Racial and Ethnic Disparities in Peripheral Artery Disease

May combine two claims.

Black Americans were underrepresented in the canagliflozin trial, comprising only 3.3% of all participants, and the trend towards greater amputations was not found in subsequent analyses.

“It is important to note that Black Americans were underrepresented in this trial comprising only 3.3% of all participants and that this trend towards greater amputations was not found in subsequent analyses.”

• cites [94] 94. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117- 2128. doi:10.1056/nejmoa1504720 sourceDisputed

  Study Procedures (p. 3) identifies this as a trial of empagliflozin versus placebo, not a canagliflozin trial. Safety and Adverse Events (p. 7) does not report an amputation trend or subsequent analyses, and a search for 3.3% found no matching passage. (LLM, conf=0.85)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The prevalence of PAD in individuals age ≥40 years is 4.3% but increases to 14.5% in those ≥70 years.

“For example, the prevalence of PAD in individuals age ≥40 years is 4.3% but increases to 14.5% in those ≥70 years.7”

• cites [7] 7. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116:1509-1526. doi: 10.1161/CIRCRESAHA.116.303849 sourcePartly supported

  The Incidence and Prevalence of PAD section says PAD prevalence rises sharply with age, supporting the direction of the comparison. It does not report 4.3% for people aged ≥40 or 14.5% for those aged ≥70; searches for both percentages did not substantiate those figures. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The overall prevalence of PAD among individuals aged ≥40 years in the United States is between 4 and 10%.

“The overall prevalence of PAD among individuals aged ≥40 years in the United States is somewhere between 4 and 10%.[4][5][6]”

• cites [4] 4. Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328-333. doi: 10.1016/j. amepre.2006.12.010 sourceNot checked — no full text of the source
• cites [5] 5. Criqui MH, Vargas V, Denenberg JO, Ho E, Allison M, Langer RD, Gamst A, Bundens WP, Fronek A. Ethnicity and peripheral arterial disease: the San Diego Population Study. Circulation. 2005;112:2703-2707. doi: 10.1161/ CIRCULATIONAHA.105.546507 sourceNot checked — no full text of the source
• cites [6] 6. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arte- rial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110:738-743. doi:10.1161/01.CIR.0000137913.26087.F0 sourceSupported

May combine two claims.

Implicit bias may lead physicians to provide dissimilar lower quality treatment to patients of marginalized groups, low-value clinical interactions between physician and minority patients, and stereotype threat where patients avoid medical care out of the fear of being racially stereotyped, all contributing to racial disparities in healthcare.

“Furthermore, implicit bias may lead physicians to provide dissimilar lower quality treatment to patients of marginalized groups, low-value clinical interactions between physician and minority patients, and stereotype threat where patients avoid medical care out of the fear of being racially stereotyped, all contributing to racial disparities in healthcare.41,47”

• cites [41] 41. Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, Davey-Smith G, Dennison-Himmelfarb CR, Lauer MS, Lockwood DW, et al; American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardio- vascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132:873-898. doi: 10.1161/CIR. 0000000000000228 sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [47] 47. Balsa AI, McGuire TG. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ. 2003;22:89-116. doi: 10.1016/s0167-6296(02)00098-x sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Black Americans have significantly higher rates of end stage renal disease (ESRD).

“Black Americans also have significantly higher rates of end stage renal disease (ESRD).35”

• cites [35] 35. Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP. Social determinants of racial disparities in CKD. J Am Soc Nephrol. 2016;27:2576-2595. doi: 10.1681/ASN.2016010027 sourceSupported

May combine two claims.

Awareness about PAD is low in the general population but especially among Black Americans.

“In addition, awareness about PAD is low in the general population but especially among Black Americans.”

• cites [45] 45. Hirsch AT, Murphy TP, Lovell MB, Twillman G, Treat-Jacobson D, Harwood EM, Mohler ER 3 rd , Creager MA, Hobson RW 2 nd , Robertson RM, et al; Peripheral Arterial Disease Coalition. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey. Circulation. 2007;116:2086-2094. doi: 10.1161/CIRCULATIONAHA.107.725101 sourcePartly supported

  The Knowledge of Risk Factors section reports low PAD awareness—about 25%—and the Ethnicity, Socioeconomic Status, Gender, and Health Disparities section reports lower awareness among nonwhite respondents. The paper does not establish the claim specifically for Black Americans rather than nonwhite respondents as a group. Its survey also covered adults aged 50 or older, not the general population of all ages. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Hispanic Americans may have a lower prevalence of PAD than non-Hispanic White Americans and substantially less than Black Americans.

“Interestingly, Hispanic Americans may have a lower prevalence than non-Hispanic White Americans and substantially less than Black Americans.”

• cites [22] 22. Forbang NI, Hughes-Austin JM, Allison MA, Criqui MH. Peripheral artery disease and non-coronary atherosclerosis in Hispanics: another paradox? Prog Cardiovasc Dis. 2014;57:237-243. doi: 10.1016/j.pcad.2014.07.008 sourceSupported

May combine two claims.

Black Americans and Hispanic Americans are less likely than NHW to be initiated on statin therapy or achieve LDL goals.

