Closing the Gaps in Racial Disparities in CLI Outcomes and Amputation Rates

Written by Cynthia Laufenberg, MA

Presented by Yolanda Bryce, MD, RVPI

At the opening session on the first day of AMP 2022, “The Amputation Epidemic: Impact on Minority & Underserved Populations,” Dr. Yolanda Bryce of Memorial Sloan Kettering discussed the racial disparities in patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI). Black patients have up to 2.8 times higher risk of PAD.

“Race is consistently the determining risk of both CLI-related major  limb amputation and underutilization of limb salvage techniques,” Dr. Bryce noted. “Large registry-based studies and meta-analyses demonstrate non-White race alone more than doubles the risk of primary amputation in patients with CLI and lowers the rate of utilization of limb salvage techniques by at least 28%.” Lack of use of limb salvage techniques is assumed to be due to poor access to quality health care, and disparities persist even in centers in wealthy zone improvement plan ZIP codes and with relatively high capacity for limb salvage.

Dr. Bryce presented information from “Influence of Race on the Management of Lower Extremity Ischemia: Revascularization vs Amputation,” an original investigation from Durazzo, et al, published in JAMA in 2013 that found black patients had 1.77 times the odds of receiving an amputation compared with white patients.

She also spoke about racial disparities in patients with PAD/CLI and diabetes. “The prevalence of diagnosed diabetes is highest among American Indians/Alaska Natives (14.7%), followed by people of Hispanic origin (12.5%), Blacks (11.7%), Asians (9.2%), and Whites (7.5%),” she noted. Diabetes is associated with a 2-fold to 4-fold increase in the prevalence of PAD and CLI.

Dr. Bryce concluded with recent efforts to improve healthcare to minorities, including the Amputation Reduction and Compassion (ARC) Act, and called for more to be done to close the gaps in racial disparities when it comes to PAD, CLI, and amputation.