Black patients present with more severe vascular disease and a greater burden of risk factors than white patients at time of major vascular intervention
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Background While many studies have demonstrated racial disparities after major vascular surgery, few have identified the reasons for these disparities and those that did often lacked clinical granularity. Therefore, our aim was to evaluate differences in initial vascular intervention between black and white patients. Methods We identified black and white patients' initial carotid, abdominal aortic aneurysm (AAA), and infrainguinal peripheral artery (PAD) interventions in the Vascular Quality Initiative registry from 2009-2014. We excluded non-black or non-white patients as well as those with Hispanic ethnicity, asymptomatic PAD, or a history of prior ipsilateral interventions. We compared baseline characteristics and disease severity at time of intervention on a national and regional level. Results We identified 76,372 patients (9% black), including 35,265 carotid (5% black), 17,346 AAA (5% black), and 23,761 PAD interventions (18% black). For all operations, black patients were younger, more likely female, and had more insulin-dependent diabetes, hypertension, congestive heart failure, renal dysfunction, and dialysis dependence. Black patients were less likely to be on a statin prior to AAA (62 vs. 69%, P < .001) or PAD intervention (61 vs. 67%, P < .001) and also less likely to be discharged on an antiplatelet and statin regimen after these procedures (AAA: 60% vs. 64%, P = .01; PAD: 64% vs. 67%, P < .001). Black patients presented with more severe disease, including higher proportions of symptomatic carotid disease (36 vs. 31%, P < .001), symptomatic/ruptured AAA (27 vs. 16%, P < .001), and chronic limb-threatening ischemia (73 vs. 62%, P < .001). Black patients more often presented with concurrent iliac artery aneurysms at the time of AAA repair (elective open AAA repair: 46% vs. 26%, P < .001; elective EVAR: 38% vs. 23%, P < .001). Conclusions Black patients present with more advanced disease at the time of initial major vascular operation. Efforts to control risk factors, identify and treat arterial disease in a timely fashion, and optimize medical management among black patients may provide opportunity to improve current disparities.
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Black Americans are more likely to initially present with critical limb ischemia compared with NHW.
“It has been shown that Black Americans are more likely to initially present with critical limb ischemia compared with NHW.56”
From Racial and Ethnic Disparities in Peripheral Artery Disease (2021) · cites this paper as [56]
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Racial disparities in surgical management and outcomes of acute limb ischemia in the United States
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Self-citationAsian race is associated with peripheral arterial disease severity and postoperative outcomes
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Real-World Racial Variation in Treatment and Outcomes Among Patients with Peripheral Artery Disease
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Racial and Ethnic Disparities in Treatment of Critical Limb Ischemia: A National Perspective
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The impact of race on outcomes following ruptured abdominal aortic aneurysm repair
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Mortality differences by race over 20 years in individuals with peripheral artery disease
Dicks, A. B., Lakhter, V., Elgendy, I. Y., Schainfeld, R. M., Mohapatra, A., Giri, J. S., Weinberg, M. D., Weinberg, I., & Parmar, G. M. (2023) · Vascular Medicine · doi:10.1177/1358863x231159947 · Cited by 9 · see citing works
Mallela, D. P., Canner, J. K., Zarkowsky, D. S., Haut, E. R., Abularrage, C. J., & Hicks, C. W. (2022) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000016 · Cited by 9 · see citing works
Cannabis Use and Sinonasal Symptoms in US Adults
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Community sociodemographics and rural hospital survival
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Peripheral Artery Disease and African Americans: Review of the Literature
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The Relationship Between Peripheral Arterial Disease Severity and Socioeconomic Status
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Arterial dissection during peripheral vascular interventions
Damara, F. A., Alameddine, D., Slade, M. A., Cardella, J. A., Tonnessen, B. H., Guzman, R. J., & Chaar, C. I. O. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.10.004 · Cited by 4 · see citing works
Exploring Prognostic Implications of Race and Ethnicity in Patients With Peripheral Arterial Disease
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Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study
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The use of telemedicine in peripheral artery disease and limb salvage
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Using Administrative Data to Better Treat Chronic Limb Threatening Ischemia
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Self-citationImpact of socioeconomic disparities on major lower extremity revascularization complications
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Lakkireddy, D., Angiolillo, D. J., Charlton-Ouw, K. M., Jefferson, B. K., Peeran, S. M., Bisharat, M. B., Ortega‐Paz, L., Harxhi, A., Kaul, S., Michaud, E., et al. (2024) · Clinical Cardiology · doi:10.1002/clc.70039 · Cited by 3 · see citing works
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Ali, I., Arslan, B., Beasley, R. E., Bechara, C. F., Berens, P. M., Chandra, V., Chohan, O., Cote, C. L., Dadrass, F., Dhand, S., et al. (2023) · Springer eBooks · doi:10.1007/978-3-031-36480-8_6 · Cited by 1 · see citing works
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Self-citationEvolving Trends and Health Disparities in Peripheral Artery Disease in the United States (1999–2024)
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Non-White Patients Have a Higher Risk of Stroke Following Transcarotid Artery Revascularization
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Race and Outcomes after Endovascular Intervention: Can We Improve Outcomes for All?
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Gender Influence on Abdominal Aortic Aneurysm Surgery in a Caribbean Population
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- Authors
- Soden, P. A., Zettervall, S. L., Deery, S. E., Hughes, K., Stoner, M. C., Goodney, P. P., Vouyouka, A. G., & Schermerhorn, M. L.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Howard University Hospital (US)
- University of Rochester Medicine (US)
- Dartmouth–Hitchcock Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Schermerhorn, Marc L.
- ORCID
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 67
- Issue
- 2
- Pages
- 549-556.e3
- ISSN
- 0741-5214 (ISSN-L)
- PMC
- PMC5794625
- OpenAlex
- W2758716993
- Semantic Scholar
- ea8c6e7ed3456a9b812936937f7b77c08ff274eb
- Cited by
- 112
- References
- 43
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 13 · 2023: 29 · 2022: 22 · 2021: 16 · 2020: 4 · 2019: 7 · 2018: 3
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5t32hl007734-30, HL0-07734)
- National Heart, Lung, and Blood Institute (T-32HL007734, R01HL105453, HL007734)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- racial disparities, vascular surgery, carotid endarterectomy, abdominal aortic aneurysm repair, peripheral arterial disease, infrainguinal revascularization, critical limb ischemia, iliac artery aneurysm, endovascular aneurysm repair, statin use, antiplatelet therapy, disease severity, risk factors, Black patients, Vascular Quality Initiative
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Black or African American, Female, Health Status, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Severity of Illness Index, Sex Factors, United States, Vascular Diseases, Vascular Surgical Procedures, Comorbidity, White People, Health Status Disparities, Healthcare Disparities
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