM, conf=0.77)

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Authors
Holman, K. H., Henke, P. K., Dimick, J. B., & Birkmeyer, J. D.
Affiliations
University of Michigan (US)
Corresponding author
Henke, Peter K.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2011-08
Volume
54
Issue
2
Pages
420-426.e1
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2011.02.035
PMC
PMC3152619
OpenAlex
W1965476814
Cited by
177
References
27
Citations by year
2026: 7 · 2025: 20 · 2024: 13 · 2023: 33 · 2022: 14 · 2021: 17 · 2020: 8 · 2019: 11 · 2018: 10 · 2017: 5 · 2016: 9 · 2015: 6 · 2014: 12 · 2013: 8 · 2012: 3
FWCI
7.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Robert Wood Johnson Foundation
  • National Institute on Aging (P01AG019783-07S1)
  • National Cancer Institute (CA115571-01 A2)
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
racial disparities, lower limb amputation, revascularization, peripheral arterial disease, limb salvage, wound debridement, toe amputation, Medicare beneficiaries, black-white disparities, hospital referral regions, timing of revascularization, socioeconomic status, diabetes mellitus, comorbidities, regional variation in care, health care access, quality of care, health equity
MeSH terms
Aged, Aged, 80 and over, Amputation, Surgical, Black or African American, Debridement, Female, Medicare, Humans, Male, Residence Characteristics, Retrospective Studies, Risk Factors, Time Factors, United States, Vascular Surgical Procedures, Logistic Models, Odds Ratio, Treatment Outcome, Risk Assessment, Limb Salvage, Lower Extremity, White People, Healthcare Disparities, Endovascular Procedures, Peripheral Arterial Disease

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