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Cited by 36Peripheral Artery Disease ManagementHealth disparities and outcomesCardiovascular and exercise physiology

Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education

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McDermott, Mary M., Polonsky, Tamar S., Kibbe, Melina R., Tian, Lu, Zhao, Lihui, Pearce, William H., Gao, Ying, Guralnik, Jack M.·2017·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2017.02.037PMC PMC5621652
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Abstract

Objective: The objective of this study was to determine whether blacks with lower extremity peripheral artery disease (PAD) have faster functional decline than whites with PAD. Methods: Participants with ankle‐brachial index <0.90 were identified from Chicago medical centers and observed longitudinally. Mobility impairment and the 6‐minute walk were assessed at baseline and every 6 to 12 months. Mobility loss was defined as becoming unable to walk up and down a flight of stairs or to walk ¼ mile without assistance. Results: Of 1162 PAD participants, 305 (26%) were black. Median follow‐up was 46.0 months. Among 711 PAD participants who walked 6 minutes continuously at baseline, black participants were more likely to become unable to walk 6 minutes continuously during follow‐up (64/171 [37.4%] vs 156/540 [28.9%]; log‐rank, P = .006). Black race was associated with becoming unable to walk 6 minutes continuously, adjusting for age, sex, ankle‐brachial index, comorbidities, and other confounders (hazard ratio, 1.45; 95% confidence interval, 1.05‐1.99; P = .022). This association was attenuated after adjustment for income and education (P = .229). Among 844 participants without baseline mobility impairment, black participants had a higher rate of mobility loss (64/209 [30.6%] vs 164/635 [25.8%]; log‐rank, P = .009). Black race was associated with increased mobility loss, adjusting for potential confounders (hazard ratio, 1.42; 95% confidence interval, 1.04‐1.94; P = .028). This association was attenuated after additional adjustment for income and education (P = .392) and physical activity (P = .113). There were no racial differences in average annual declines in 6‐minute walk, usual‐paced 4‐meter walking velocity, or fast‐paced 4‐meter walking velocity. Conclusions: Black PAD patients have higher rates of mobility loss and becoming unable to walk for 6 minutes continuously. These differences appear related to racial differences in socioeconomic status and physical activity.

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  • Black Americans with PAD have greater ambulatory dysfunction, faster functional decline, and higher rates of mobility loss when compared with NHW as measured by serial walking tests.

    “Black Americans with PAD also have greater ambulatory dysfunction, faster functional decline, and higher rates of mobility loss when compared with NHW as measured by serial walking tests.54,57”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [57]

    The Results report higher mobility loss among Black participants with PAD, and the Discussion describes lower walking performance at baseline. But the Results explicitly found no difference between Black and white participants in average annual decline on the six-minute or four-meter walking tests, so the claim of faster functional decline is not supported. (LLM, conf=0.94)

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  • Black Americans with PAD have greater degrees of functional decline over time that appears to be related to less access to exercise along with socioeconomic status.

    “In addition, Black Americans with PAD have greater degrees of functional decline over time that appears to be related to less access to exercise along with socioeconomic status.57”

    From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [57]

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Authors
McDermott, M. M., Polonsky, T. S., Kibbe, M. R., Tian, L., Zhao, L., Pearce, W. H., Gao, Y., & Guralnik, J. M.
Affiliations
  • Northwestern University (US)
  • University of Chicago (US)
  • University of North Carolina at Chapel Hill (US)
  • University of Maryland, Baltimore (US)
Corresponding author
McDermott, Mary M.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2017-09
Volume
66
Issue
3
Pages
826-834
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2017.02.037
PMC
PMC5621652
OpenAlex
W2613480717
Semantic Scholar
db0f87d4d24226076efadbb19b8db8b513620413
Cited by
36
References
40
Citations by year
2026: 1 · 2025: 8 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 6 · 2017: 1
FWCI
2.51
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (R01-HL083064, R01-HL64739, R01-HL58099, R01-HL076298, R01-HL71223, R01-HL089619, R01-HL109244)
Topics
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
peripheral arterial disease, racial disparities, functional decline, mobility impairment, 6-minute walk test, lower extremity, socioeconomic status, education, income, physical activity, Black patients, ankle-brachial index
MeSH terms
Walk Test, Aged, Aged, 80 and over, Black or African American, Chicago, Educational Status, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic Factors, Time Factors, Exercise Tolerance, Disease Progression, Lower Extremity, White People, Dependent Ambulation, Mobility Limitation, Health Status Disparities, Ankle Brachial Index, Peripheral Arterial Disease

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