The influence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities.
OBJECTIVE
To assess whether rates of amputation and leg-sparing surgery for peripheral vascular disease of the lower extremities differ between African-American and white patients.


METHODS
Retrospective cohort study using Medicare claims data for 1989 and 1990.


METHODS
A total of 3313 hospitals in the United States.


METHODS
Random sample of 19,236 Medicare Part A enrollees who underwent amputation and/or leg-sparing surgery for peripheral vascular disease.


METHODS
Adjusted odds of toe and/or foot amputation, below-knee amputation, above-knee amputation, lower extremity arterial vascularization, and percutaneous transluminal angioplasty for African American relative to whites, controlling for case-mix, region, and hospital characteristics.


RESULTS
African-American patients were significantly more likely than white patients to undergo above-knee, below-knee, and toe and/or foot amputation and significantly less likely to undergo lower-extremity arterial revascularization and percutaneous transluminal angioplasty. These associations occurred for diabetic patients and nondiabetic patients but were more pronounced among patients who did not have diabetes.


CONCLUSIONS
Potential explanations include unmeasured factors such as severity of disease and the technical expertise available at hospitals or other factors such as lack of compliance with medical treatment and race-specific treatment decisions by providers. Whatever the cause, interventions aimed toward reducing the number of amputations among African Americans are needed. Further work is required to determine where such interventions should be targeted.
Guadagnoli
E
E
Department of Health Care Policy, Harvard Medical School, Boston, Mass., USA.
Ayanian
J Z
JZ
Gibbons
G
G
McNeil
B J
BJ
LoGerfo
F W
FW
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D012111:Residence Characteristics; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*; D044465:White People