“However, Black Americans and Hispanic Americans are less likely than NHW to be initiated on statin therapy or achieve LDL (low-density lipoprotein) goals.37,38”

• cites [37] 37. Hua S, Isasi CR, Kizer JR, Matsushita K, Allison MA, Tarraf W, Qi Q, Ponce SG, Daviglus M, Kaplan RC. Underuse of cardiovascular medications in individu- als with known lower extremity peripheral artery disease: HCHS/SOL. J Am Heart Assoc. 2020;9:e015451. doi: 10.1161/JAHA.119.015451 sourcePartly supported

  The Discussion (page unavailable) reports low statin use among Hispanic/Latino adults with known peripheral artery disease, supporting the claim's general point about underuse in that group. The paper does not establish that Black or Hispanic Americans are less likely than non-Hispanic White Americans to start statins or achieve LDL goals; it studies medication use in a Hispanic/Latino sample, not those comparisons or outcomes. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [38] 38. Nanna MG, Navar AM, Zakroysky P, Xiang Q, Goldberg AC, Robinson J, Roger VL, Virani SS, Wilson PWF, Elassal J, et al. Association of patient perceptions of cardiovascular risk and beliefs on statin drugs with racial differences in statin use: insights from the patient and provider assess- ment of lipid management registry. JAMA Cardiol. 2018;3:739-748. doi: 10.1001/jamacardio.2018.1511 sourcePartly supported

  The Results section (page unavailable) reports lower statin use and higher LDL-C levels among African American than Caucasian patients. The Methods section (page unavailable) says some Caucasian participants identified as Hispanic, so the comparator was not specifically non-Hispanic White patients. The paper does not report a separate Hispanic comparison, statin initiation rates, or LDL-goal achievement. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

May combine two claims.

Hispanic Americans also have higher prevalence of these risk factors compared with NHW but do not have higher rates of PAD.

“Hispanic Americans also have higher prevalence of these risk factors compared with NHW but do not have higher rates of PAD.22”

• cites [22] 22. Forbang NI, Hughes-Austin JM, Allison MA, Criqui MH. Peripheral artery disease and non-coronary atherosclerosis in Hispanics: another paradox? Prog Cardiovasc Dis. 2014;57:237-243. doi: 10.1016/j.pcad.2014.07.008 sourceSupported

May combine two claims.

Disparities among housing, income, education level, and access to quality health care disadvantage underserved populations, and these populations are much more likely to be Black or Hispanic.

“Disparities among housing, income, education level, and access to quality health care disadvantage underserved populations, and these populations are much more likely to be Black or Hispanic.41”

• cites [41] 41. Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, Davey-Smith G, Dennison-Himmelfarb CR, Lauer MS, Lockwood DW, et al; American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardio- vascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132:873-898. doi: 10.1161/CIR. 0000000000000228 sourcePartly supported

  The sections on socioeconomic disadvantage and race/ethnicity link income and education to cardiovascular risk and describe racial differences in healthcare experiences. The allostatic-load section also notes lower average educational and occupational attainment among Black adults. But the cited passages do not establish that underserved populations facing the listed housing, income, education, and healthcare disparities are much more likely to be Black or Hispanic; the paper describes the picture for Latinos as more complex. Page numbers were not available in our copy. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Black Americans are more likely to smoke cigarettes and less likely to quit cigarette smoking compared with NHW, with high rates of menthol cigarette use.

“Black Americans are also more likely to smoke cigarettes and less likely to quit cigarette smoking compared with NHW with high rates of menthol cigarette use supporting current plans to regulate menthol tobacco products.32,33”

• cites [32] 32. Caraballo RS, Kruger J, Asman K, Pederson L, Widome R, Kiefe CI, Hitsman B, Jacobs DR Jr. Relapse among cigarette smokers: the CARDIA longitudi- nal study -1985-2011. Addict Behav. 2014;39:101-106. sourcePartly supported

  The Results (§3.3) show that, among CARDIA participants who had ever smoked, Black participants were more likely than White participants to smoke at each follow-up and less likely to remain abstinent after quitting. The Discussion (§4) mentions a preference for menthol cigarettes among Black smokers, but does not quantify menthol-use rates. The study of ever smokers also does not establish that Black Americans overall are more likely to smoke than non-Hispanic White Americans. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [33] 33. Safford MM, Brown TM, Muntner PM, Durant RW, Glasser S, Halanych JH, Shikany JM, Prineas RJ, Samdarshi T, Bittner VA, et al; REGARDS Investigators. Association of race and sex with risk of incident acute coro- nary heart disease events. JAMA. 2012;308:1768-1774. doi: 10.1001/ jama.2012.14306 sourcePartly supported

  The Results, under Sample Characteristics (page not provided), say smoking was more prevalent among Black than white participants, supporting the smoking comparison. The paper does not report racial differences in quitting or menthol cigarette use; its Methods, under Covariates (page not provided), define current smoking but do not address either point. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The Hispanic paradox is the phenomenon where Hispanic Americans have a lower prevalence of PAD but a higher prevalence of risk factors that lead to PAD, particularly diabetes.

“This phenomenon is coined the Hispanic paradox as they have a lower prevalence of PAD, but a higher prevalence of risk factors that lead to PAD, particularly diabetes.22”

• cites [22] 22. Forbang NI, Hughes-Austin JM, Allison MA, Criqui MH. Peripheral artery disease and non-coronary atherosclerosis in Hispanics: another paradox? Prog Cardiovasc Dis. 2014;57:237-243. doi: 10.1016/j.pcad.2014.07.008 sourceSupported

May combine two claims.

Both low household income and low education level have been associated with the development of PAD in US adults.

“Both low household income and low education level have been associated with the development of PAD in US adults.43”

• cites [43] 43. Pande RL, Creager MA. Socioeconomic inequality and peripheral artery dis- ease prevalence in US adults. Circ Cardiovasc Qual Outcomes. 2014;7:532- 539. doi: 10.1161/CIRCOUTCOMES.113.000618 sourcePartly supported

  The Results and Discussion report higher PAD prevalence among US adults with lower income and lower education. But the Discussion says the data are cross-sectional and that prospective studies of incident PAD are needed, so the paper does not establish an association with PAD development. The education association also ceased to be significant after full adjustment. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In a sample of 2501 adults over the age of 50 years, 15.2% of NHW and 12.1% of Hispanics knew that PAD can lead to amputation, whereas only 6.2% of Black Americans surveyed knew this.

