Disparities in Treatment of Peripheral Artery Disease and Critical Limb Ischemia: A National Perspective

Waseem Wahood, a third-year medical student at Dr. Kiran C. Patel College of Allopathic Medicine in Davie, FL, spoke to ISET 2022 attendees about disparities in the treatment of peripheral artery disease (PAD) and critical limb ischemia (CLI). Recent guidelines have emphasized the use of medical management, early diagnosis, and a multidisciplinary team to effectively treat patients with PAD or CLI. Previous studies highlighted that non-White patients with CLI were more likely to receive amputations and revascularization. However, White patients had the lowest mortality rate and the highest proportion of medical management, indicating that they may have earlier management, and earlier disease progression, than their non-White counterparts.

“We wanted to analyze the trend over a 14-year time period to investigate if the disparities gap in treatment is closing,” Wahood said. “To do this, we utilized the National Inpatient Sample (NIS) from 2005 to 2018 for patients with PAD or CLI with procedures, including amputations and revascularizations.” The NIS database has a variable called “Race” that categorizes patients as White, Black, and Hispanic (which is an ethnicity, Wahood pointed out) and “Other Races” (including Asian American, Native American, and Pacific Islander). Wahood and his team used the Corcoran-Armitage test, which shows trends in the utilization of these procedures among the races; a one-way ANOVA test; and a multi-variable regression, which showed patient profiles for those who received any revascularization or major amputation.

“We had 12 million admissions in our database with PAD, and about 7 million with CLI,” said Wahood. “I wanted to show that there's a really low proportion of patients or admissions that involved revascularization. And it's a little bit higher with amputations in both groups.” They looked at all patients who received revascularization for PAD and at the proportion of those who identified as White, Black, Hispanic, and other, and, and for different categories. “For those who identified as White, their proportion decreased by 0.47%, which looks small, but with 12 million admissions, it's much larger than that. For those who identified as Black, it increased over time.” There was no statistically significant trend in proportion of admissions involving any of the races. “For Black vs White, the gap is slowly closing,” Wahood said.

There was also no statistically significant trend in major amputations for CLI. All other races have had higher odds of receiving treatment compared with whites. However, those who identified as Black with PAD had lower odds of receiving revascularization compared with White patients.

“There are major disparities for treatment regarding PAD and CLI for non-White populations,” Wahood concluded. “Non-white patients are more likely to receive amputations and less likely to receive revascularization for PAD compared with white patients. The gap is slowly closing, however, which may demonstrate that the guidelines have been effective in mitigating disparities."