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Home > Vascular Annual Meeting > PVSS16. Racial/Ethnic Disparities in Amputation and...

PVSS16. Racial/Ethnic Disparities in Amputation and Revascularization: A Nationwide Inpatient Sample Study

Kakra Hughes, MD; David Rose, MD; Tolulope Oyetunji, MD; Cherie Phillips, MD; Wayne Frederick, MD; Terence Fullum, MD; Edward Cornwell, III, MD; Julie Freischlag, MD; David Chang, PhD
Howard University College of Medicine, Washington, DC

OBJECTIVES: Several reports have suggested that patients of minority status presenting with critical limb ischemia are more likely to undergo a major limb amputation when compared to white patients. This study is undertaken in an attempt to evaluate what improvement has been made in recent years to correct this discrepancy, and to determine how an increase in adoption of endovascular techniques might impact on this disparity.

METHODS: The Nationwide Inpatient Sample Database (NIS) was queried three times to identify all patients admitted with critical limb ischemia; all patients undergoing an open or endovascular lower extremity revascularization procedure; and all patients who underwent a major lower extremity amputation from 1998 to 2005. Comparisons were done between the different ethnic groups in each of these queries.

RESULTS: The NIS identified 240,139 patients presenting with critical limb ischemia. Of the 186,239 patients who had ethnicity data, there were 68.2% White 19.5% Black, 9.0% Hispanic, and 1.24% Asian patients. A second NIS query identified 83,328 patients undergoing open or endovascular revascularization for critical limb ischemia. Of the 63,639 of these for whom ethnic data was available, 73.7% were White,15.9% Black, 7.4% Hispanic and 1.1% Asian. 76.7% open and 23.3% endovascular interventions were performed in Whites; 76.8% open and 23.2% endovascular interventions in Blacks; 73.9% open and 26.0% endovascular interventions in Hispanics; and 75.2% open and 24.8% endovascular interventions in Asians. A third query of the NIS revealed that 111,548 patients underwent a major lower extremity amputation during the study interval. Among the 84,498 of these patients who had race data recorded, 61% were White, 25.4% Black, 10.1% Hispanic and1.1% Asian. White patients were noted to have a statistically significant higher incidence of cardiac and pulmonary comorbidities in all three queries whereas Blacks were more likely to have diabetes mellitus and renal failure. The mean Charlson Comorbidity Scores for the different ethnic groups undergoing amputation were 2.1 for Whites, 2.0 for Blacks, 2.3 for Hispanics, and 2.5 for Asians. Whereas these Charlson Score differences amongst the ethnic groups achieved statistical significance (i.e., Blacks were significantly healthier than Whites; whereas Asians and Hispanics were less healthy than Whites), these small differences may not necessarily be clinically meaningful.

CONCLUSIONS: Although Blacks make up only 12.8% of the U.S. population, they make up a disproportionate19.5% of patients admitted for critical limb ischemia with a corresponding 25.4% of patients undergoing amputation. A relatively low 15.9% of patients undergoing peripheral revascularization were listed as Black. This disparity remained constant across the study period, unaffected by increased adoption of endovascular intervention. Blacks presenting with critical limb ischemia are more likely to have diabetes and renal failure whereas Whites are more likely to have cardiac and pulmonary comorbidities.

AUTHOR DISCLOSURES: K. Hughes, None; D. Rose, None: T. Oyetunji, None; C. Phillips, None; W. Frederick, None; T. Fullum, Ethicon Endosurgery, Inc.; E. Cornwell, III, None; J. Freischlag, None; D. Chang, None.

Table 1.