“In a sample of 2501 adults over the age of 50 years, 15.2% of NHW and 12.1% of Hispanics knew that PAD can lead to amputation, whereas only 6.2% of Black Americans surveyed knew this.45”

• cites [45] 45. Hirsch AT, Murphy TP, Lovell MB, Twillman G, Treat-Jacobson D, Harwood EM, Mohler ER 3 rd , Creager MA, Hobson RW 2 nd , Robertson RM, et al; Peripheral Arterial Disease Coalition. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey. Circulation. 2007;116:2086-2094. doi: 10.1161/CIRCULATIONAHA.107.725101 sourcePartly supported

  Table 5 (shown in the Predictors of PAD Awareness section; page unavailable) gives the stated amputation percentages for white, Hispanic, and Black respondents. But its heading specifies that these percentages are among respondents aware of PAD, not all 2501 adults surveyed. The Sample and Survey Design section also defines the sample as adults aged 50 or older, rather than over 50. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In a study of 1018 patients with CAD followed annually, incident symptomatic PAD was significantly associated with increased risk of subsequent cardiovascular events, death, myocardial infarction, and need for coronary revascularization.

“In this large cohort of individuals with CAD, incident symptomatic PAD was significantly associated with increased risk of subsequent cardiovascular events, death, myocardial infarction, and need for coronary revascularization.52”

• cites [52] 52. Grenon SM, Vittinghoff E, Owens CD, Conte MS, Whooley M, Cohen BE. Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: insights from the Heart and Soul Study. Vasc Med (United Kingdom). 2013;18:176-84. doi:10.1177/1358863X13493825 sourceSupported

May combine two claims.

In an administrative dataset study, overall undertreatment with medication therapy of patients with PAD did not appear to vary by race, although all non-White groups were bundled together.

“In an administrative dataset study, there was overall undertreatment with medication therapy of patients with PAD that did not appear to vary by race, 82 although all non-White groups were bundled together making it challenging to fully assess heterogeneity in individual groups.”

• cites [82] 82. Berger JS, Ladapo JA. Underuse of prevention and lifestyle counseling in patients with peripheral artery disease. J Am Coll Cardiol. 2017;69:2293- 2300. doi: 10.1016/j.jacc.2017.02.064 sourcePartly supported

  The Discussion reports underuse of cardiovascular prevention medication in patients with PAD and says race/ethnicity did not affect secondary-prevention use in the multivariable analysis. But the Methods (Other Measures; page unavailable) say patients were characterized as non-Hispanic White, non-Hispanic Black, Hispanic, or other race, so the claim that all non-White groups were bundled together is not supported by the paper’s stated categories. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

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”

• cites [54] 54. Rucker-Whitaker C, Greenland P, Liu K, Chan C, Guralnik JM, Criqui MH, Taylor L, Pearce WH, McGraeMcDermott M. Peripheral arterial dis- ease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning. J Am Geriatr Soc. 2004;52:922-930. doi: 10.1111/j.1532-5415.2004.52259.x sourceNot checked — no full text of the source
• cites [57] 57. McDermott MM, Polonsky TS, Kibbe MR, Tian L, Zhao L, Pearce WH, Gao Y, Guralnik JM. Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education. J Vasc Surg. 2017;66:826-834. doi:10.1016/j.jvs.2017.02.037 sourcePartly supported

  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)

  Experimental — accuracy not yet measured

May combine two claims.

Several observational studies have shown that statins reduce the rate of amputation with relative risk reductions between 18% and 35% that are not seen with the use of nonstatin lipid-lowering therapies.

“Several observational studies have shown that statins reduce the rate of amputation with relative risk reductions between 18% and 35% that are not seen with the use of nonstatin lipid-lowering therapies such as fibrates, bile acid sequestrants, nicotinic acid, and cholesterol absorption inhibitors.67,68”

• cites [67] 67. Hsu CY, Chen YT, Su YW, Chang CC, Huang PH, Lin SJ. Statin therapy reduces future risk of lower-limb amputation in patients with diabetes and peripheral artery disease. J Clin Endocrinol Metab. 2017;102:2373-2381. doi: 10.1210/jc.2016-3717 sourcePartly supported

  The Results report a 25% lower risk of any lower-extremity amputation among statin users, without a significant reduction among nonstatin users. The Discussion reports a 35% reduction in another observational study, but its 18% figure is for a composite of limb outcomes, including revascularization and ischemic amputation—not amputation alone. The cited paper therefore does not establish the full 18%–35% range specifically for amputation. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [68] 68. Sohn MW, Meadows JL, Oh EH, Budiman-Mak E, Lee TA, Stone NJ, Pearce WB. Statin use and lower extremity amputation risk in nonelderly diabetic patients. J Vasc Surg. 2013;58:1578-1585.e1. doi: 10.1016/j.jvs.2013.06.069 sourcePartly supported

  The Discussion reports a 35% lower amputation risk among statin users in this observational cohort of nonelderly patients with diabetes. It does not report an 18% reduction, and its finding for nonstatin therapies is more cautious: their association with lower risk was not statistically significant, but the study was underpowered to assess it. The Discussion also reports fewer minor amputations with fenofibrate in another trial. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Individuals who continue smoking experience increased mortality and higher amputation rates.

“Those individuals who continue smoking experience increased mortality and higher amputation rates.63”

• cites [63] 63. Armstrong EJ, Wu J, Singh GD, Dawson DL, Pevec WC, Amsterdam EA, Laird JR. Smoking cessation is associated with decreased mortal- ity and improved amputation-free survival among patients with symptom- atic peripheral artery disease. J Vasc Surg. 2014;60:1565-1571. doi: 10.1016/j.jvs.2014.08.064 sourcePartly supported

  Table IV (CONCLUSIONS; page unavailable) reports higher five-year mortality among patients with peripheral artery disease who continued smoking (31% versus 14% among quitters) and a higher observed major-amputation rate (22% versus 7%). The DISCUSSION cautions that a larger study would likely be needed to detect a significant difference in major amputations. The claim omits both that uncertainty and the study’s patient population. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Although overall mortality from coronary artery disease has decreased over time, the mortality gap between Black and White Americans has persisted over the last 6 decades.

