Racial and ethnic differences in patterns of treatment for acute peripheral arterial disease in the United States, 1998-2006.
OBJECTIVE
Prior studies have documented racial and ethnic disparities in rates of amputations for peripheral arterial disease (PAD) in the United States. We analyze whether there are underlying differences in the types of treatment provided to patients who are acutely hospitalized for PAD.


METHODS
The 1998-2006 Nationwide Inpatient Sample was used to examine patterns of treatment. We considered a hospitalization an acute admission for PAD if (1) the primary diagnosis was PAD, and (2) the patient was admitted urgently or emergently or through an emergency department. Vascular interventions were designated as open bypass, endovascular intervention, or major amputation, defined as disarticulation at the ankle or higher amputation.


RESULTS
From 1998 through 2006, the likelihood of an endovascular procedure being performed during an acute hospitalization for PAD increased from 11.5% to 35.3%, and open vascular procedures decreased from 34.9% to 25.4%. The likelihood of a major amputation during an acute hospitalization for PAD decreased from 29.7% to 20.3%. Black and Hispanic patients were more likely than white patients to undergo amputation and were less likely to have an endovascular or open revascularization.


CONCLUSIONS
Use of endovascular procedures has increased and use of open vascular bypass has decreased in the inpatient treatment of acute PAD. Although the overall likelihood of amputation has decreased, racial and ethnic differences persist, with black and Hispanic patients experiencing a higher likelihood of amputation.
Rowe
Vincent L
VL
CardioVascular Thoracic Institute, Division of Vascular and Endovascular Surgery, Department of Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, USA. vrowe@surgery.usc.edu
Weaver
Fred A
FA
Lane
John S
JS
Etzioni
David A
DA
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000639:trends; D019992:Databases as Topic; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000639:trends; D006801:Humans; D016013:Likelihood Functions; D023821:Limb Salvage / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D016491:Peripheral Vascular Diseases / Q000208:ethnology / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D044469:Racial Groups / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D044465:White People / Q000706:statistics & numerical data