Deficient treatment outcomes after PVI in Black and low-income adults with PAD

The risk of undergoing femoropopliteal peripheral vascular intervention (PVI) was higher in Black or low-income adults with peripheral artery disease (PAD) than in White or high-income adults with PAD, respectively. In addition, health outcomes after PVI were worse in low-income adults or Black adults. This effect may be mediated by a higher burden of comorbidities. Targeted efforts should be made to improve the reported disparities between subpopulations [1].

Previous research has shown that Black adults demonstrate a higher prevalence of PAD than White adults and that low-income adults show a higher prevalence of PAD than high-income adults. In addition, Black or low-income adults show higher amputation rates [2]. In the current study, Dr Anna Krawisz (Beth Israel Deaconess Medical Center, MA, USA) and colleagues aimed to investigate the possible association of race and income on PVI occurrence and associated outcomes [1]. Between 2016 and 2018, data was collected from ‘fee for service’ Medicare beneficiaries ≥66 years of age. The risk of death and amputation was assessed within 1 year after PVI, stratified by income and race.

Black adults demonstrated higher PVI rates than White adults (risk ratio 1.75; P<0.01). In addition, a higher proportion of Black patients was treated for chronic limb-threatening ischaemia (CLTI) (62%) compared with White patients (50%), indicating more advanced disease in Black patients at the time of intervention. A similar pattern was observed in low-income versus high-income patients: low-income patients were more at risk of receiving PVI compared with high-income patients (risk ratio 2.02; P<0.01) and were more frequently treated for CLTI (62% vs 49%, respectively). These results were consistent across all regions of the US.

The occurrence of death or amputation after PVI was more prevalent in Black patients (17.6%) than in White patients (15.2%; risk ratio 1.16; P<0.01). Similarly, low-income patients had a higher risk of experiencing amputation or death after PVI (19.3%) than high-income patients (14.4%; risk ratio 1.34; P<0.01). The increased risk of death and amputation after PVI in Black adults and low-income adults disappeared when the analysis was adjusted for comorbidities. This indicates that comorbidities may mediate the relationship between race or income and the composite outcome of death and amputation.

Dr Krawisz argued that these data reveal disparities in care in patients with PAD. “Risk factor monitoring, early disease identification, and treatment optimisation in Black adults and low-income adults are needed to reduce these inequalities in care.”

 

1. 
   
   1. Krawisz AK, et al. Disparities in the Prevalence of and Outcomes associated with PVI by Race and Income. VA.RFO.19, AHA 2021 Scientific Sessions, 13–15 November.
   2. Allison MA, et al. Am J Prev Med. 2007;32(4):328-333.

 

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Posted on 14 January 2022