“Although overall mortality from coronary artery disease has decreased over time, the mortality gap between Black and White Americans has persisted over the last 6 decades.51”

• cites [51] 51. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA Jr, Willis M, et al; American Heart Association Council on Epidemiology and Prevention; Council on Cardio- vascular Disease in the Young; Council on Cardiovascular and Stroke Nurs- ing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; and Stroke Council. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Cir- culation. 2017;136:e393-e423. doi: 10.1161/CIR.0000000000000534 sourcePartly supported

  The Coronary Heart Disease section says CHD rates have declined in recent decades and reports higher rates of fatal CHD among African Americans than whites. It does not establish that the coronary mortality gap persisted for six decades; the 60-year trend in the Cerebrovascular Disease/Stroke section concerns stroke mortality, not coronary disease. Page numbers were not available in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

In EUCLID, only 4% (569/13,885) of participants were Black Americans, and race and ethnicity were not reported in the main findings article.

“From data reported on clinicaltrials.gov,only 4% (569/13 885) study participants were Black Americans, and race and ethnicity were not reported in the article reporting the main findings”

• cites [81] 81. Berger JS, Katona BG, Jones WS, Patel MR, Norgren L, Baumgartner I, Blomster J, Mahaffey KW, Held P, Millegård M, et al. Design and ratio- nale for the effects of ticagrelor and clopidogrel in patients with periph- eral artery disease (EUCLID) trial. Am Heart J. 2016;175:86-93. doi: 10.1016/j.ahj.2016.01.018 sourcePartly supported

  The Study design and population section (page unavailable) confirms that EUCLID had 13,885 randomized participants. The copy does not give a count or percentage of Black American participants, and this design-and-rationale paper does not establish what the later main-findings article reported about race and ethnicity. Searches for the racial count and main-findings reporting found no supporting passage. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

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]”

• cites [114] 114. Creager MA, Matsushita K, Arya S, Beckman JA, Duval S, Goodney PP, Gutierrez JAT, Kaufman JA, Joynt Maddox KE, Pollak AW, et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030: time to get to our feet: A Policy Statement From the American Heart Association. Circulation. 2021;143:875-891. doi:10.1161/cir.0000000000000967 sourceNot checked — no full text of the source
• cites [115] sourceNot checked — no full text of the source
• cites [116] sourcePartly supported

  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)

  Experimental — accuracy not yet measured

May combine two claims.

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”

• cites [57] 57. McDermott MM, Polonsky TS, Kibbe MR, Tian L, Zhao L, Pearce WH, Gao Y, Guralnik JM. Racial differences in functional decline in peripheral artery disease and associations with socioeconomic status and education. J Vasc Surg. 2017;66:826-834. doi:10.1016/j.jvs.2017.02.037 sourceSupported

May combine two claims.

Patients living in the Southern United States undergo higher rates of amputation and inversely lower rates of open or endovascular revascularization for every amputation compared with other states with lower amputation rates.

“Namely, patients living in Southern United States (the bible belt) undergo higher rates of amputation and inversely lower rates of open or endovascular revascularization for every amputation in comparison to other states with lower amputation rates.”

• cites [117] sourcePartly supported

  The Results identify 12 high-amputation, low-vascular-care regions that were generally in the South. They also report fewer open or endovascular revascularizations per amputation in high-amputation regions than in moderate-amputation regions. The claim overgeneralizes these regional findings among Medicare patients to patients throughout the Southern United States and comparisons between states. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

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]”

• cites [107] 107. Selvarajah S, Balck JH 3rd, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass J Surg Res. 2014;190:335- 343. doi:10.1016/j.jss.2014.04.029 110. sourceNot checked — no full text of the source
• cites [108] 108. Hughes K, Seetahal S, Oyetunji T, Rose D, Greene W, Chang D, Cornwell E 3rd, Obisesan T. Racial/ethnic disparities in amputation and revascu- larization: a nationwide inpatient sample study. Vasc Endovascular Surg. 2014;48:34-37. doi:10.1177/1538574413510618 111. sourceNot checked — no full text of the source
• cites [110] 110. Guadagnoli E, Ayanian JZ, Gibbons G, McNeil BJ, LoGerfo FW. The influ- ence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities. Arch Surg. 1995;130:381-386. doi: 10.1001/archsurg.1995.01430040043006 113. sourceNot checked — no full text of the source
• cites [111] 111. Newhall K, Spangler E, Dzebisashvili N, Goodman DC, Goodney P. Amputation rates for patients with diabetes and peripheral arterial disease: the effects of race and region. Ann Vasc Surg. 2016;30:292-8.e1. doi: 10.1016/j.avsg.2015.07.040 114. sourcePartly supported

  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)

  Experimental — accuracy not yet measured
• cites [112] 112. Selvarajah S, Black JH 3 rd , Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass. J Surg Res. 2014;190:335- 343. doi: 10.1016/j.jss.2014.04.029 115. sourceNot checked — no full text of the source
• cites [113] 113. Nejim B, Beaulieu RJ, Alshaikh H, Hamouda M, Canner J, Malas MB. A unique all-payer rate-setting system controls the cost but not the racial disparity in lower extremity revascularization procedures. Ann Vasc Surg. 2018;52:116-125. doi: 10.1016/j.avsg.2018.03.013 116. Loja MN, Brunson A, Li CS, Carson JG, White RH, Romano PS, Hedayati N. Racial disparities in outcomes of endovascular procedures for periph- eral arterial disease: an evaluation of California Hospitals, 2005-2009. Ann Vasc Surg. 2015;29:950-959. doi: 10.1016/j.avsg.2015.01.006 117. Goodney PP, Holman K, Henke PK, Travis LL, sourceNot checked — no full text of the source

May combine two claims.

