Gender And Racial Disparities: The Impact on Diagnosis and Treatment of Peripheral Arterial Disease

Background: Research over disparities in peripheral arterial disease (PAD) have largely been focused on racial and gender differences between White and Black Americans. However, it is unclear whether disparities are present among other minorities, especially within the Hispanic population. The goal of this study is to determine whether racial and gender differences exist between Hispanic and non-Hispanic Americans regarding access and treatment for PAD care.

Methods: We identified patients who were previously diagnosed with PAD and collected nonidentifying information from patient records including demographics, social history, and coexisting comorbidities/risk factors. Additionally, participants were asked to complete a self-reported survey regarding their perceptions on various determinants of care. Nonparametric χ2 tests and Fisher's exact tests were performed to assess the association of PAD risk factors/comorbidities to gender and ethnicity. Two-sample T-tests comparing mean results from each question on the survey were used to investigate statistical differences in responses between the gender and ethnic groups.

Results: Of the 79 patients examined for PAD, a majority had a history of tobacco usage (70.9%), hypertension (91.1%), diabetes (64.6%), alcohol usage (59.5%), hyperlipidemia (68.4%), and coronary artery disease (55.7%). On average, comorbidities among men were more prevalent than women (tobacco usage: 80% men vs 58.8% women; alcohol usage: 71.1% men vs 44.1% women; coronary artery disease: 66.7% men vs 41.2% women). Moreover, non-Hispanic men had higher rates of tobacco and alcohol consumption and coronary artery disease (CAD) compared with Hispanic men. Regarding barriers to care, Hispanic men and women reported that language represented a major barrier to care compared with non-Hispanic men and women. Furthermore, Hispanic women reported transportation barriers as an obstacle to care to a greater degree than non-Hispanic women.

Conclusion: Though the “Hispanic Paradox” suggests that Hispanics have a lower rate of CAD and PAD yet a high burden of cardiovascular risk factors compared with non-Hispanics, the reasons for it are unclear. One possibility is that Hispanics may have a higher rate of undiagnosed PAD due to the present barriers affecting their access to healthcare. This is especially possible given the transportation and language barriers noted in our study. As such, public health and policy strategies are needed to mitigate these barriers that affect Hispanics from receiving treatment and diagnosis for PAD.