title: Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods.
abstract: BACKGROUND
  While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors.
  
  
  METHODS
  This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates.
  
  
  RESULTS
  Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis.
  
  
  CONCLUSIONS
  Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
authors.affiliation: Metro Health University of Michigan Health, Wyoming, MI, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Mustapha
authors.affiliation: Vascular and Endovascular Surgery, The Surgical Clinic, PLLC, Nashville, TN, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Fisher
authors.affiliation: Stony Brook University, Stony Brook, NY, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: University of Maryland, College Park, MD, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Cardiovascular Systems, Inc., St Paul, MN, USA.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Martinsen
authors.affiliation: Cardiovascular Systems, Inc., St Paul, MN, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Kotlarz
authors.affiliation: CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
authors.affiliation: CTI Clinical Trials and Consulting Services, Inc., 1775 Lexington Avenue, Suite 200, Cincinnati, OH, 45212, USA. cgunnarsson@ctifacts.com.
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
keywords: Amputation; Hospital admission; Peripheral artery disease; Racial disparities