Amputation rates were disproportionately higher among Black Americans in regions with higher amputation rates, but no significant racial differences were found in regions where amputations were lower.

“Furthermore, Goodney et al 117 found that amputation rates were disproportionately higher among Black Americans in regions with higher amputation rates but found no significant racial differences in regions where amputations were lower.”

• cites [117] sourcePartly supported

  The Results (Patient characteristics, by population-based amputation rate; page not provided) show that African-American patients made up a larger share of amputees in the highest-rate regions than in the lowest-rate regions (50% versus 13%). The Results (Regions with high amputation rates and low intensity of vascular care; page not provided) report no significant racial difference in amputation *without prior revascularization* in regions with high vascular-care intensity—not no racial difference in overall amputation rates in low-amputation regions. The claim conflates those measures and regional categories. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Black Americans are less likely to be diagnosed and promptly treated for peripheral artery disease.

“Black Americans are disproportionately affected by this disease while they are also less likely to be diagnosed and promptly treated.”

• Also stated in: § Abstract · hedged

  “Although PAD is often underdiagnosed and undertreated in the general population, this may be especially true for Black Americans resulting in an even greater disparity than reported.2,9”

• cites [2] 2. Shu J, Santulli G. Update on peripheral artery disease: epidemiology and evidence-based facts. Atherosclerosis. 2018;275:379-381. doi: 10.1016/j. atherosclerosis.2018.05.033 sourceNot checked — no full text of the source
• cites [9] 9. Hughes K, Boyd C, Oyetunji T, Tran D, Chang D, Rose D, Siram S, Cornwell E 3rd, Obisesan T. Racial/ethnic disparities in revasculariza- tion for limb salvage: an analysis of the national surgical quality improve- ment program database. Vasc Endovascular Surg. 2014;48:402-405. doi: 10.1177/1538574414543276 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease.

“The consequences of this disparity can be grim as Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease.”

May combine two claims.

In all individuals, PAD is relatively uncommon under age 40, but significantly increases with age.

“In all individuals, PAD is relatively uncommon in those under the age of 40 years, but significantly increases with age.”

• cites [4] 4. Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328-333. doi: 10.1016/j. amepre.2006.12.010 sourceNot checked — no full text of the source

May combine two claims.

Parallel trends were seen in women, with the only difference being that Hispanic women had rates nearly as high as Black women.

“Parallel trends were seen in women, with the only difference being that Hispanic women had rates nearly as high as Black women (Figure 2).”

• cites [4] 4. Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328-333. doi: 10.1016/j. amepre.2006.12.010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

The biologic mechanisms are less well understood but are likely related to underlying social determinants of health and structural racism.

“The biologic mechanisms are less well understood but are likely related to underlying social determinants of health and structural racism.”

May combine two claims.

Rates for Black Americans were twice as high as NHW and other ethnic groups after the fifth decade of life and nearly 3× as high after the eighth decade of life.

“Rates for Black Americans were twice as high as NHW and other ethnic groups after the fifth decade of life and nearly 3× as high after the eighth decade of life (Figure 1). 4”

• cites [4] 4. Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328-333. doi: 10.1016/j. amepre.2006.12.010 sourceNot checked — no full text of the source

May combine two claims.

In MESA, using an ABI ≤1.0 as a threshold, Puerto Ricans had the highest prevalence of PAD (13%), followed by Mexicans (10.7%), Dominicans (9.4), and other Hispanic Americans (6.0%).

“In Multi-Ethnic Study of Atherosclerosis (MESA), using an ABI (ankle-brachial index) ≤1.0 as a threshold, PAD prevalence was determined in specific nationalities of the Hispanic population and found that Puerto Ricans had the highest prevalence of PAD (13%), followed by Mexicans (10.7%),Dominicans (9.4), and other Hispanic Americans (6.0%).8”

• cites [8] 8. Allison MA, Criqui MH, McClelland RL, Scott JM, McDermott MM, Liu K, Folsom AR, Bertoni AG, Sharrett AR, Homma S, et al. The effect of novel cardiovascular risk factors on the ethnic-specific odds for peripheral arte- rial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol. 2006;48:1190-1197. doi: 10.1016/j.jacc.2006.05.049 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Black Americans have the highest rates of hypertension worldwide.

“Black Americans have the highest rates of hypertension worldwide.26”

• cites [26] 26. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, et al; American Heart Association Statis- tics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics-2014 update: a report from the Ameri- can Heart Association. Circulation. 2014;129:399-410. doi: 10.1161/01. cir.0000442015.53336.12Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Black Americans and Hispanics have the highest incidence of diabetes in the United States, with rates twice as high in Black Americans and 1.3× higher in Hispanics compared with NHW, over their respective lifetimes.

“Black Americans and Hispanics have the highest incidence of diabetes in the United States, with rates twice as high in Black Americans and 1.3× higher in Hispanics compared with NHW, over their respective lifetimes.34”

• cites [34] 34. Rosero EB, Kane K, Clagett GP, Timaran CH. A systematic review of the limitations and approaches to improve detection and management of peripheral arterial disease in Hispanics. J Vasc Surg. 2010;51:27S-35S. doi: 10.1016/j.jvs.2009.08.085 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Although this phenomenon has not specifically been studied in individuals with PAD, it is likely that the same biologic mechanism applies to atherosclerotic disease in other vascular beds.

“Although this phenomenon has not specifically been studied in individuals with PAD, it is likely that the same biologic mechanism applies to atherosclerotic disease in other vascular beds.”

May combine two claims.

Even after controlling for atherosclerotic risk factors, Native Americans still had higher rates of PAD compared with NHW, but not higher than other minority ethnic groups.

“Even after controlling for atherosclerotic risk factors, Native Americans still had higher rates of PAD compared with NHW, but not higher than other minority ethnic groups.”

