Black patients in areas with lowest PAD rates disproportionally at higher risk for amputation

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Mark A. Eid

It’s among the most topical areas of discussion in current U.S. cultural life: Black people face disparities in terms of healthcare outcomes. And the recently concluded SVS ONLINE digital conference produced fresh research in the affirmative.

Data presented during Scientific Session 8 on July 2 suggested that Black patients in areas with the lowest rates of peripheral artery disease (PAD) and diabetes are at disproportionally higher risk for amputation. But areas with higher prevalence of the disorder—in addition to diabetes—have the lowest rates of amputation, suggesting that these locations are better equipped to care for these high-risk patients, say investigators behind the study from which the data came.

The conclusions were delivered by presenting author Mark A. Eid, MD, a surgery resident at Dartmouth Hitchcock Medical Center, in Lebanon, New Hampshire, in a talk entitled, “Racial and regional disparities in the prevalence of peripheral artery disease and diabetes and amputation rates among Medicare patients.”

Eid was part of a research team that set out to investigate patients with PAD and diabetes at increased risk for non-traumatic amputations. “The associations of race with amputation risk among patients with both PAD and diabetes is not well understood in recent national patient cohorts,” they cited.

Accessing data from the Centers for Medicare & Medicaid Services (CMS) from 2007–2016, Eid et al identified a 10.5 million-plus cohort of patients concurrently diagnosed with both PAD and diabetes. Patients were then followed from the time of diagnosis in order to identify major and minor amputation events, the investigators said, and stratified by race—Black, white and Hispanic—in order to determine differences in outcomes. “We examined associations between the regional prevalence of PAD and diabetes and amputation rates, at the level of the state and the hospital referral region,” they went on.

The average rate of amputation between 2007 and 2016 was 25.9 amputations per 1,000 patients with PAD and diabetes, Eid et al found. Analyzed by race, Black patients had almost a two-fold higher rate of amputation as compared to white patients (52.2 vs. 30.7 per 1,000 patients; p<0.001) while similar rates when compared to Hispanic patients (52.2 vs. 46.5 per 1,000 patients; p=0.09), the researchers revealed.

“However, states with larger populations of patients with diabetes and PAD had lower rates of amputation across all races,” Eid said. “We also observed an indirect and significant association between regional prevalence of PAD and diabetes and, amputation risk for both white and Black patients.”

Eid et al said that the implications of the study show that regions with higher prevalence of PAD and diabetes “paradoxically have lower rates of amputation, perhaps due to better infrastructure and resources.”

They further concluded: “Concomitant PAD and diabetes is common among Medicare patients, yet rates vary by more than six-fold across the U.S. Regardless of location or prevalence of disease, people of color are disproportionally at higher risk for amputation. Black patients in areas with the lowest rates of PAD and diabetes are disproportionally the highest risk for amputation overall.”

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