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Home > Press Center > Non-White, Low Income Patients

Contact:
Emily Kalata
Assistant Director, Communications
312.334.2309

New research clearly shows a disparity in America’s healthcare services for minorities from low income areas who do not understand peripheral vascular disease (PVD) and it symptoms, and who lack insurance and access to quality medical providers.

In a study published in the January 2007 issue of the Journal for Vascular Surgery, the researchers studied 240,740 minority patients with an annual income of less than $25,000 who had lower extremity ischemia, where blood flow and oxygen was not getting to the legs. Patients either had to have vascular grafts (66.3 percent) or had major amputation (33.7 percent).

According to author Mohammad Hamed Eslami, MD, assistant professor of surgery in the division of vascular surgery at the University of Massachusetts Medical School, Worcester, many of the disadvantaged who develop PVD legs, arms, stomach or kidneys) do not realize the importance of early diagnosis and treatment of the disease, which can include peripheral arterial disease (PAD). 

People with PAD get hardening of the arteries (artherosclerosis) when fatty deposits (plaque) build up in the linings veins or arteries, which carry oxygen and nutrients to all the tissues of the body, including the stomach and kidneys. When circulation is restricted, symptoms most often are displayed by cramped or tired arms and legs (a condition called intermittent claudication) can occur. Early on, PAD may only cause difficulty in walking, but when more severe, it can cause painful foot ulcers, infections and even gangrene, which could require amputation. People with PAD also can have plaque in their brains and their hearts, and therefore have a higher risk of death from heart attack and stroke.

When PAD advances, the poor often go to emergency rooms for care. Amputation of the lower limbs is sometimes the only treatment option for vascular surgeons. Dr. Eslami emphasized the importance of educating them about the signs and symptoms of PVD and offering screenings to the underserved to help decrease amputation.   

The Society for Vascular Surgery (SVS) recommends that people review the following risks for PAD:

• Age (older than 40 years)
• High Blood Pressure
• Diabetes
• High Cholesterol
• Smoking
• Obesity
• Family history of vascular disease
• Existent artherosclerosis in other arteries, such as the heart and brain

Diabetes often precedes PAD, so information about the dangers and symptoms of diabetes, and how it should be monitored, should be available to minorities, said Dr. Eslami. If diabetes becomes worse, lack of blood flow, nerve damage or ulceration can occur in the legs and amputation may be required. He added that patients need to learn about the dangers of renal (kidney) failure (when the blood cannot get to the kidney which results in waste and concentrate urine that cannot be passed on without losing electrolytes). “In our study, patients 72 years and older, those with renal failure and diabetics, more commonly had amputations,” said Dr. Eslami. Care of the feet, to avoid cuts and ulcerations that do not heal, should be explained to the patients, as well as follow-up care, no matter what the condition.

Dr. Eslami indicated that many in this socioeconomic group could not afford early proper medical care, even if it was available. He said that barriers to appropriate medical care, including screenings for PAD, must be removed and more general practitioners and vascular surgeons should practice in underserved areas.

Vivian Ho, PhD, an economist as Rice University, has done an analysis of 2005 Medicare claims data and found that adding one vascular surgeon for every 33,000 Medicare beneficiaries in a region yielded a 1.5 percent decrease in amputations.

“In our study, we found that patients from low income areas, Medicaid and Medicare patients, and non-teaching hospitals had more amputations rates. Patients with Medicaid also presented more commonly with gangrene,” said Dr. Eslami. 

"In addition to the immense psychological problem of limb loss, financial impact of the care of the amputees is estimated to be more than $4 billion annually,” added Dr. Eslami.

SVS believes that patient education is of utmost importance. If you experience symptoms of PAD in your legs, see a vascular surgeon. Visit www.VascularWeb.org to find a vascular surgeon in your area or call 800-258-7188 for a free brochure. The SVS offers a few suggestions for prevention of PAD:

• Walking can increase your circulation, therefore helping to prevent plaque.
• Be physically active (including a supervised exercise program).
• Eat a low-saturated-fat, low-cholesterol diet.

When recommended by your physician, take medications to help improve walking distance, such as antiplatelet agents or cholesterol-lowering medications.

Data for the study was collected from the Nationwide Inpatient Sample, which offers discharge data on 20 percent of all U.S. patients from non-federal hospitals.