• cites [23] 23. Baxter AR, Jacobowitz GR, Guo Y, Maldonado T, Adelman MA, Berger JS, Rockman CB. Increased prevalence of moderate and severe peripheral arterial disease in the American Indian (AI)/Alaskan Native (AN) population; a study of 96,000 AI/AN. Ann Vasc Surg. 2017;38:177-183. sourceNot checked — no full text of the source

May combine two claims.

Although the rates of hypertension treatment are lowest among Black Americans, the rates of hypertension prevalence are highest in Black Americans.

“Although the rates of hypertension treatment are lowest among Black Americans, the rates of hypertension prevalence are highest in Black Americans.27”

• cites [27] 27. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hyper- tension. 2004;44:398-404. doi:10.1161/01.HYP.0000142248.54761.56 sourceNot checked — no full text of the source

May combine two claims.

Black Americans are not only more likely to have PAD than other racial and ethnic groups but also tend to present with more severe disease, have more atypical symptoms, and are more likely to suffer worse outcomes.

“Black Americans are not only more likely to have PAD than other racial and ethnic groups but also tend to present with more severe disease, have more atypical symptoms, and are more likely to suffer worse outcomes.24”

• cites [24] 24. Collins TC, Johnson M, Henderson W, Khuri SF, Daley J. Lower extremity nontraumatic amputation among veterans with peripheral arterial disease: is race an independent factor? Med Care. 2002;40(suppl 1):I106-I116. doi:10.1097/00005650-200201001-00012 sourceNot checked — no full text of the source

May combine two claims.

The lower wealth and higher rate of incarceration of Black Americans also impact access to health care and leads to overall worse outcomes.

“The lower wealth and higher rate of incarceration of Black Americans also impact access to health care and leads to overall worse outcomes.40”

• cites [40] 40. Churchwell K, Elkind MSV, Benjamin RM, Carson AP, Chang EK, Lawrence W, Mills A, Odom TM, Rodriguez CJ, Rodriguez F, et al; American Heart Associa- tion. Call to action: structural racism as a fundamental driver of health dispari- ties: a presidential advisory from the American Heart Association. Circulation. 2020;142:e454-e468. doi: 10.1161/CIR.0000000000000936 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Exposure to pollutants as well as lack of safe spaces to exercise can directly result in lower health, with the latter being especially important for PAD.

“Exposure to pollutants as well as lack of safe spaces to exercise can directly result in lower health, with the latter being especially important for PAD.”

• AssumptionRests on an assumption: As a result of historical segregation, Black communities have higher exposure to air pollution, lower access to green space, and less opportunity to build wealth through home equity.

Probably not a substantial claim: may not pass S4 (based).

There is no reason to postulate any differential effects of PCSK9 inhibitors by race or ethnicity.

“Though there is no reason to postulate any differential effects of PCKS9 inhibitors by race or ethnicity, the lack of diversity in the clinical trial samples is a concern for equitable access to novel therapies and emphasizes the importance of specifically creating new approaches to enhance diversity in clinical trials throughout the drug development process.”

May combine two claims.

In the REACH registry US sample, aspirin was used in 62% of Black Americans, 68% of Hispanic Americans, and 72% of non-Hispanic White Americans.

“In the REACH registry sample in the United States, aspirin was used in 62% of Black Americans compared with 68% of Hispanic Americans and 72% of NHW Americans.”

• cites REACH registryNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Presence of PAD alone even without symptoms imposes a substantial increased morbidity and mortality from myocardial infarction and ischemic stroke, especially in Black Americans who already experience greater mortality from these diseases.

“Given the significant increase in coronary and cerebrovascular events that PAD confers, presence of PAD alone even without symptoms imposes a substantial increased morbidity and mortality from myocardial infarction and ischemic stroke, especially in Black Americans who already experience greater mortality from these diseases.”

May combine two claims.

Cigarette smoking is one of the most important risk factors for PAD, with 80% of patients with PAD being current or former smokers.

“Cigarette smoking is one of the most important risk factors for PAD, with 80% of patients with PAD being current or former smokers.58”

• cites [58] 58. Smith GD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study. Circulation. 1990;82:1925- 1931. doi: 10.1161/01.cir.82.6.1925 sourceNot checked — no full text of the source

May combine two claims.

In the ODYSSEY trial of alirocumab, there was reduction in cardiovascular events in patients with polyvascular disease but no information was provided regarding patient race or ethnicity.

“In the ODYSSEY (Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab trial) trial of alirocumab, there was reduction in cardiovascular events in patients with polyvascular disease but no information was provided regarding patient race or ethnicity.”

May combine two claims.

In a study by Rucker-Whitaker et al, Black Americans had a higher prevalence of asymptomatic disease than NHW that attenuated with adjustment for diabetes, suggesting that diabetes was a contributing factor to this difference.

“In a study by Rucker-Whitaker et al, 54 Black Americans had a higher prevalence of asymptomatic disease than NHW that attenuated with adjustment for diabetes, suggesting that diabetes was a contributing factor to this difference.”

• cites [54] 54. Rucker-Whitaker C, Greenland P, Liu K, Chan C, Guralnik JM, Criqui MH, Taylor L, Pearce WH, McGraeMcDermott M. Peripheral arterial dis- ease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning. J Am Geriatr Soc. 2004;52:922-930. doi: 10.1111/j.1532-5415.2004.52259.x sourceNot checked — no full text of the source

May combine two claims.

In the REACH registry subset of patients with PAD, 41% of Black Americans and 31% of Hispanic Americans had elevated cholesterol compared with 25% of White Americans along with correspondingly lower rates of statin use.

