title: Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region.
abstract: BACKGROUND
  It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease (PAD) is improving. We examined national trends in care of patients with both PAD and diabetes.
  
  
  METHODS
  A cohort of patients diagnosed with PAD and diabetes between 2007 and 2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR).
  
  
  RESULTS
  From 2007 to 2011, 2.3 per 1,000 patients underwent a major amputation with the higher rate among black patients (5.5 per 1,000 vs. 1.9 per 1,000; P < 0.001) compared with nonblack. The rate varied widely by HRR (1.2 per 1,000-6.2 per 1,000), with higher variation in amputation rates in black patients (2.1-16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients, and 75.4% among nonblack patients, with the disparity between the 2 groups increasing over time.
  
  
  CONCLUSIONS
  Prevalence of concurrent PAD and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and HRR. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, VT. Electronic address: karina.a.newhall@hitchcock.org.
authors.forename: Karina
authors.initials: K
authors.lastname: Newhall
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Emily
authors.initials: E
authors.lastname: Spangler
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Hanover, NH.
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
authors.affiliation: VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, VT; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Philip
authors.initials: P
authors.lastname: Goodney
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D057510:Endovascular Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D014481:United States / Q000453:epidemiology