title: An evaluation of gender and racial disparity in the decision to treat surgically arterial disease.
abstract: OBJECTIVE
  In 1994, our hospital reported a significant gender disparity in the treatment of peripheral artery disease (PAD). The objective of this study was to determine if this gender-based treatment disparity still persists after 15 years.
  
  
  METHODS
  A retrospective review of patients with PAD and carotid artery disease based on vascular laboratory studies was performed from January 2006 to February 2008. PAD was identified by ankle-brachial index <or= 0.9 or abnormal waveform. Treatable carotid artery disease was identified by symptomatic stenosis 60%-99% or asymptomatic stenosis 80%-99%. Patients with interventions before January 2006 were excluded. Demographics, risk factors, and interventions were recorded. Univariate and multivariate analyses were performed to identify risk factors and independent predictors of intervention.
  
  
  RESULTS
  Of 2,313 peripheral artery studies, 592 patients with PAD and no prior intervention were identified. Sixty-five (21.7%) of 299 men and 47 (16.0%) of 293 women underwent angioplasty, stenting, endarterectomy, or bypass grafting. This difference was not significant (P = .077). However, by multivariate analysis of patients with critical limb ischemia, Caucasian race was an independent predictor of intervention (P = .010; odds ratio [OR] 3.363). Of 3,505 carotid duplex studies, 253 patients with treatable carotid artery disease and no prior intervention were identified. Seventy-eight (52.7%) of 148 men and 43 (41.0%) of 105 women underwent carotid endarterectomy (CEA) or stenting. This difference was not significant (P = .065). However, by multivariate analysis, Caucasian race was identified as an independent predictor of intervention (P = .015, OR 3.033). Insurance status was not a predictor of intervention in either the PAD (P = .70) or carotid artery disease cohort (P = .99).
  
  
  CONCLUSIONS
  Our data reveal that gender was not an independent predictor of intervention for PAD or carotid artery disease; however, Caucasian race independently predicted a greater likelihood of intervention in PAD patients with critical limb ischemia and in the carotid artery disease cohort. This study demonstrates the importance of performance assessments in uncovering unsuspected treatment disparities.
authors.affiliation: Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill 60611, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Amaranto
authors.forename: Farah
authors.initials: F
authors.lastname: Abbas
authors.forename: Seth
authors.initials: S
authors.lastname: Krantz
authors.forename: William H
authors.initials: WH
authors.lastname: Pearce
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: Melina R
authors.initials: MR
authors.lastname: Kibbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D000842:Ankle / Q000098:blood supply; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000208:ethnology / Q000601:surgery*; D002641:Chicago / Q000453:epidemiology; D003251:Constriction, Pathologic; D016894:Endarterectomy, Carotid; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007511:Ischemia / Q000208:ethnology / Q000503:physiopathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D016017:Odds Ratio; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000208:ethnology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data