“In the REACH (Reduction of Atherothrombosis for Continued Health) registry subset of patients with PAD, 41% of Black Americans and 31% of Hispanic Americans had elevated cholesterol compared with 25% of White Americans along with correspondingly lower rates of statin use.73”

• cites [73] 73. Meadows TA, Bhatt DL, Hirsch AT, Creager MA, Califf RM, Ohman EM, Cannon CP, Eagle KA, Alberts MJ, Goto S, et al; REACH Regis- try Investigators. Ethnic differences in the prevalence and treatment of cardiovascular risk factors in US outpatients with peripheral arterial disease: insights from the reduction of atherothrombosis for contin- ued health (REACH) registry. Am Heart J. 2009;158:1038-1045. doi: 10.1016/j.ahj.2009.09.014 sourceNot checked — no full text of the source

May combine two claims.

Use of antiplatelet therapy was higher in non-Hispanic White (39%) than in Black Americans (30.5%), but this did not reach statistical significance.

“Another study that looked at the prevalence of PAD in a racially diverse population, found that the use of antiplatelet therapy was higher in NHW (39%) than in Black Americans (30.5%); however, this did not reach statistical significance.20”

• cites [20] 20. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM. The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med. 2003;163:1469-1474. doi: 10.1001/archinte.163.12.1469 sourceNot checked — no full text of the source

May combine two claims.

Smoking increases the risk of PAD substantially and is a more powerful risk factor for PAD than coronary artery disease and cerebrovascular disease.

“Smoking increases the risk of PAD substantially and is a more powerful risk factor for PAD than coronary artery disease and cerebrovascular disease.59”

• cites [59] 59. Lu JT, Creager MA. The relationship of cigarette smoking to peripheral arte- rial disease. Rev Cardiovasc Med. 2004;5:189-193.Not checked — no full text of the source

May combine two claims.

In the FOURIER trial of evolocumab, patients with PAD had a 3.5 absolute risk reduction for cardiovascular events, and among those with symptomatic PAD, there was a 42% reduction in major adverse limb events.

“In the FOURIER (Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects With Elevated Risk) trial of evolocumab, patients with PAD had a 3.5 absolute risk reduction for cardiovascular events, and among those with symptomatic PAD, there was a 42% reduction in major adverse limb events.74”

• cites [74] 74. Bonaca MP, Nault P, Giugliano RP, Keech AC, Pineda AL, Kanevsky E, Kuder J, Murphy SA, Jukema JW, Lewis BS, et al. Low-density lipopro- tein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER Trial (Fur- ther Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation. 2018;137:338-350. doi: 10.1161/CIRCULATIONAHA.117.032235 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

No racial differences in the use or potential benefits of cilostazol have been reported.

“No racial differences in the use or potential benefits have been reported.”

May combine two claims.

Smoking is linked to poor cardiovascular outcomes and smoking cessation can slow the progression of PAD.

“Smoking is linked to poor cardiovascular outcomes and smoking cessation can slow the progression of PAD.61”

• cites [61] 61. Gornik HL, Creager MA. Medical treatment of peripheral artery disease In: Vascular Medicine: A Companion to Braunwald's Heart Disease: Second ed. Philadelphia, PA: Elsevier; 2013. sourceNot checked — no full text of the source

May combine two claims.

Asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carried a similar high rate of mortality compared with those with symptomatic PAD and significantly higher than those without PAD.

“In another study, asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carried a similar high rate of mortality compared with those with symptomatic PAD and significantly higher than those without PAD.55”

• cites [55] 55. Diehm C, Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, Darius H, Burghaus I, Trampisch HJ; German Epidemiological Trial on Ankle Bra- chial Index Study Group. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120:2053-2061. doi: 10.1161/CIRCULATIONAHA.109.865600 sourceNot checked — no full text of the source

May combine two claims.

In CHARISMA >80% and in CAPRIE >95% of patients were non-Hispanic White, despite higher prevalence of PAD in Black Americans.

“Of the >15 000 patients included in the CHARISMA trial >80% were NHW and in the >19 000 patients in the CAPRIE >95% were NHW, despite the higher prevalence of PAD in Black Americans.”

May combine two claims.

Black Americans are more likely or just as likely to attempt smoking cessation than NHW.

“Interestingly, Black Americans are more likely or just as likely to attempt smoking cessation than NHW.65”

• cites [65] 65. Kulak JA, Cornelius ME, Fong GT, Giovino GA. Differences in quit attempts and cigarette smoking abstinence between whites and African Americans in the United States: literature review and results from the International Tobacco Control US Survey. Nicotine Tob Res. 2016;18(suppl 1):S79-S87. doi:10.1093/ntr/ntv228 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S4 (based).

The major medical trials that serve as the basis for medical societies' recommendations for PAD largely underrepresented racial minorities and especially Black Americans.

“It is important to note, however, that the major medical trials that serve as the basis for medical societies' recommendations for PAD, largely underrepresented racial minorities and especially Black Americans.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There is a wealth of literature demonstrating that statin therapy reduces incident cardiovascular events.

“There is a wealth of literature demonstrating that statin therapy reduces incident cardiovascular events.70,71”

• cites [70] 70. Collins R, Armitage J, Parish S, Sleigh P, Peto R, Heart Protection Study Col- laborative Group. MRC/BHF Heart Protection Study of cholesterol lowering simvastatin in 5963 people with diabetes: a randomized controlled trial. Lan- cet. 2003;361:2005-2016. doi: 10.1016/s0140-6736(03)13636-7 sourceNot checked — no full text of the source
• cites [71] 71. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, et al; Cholesterol Treatment Trial- ists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267-1278. doi: 10.1016/S0140-6736(05)67394-1 sourceNot checked — no full text of the source

May combine two claims.

Black Americans have a higher prevalence of asymptomatic PAD and less awareness about what PAD entails, which collectively puts them at increased risk for a delay in care.

“Black Americans have a higher prevalence of asymptomatic PAD and less awareness about what PAD entails, which collectively puts them at increased risk for a delay in care.”

May combine two claims.

Patients with PAD are routinely undertreated with optimal medical management, with Black Americans disproportionately treated with suboptimal regimens.

“In spite of the well-established clinical benefit and current guideline recommendations, patients with PAD are routinely undertreated with optimal medical management, with Black Americans disproportionately being treated with suboptimal regimens.”

