Abstract
BACKGROUND: Chronic limb-threatening ischemia (CLTI) disproportionately affects racial minority populations, with Black patients experiencing higher amputation rates and reduced access to vascular care. Recent national campaigns have aimed to improve early screening and diagnosis of peripheral arterial disease (PAD), but it is unclear whether these efforts have improved outcomes.
OBJECTIVES: To assess temporal trends in treatment, outcomes, and healthcare utilization for Black versus White Medicare beneficiaries with CLTI undergoing endovascular revascularization.
METHODS: We conducted a retrospective cohort study using Medicare claims data for beneficiaries aged ≥66 years who underwent endovascular revascularization for CLTI from January 2016 to December 2023. The primary outcome was a composite of major amputation or death over 4 years, evaluated using Cox models. Healthcare utilization was assessed via adjusted rate ratios (aRRs) for vascular provider visits, emergency department use, and hospital admissions.
RESULTS: Among 303,906 patients, 17.2% (N=52,376) identified as Black. Black patients were younger, had more comorbidities, and more often presented with gangrene. They more frequently underwent angioplasty alone and less frequently received stents. Over a median 1.7 years of follow-up, Black patients had higher risk of major amputation (HR 1.49; 95% CI, 1.45-1.53) and lower mortality (HR 0.91; 95% CI, 0.90-0.93). They had fewer vascular visits before (aRR 0.91) and after (aRR 0.92) revascularization, but more ED visits (aRR 1.09) and hospital readmissions (aRR 1.28).
CONCLUSIONS: Despite national initiatives, Black patients with CLTI continue to face higher amputation risk and reduced access to longitudinal vascular care, underscoring the need for sustained, equity-focused interventions.