title: The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002-2011).
abstract: The purpose of this study was to examine trends in racial and gender disparities in the severity of lower extremity amputation among individuals with peripheral artery disease (PAD) over the period of a decade (2002-2011). This is a longitudinal secondary analysis of data from the Healthcare Utilization Project Nationwide Inpatient Survey (HCUP-NIS) for the years 2002-2011. Level of amputation was determined from ICD-9-CM procedure and coded as either transfemoral (TF) or transtibial (TT). The main predictors were gender and race; covariates including age, race, income, insurance status and presence of vascular disease were incorporated as control variables in regression analysis. A total 121,587 cases of non-traumatic dysvascular amputations were identified. Female gender (odds ratio (OR) 1.35; 95% confidence interval (CI) 1.32, 1.39) and black race (OR 1.17; 95% CI 1.12, 1.23) are both significantly associated with increased odds for receiving TF amputation with no change in these odds over the decade of study. Other covariates with significant associations with TF amputation level include increased age (OR 1.03; 95% CI 0.99, 1.09), low income (OR 1.21; 95% CI 1.15, 1.27), Medicaid insurance (OR 1.36; 95% CI 1.29, 1.44), Medicare insurance (OR 1.27; 95% CI 1.21, 1.32), and cerebrovascular disease (OR 2.12; 95% CI 2.03, 2.23). In conclusion, although overall rates of amputation have decreased, disparities in level of amputation related to female gender and black race have not significantly changed over time. Higher-level amputation has significant consequences from a quality-of-life, medical and economic perspective.
authors: Widener University, Institute for Physical Therapy Education, Chester, PA, USA kmlefebvre@mail.widener.edu.
authors: Kristin M
authors: KM
authors: Lefebvre
authors: Springfield College, Department of Physical Therapy, Springfield, MA, USA.
authors: Julia
authors: J
authors: Chevan
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000639:trends; D002561:Cerebrovascular Disorders / Q000208:ethnology; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology* / Q000639:trends; D006801:Humans; D007182:Income; D016014:Linear Models; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People
keywords: gender and race; health disparities; trends in amputation