Disparities in the treatment and outcomes of vascular disease in Hispanic patients.
BACKGROUND
The Hispanic population represents the fastest growing minority in the United States. As the population grows and ages, the vascular surgery community will be providing increasing amounts of care to this diverse group. To appropriately administer preventive and therapeutic care, it is important to understand the incidence, risk factors, and natural history of vascular disease in Hispanic patients.


METHODS
We analyzed hospital discharge databases from New York and Florida to determine the rate of lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic aneurysm (AAA) repair in Hispanics relative to the general population. The rates of common comorbidities, the indications for the procedures, and outcomes during the same hospitalization as the index procedure were determined. Multivariate logistic regression analysis was used to determine the differences between Hispanics and white non-Hispanics with respect to rate of procedure, symptoms at presentation, and outcome after procedure. Demographic variables and length of stay were also analyzed.


RESULTS
The rate of LER, CR, and AAA repair was significantly lower in Hispanic patients than in white non-Hispanics. Despite this lower rate of intervention, Hispanics were significantly more likely than whites to present with limb-threatening lower extremity ischemia (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.91 to 2.29), symptomatic carotid artery disease (OR, 1.57; 95% CI, 1.4 to 1.75), and ruptured AAA (OR, 1.26; 95% CI, 1.04-1.52) than white non-Hispanics These differences were maintained after controlling for the presence of diabetes mellitus and other comorbidities. Hispanic patients had higher rates of amputation during the same hospitalization after LER (6.2% vs 3.4%, P < .0001) and higher mortality after elective AAA repair (5% vs 3.4%, P = .0032). Length of stay after LER, CR, and AAA repair was longer for Hispanic patients than white non-Hispanics.


CONCLUSIONS
Significant disparities in the rate of utilization of three common vascular surgical procedures exist between Hispanic patients and the general population. In addition, Hispanics appear to present with more advanced disease and have worse outcomes in some cases. Reasons for these disparities must be determined to improve these results in the fastest growing segment of our society.
Morrissey
Nicholas J
NJ
Division of Vascular Surgery, New York Presbyterian Hospital, Columbia College of Physicians and Surgeons, Weill Medical College of Cornell University, New York, NY 10032, USA. njm2106@columbia.edu
Giacovelli
Jeannine
J
Egorova
Natalia
N
Gelijns
Annetine
A
Moskowitz
Alan
A
McKinsey
James
J
Kent
Kenneth Craig
KC
Greco
Giampaolo
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D002340:Carotid Artery Diseases / Q000628:therapy; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*