Abstract
BACKGROUND: Research on disparities in peripheral artery disease (PAD) often examines factors individually. However, complex interactions between sex, race, and geography likely influence outcomes and treatment use OBJECTIVE: This study investigates the combined effects of race and community characteristics on outcomes and treatment utilization among Medicare beneficiaries with PAD METHODS: This retrospective cohort study analyzed 100% Medicare Standard Analytic Files from 2017 to 2023. Primary outcomes included death, major amputation, and endovascular and surgical revascularization. Kaplan-Meier and Cox proportional hazards regression were used to examine the associations between outcomes and individual-level race (Black versus White) and county-level minority population percentage (the percentage that was not non-Hispanic White, using the Distressed Community Index).
RESULTS: Black patients had an increased risk of death and major amputation than White patients (death: Hazard Ratio [HR]=1.13, 95% Confidence Interval [CI]=1.12, 1.13; major amputation: HR=2.79, 95% CI=2.72, 2.86). These risks were exacerbated in counties with a higher percentage of minority populations. While Black patients were more likely to receive endovascular revascularization treatment than White patients overall (HR=1.06, 95%CI=1.05, 1.08), those residing in counties in the highest quartile of minority population percentage were significantly less likely to receive endovascular revascularization (HR=0.95, 95% CI=0.94, 0.97) compared to those in the lowest quartile of minority population percentage.
CONCLUSIONS: This study highlights the combined impact of race and community characteristics on health disparities in PAD populations. More access to appropriate interventions among Black patients residing in areas with high-minority populations could significantly improve health outcomes and advance equity.