• AssumptionRests on an assumption: Disparities in treatment and outcomes are not fully explained by clinical factors such as disease severity and comorbidities.

The quote only partly states this claim.

Black Americans are less likely to be treated with optimal medical therapy.

“less likely to be treated with optimal medical therapy”

• cites [20] 20. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM. The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med. 2003;163:1469-1474. doi: 10.1001/archinte.163.12.1469 sourceNot checked — no full text of the source
• cites [39] 39. Gober L, Bui A, Ruddy JM. Racial and gender disparity in achieving optimal medical therapy for inpatients with peripheral arterial disease. Ann Vasc Med Res. 2021;7:1115.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [107] 107. Selvarajah S, Balck JH 3rd, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass J Surg Res. 2014;190:335- 343. doi:10.1016/j.jss.2014.04.029 110. sourceNot checked — no full text of the source

May combine two claims.

Disparities in the detection and treatment of PAD exist disproportionately and detrimentally impact Black Americans.

“Furthermore, disparities in the detection and treatment of PAD exist disproportionately and detrimentally impact Black Americans.”

• AssumptionRests on an assumption: Disparities in treatment and outcomes are not fully explained by clinical factors such as disease severity and comorbidities.

May combine two claims.

Black amputees are less likely than non-Hispanic White patients to undergo revascularization procedures, have limb-related admissions, or wound debridement before amputation.

“Similarly, a retrospective study using Medicare inpatient data from 2003 to 2006 showed that Black amputees are less likely than NHW to undergo revascularization procedures, have limbrelated admissions, or wound debridement before amputation.108”

• cites [108] 108. Hughes K, Seetahal S, Oyetunji T, Rose D, Greene W, Chang D, Cornwell E 3rd, Obisesan T. Racial/ethnic disparities in amputation and revascu- larization: a nationwide inpatient sample study. Vasc Endovascular Surg. 2014;48:34-37. doi:10.1177/1538574413510618 111. sourceNot checked — no full text of the source

May combine two claims.

Black Americans are more likely to be diagnosed later and with more disease.

“Black Americans are more likely to be diagnosed later and with more disease”

• cites [20] 20. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM. The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med. 2003;163:1469-1474. doi: 10.1001/archinte.163.12.1469 sourceNot checked — no full text of the source
• cites [39] 39. Gober L, Bui A, Ruddy JM. Racial and gender disparity in achieving optimal medical therapy for inpatients with peripheral arterial disease. Ann Vasc Med Res. 2021;7:1115.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [107] 107. Selvarajah S, Balck JH 3rd, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass J Surg Res. 2014;190:335- 343. doi:10.1016/j.jss.2014.04.029 110. sourceNot checked — no full text of the source

May combine two claims.

Both Black Americans and Hispanic Americans are more likely to present with more severe disease and to subsequently be found less suitable for revascularization.

“Both Black Americans and Hispanic Americans are more likely to present with more severe disease and to subsequently be found less suitable for revascularization.”

The quote only partly states this claim.

Black Americans are ultimately more likely to die from major cardiovascular events.

“and ultimately more likely to die from major cardiovascular events.20,39,107”

• cites [20] 20. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM. The prevalence of peripheral arterial disease in a racially diverse population. Arch Intern Med. 2003;163:1469-1474. doi: 10.1001/archinte.163.12.1469 sourceNot checked — no full text of the source
• cites [39] 39. Gober L, Bui A, Ruddy JM. Racial and gender disparity in achieving optimal medical therapy for inpatients with peripheral arterial disease. Ann Vasc Med Res. 2021;7:1115.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [107] 107. Selvarajah S, Balck JH 3rd, Haider AH, Abularrage CJ. Racial disparity in early graft failure after infrainguinal bypass J Surg Res. 2014;190:335- 343. doi:10.1016/j.jss.2014.04.029 110. sourceNot checked — no full text of the source

May combine two claims.

Black Americans are more likely to have type 2 diabetes, much less likely to be aware of their diagnosis, and when treated are less likely to achieve adequate glycemic control.

“Although type 2 diabetes is a treatable and potentially reversible condition, Black Americans are more likely to have this disease, much less likely to be aware of their diagnosis and, when treated, are less likely to achieve adequate glycemic control.92”

• cites [92] 92. Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examina- tion Study, 1999 to 2004. Circulation. 2011;124:17-23. doi: 10.1161/ CIRCULATIONAHA.110.003954Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Numerous studies have shown that Black patients with PAD are less likely to undergo revascularization and more likely to be amputated.

“Numerous studies have shown that Black patients with PAD are less likely to undergo revascularization and more likely to be amputated.”

May combine two claims.

Rates of hypertension treatment are lowest among Black Americans, whereas rates of hypertension prevalence are highest in Black Americans.

“Furthermore, the rates of hypertension treatment are lowest among Black Americans, whereas the rates of hypertension prevalence are highest in Black Americans, further exacerbating this issue.27”

• cites [27] 27. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hyper- tension. 2004;44:398-404. doi:10.1161/01.HYP.0000142248.54761.56 sourceNot checked — no full text of the source

May combine two claims.

Black Americans had lower scores for objective functional measures (normal and fast 4-m walking velocity and shorter 6-minute walk distance), suggesting they are likely to benefit from exercise therapy.

“Black Americans had lower scores for objective functional measures (normal and fast 4-m walking velocity and shorter 6-minute walk distance) suggesting that they are likely to benefit from exercise therapy.54”

• cites [54] 54. Rucker-Whitaker C, Greenland P, Liu K, Chan C, Guralnik JM, Criqui MH, Taylor L, Pearce WH, McGraeMcDermott M. Peripheral arterial dis- ease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning. J Am Geriatr Soc. 2004;52:922-930. doi: 10.1111/j.1532-5415.2004.52259.x sourceNot checked — no full text of the source