Impact of race on the treatment for peripheral arterial occlusive disease

Purpose: The purpose of this study was to determine the impact of race on t he treatment of peripheral artery occlusive disease (PAOD) and to examine t he role of access to care and disease distribution on the observed racial d isparity. Methods: The study was performed as a retrospective analysis of hospital di scharge abstracts from 1992 to 1995 in 202 non-federal, acute-care hospital s in the state of Florida. The subjects were patients older than 44 years o f age who underwent major lower extremity amputation or revascularization ( bypass grafting or angioplasty) for PAOD. The main outcome measures were in cidence of intervention, incidence per demographic group, multivariate pred ictors of amputation versus revascularization, multivariate predictors of a mputation versus revascularization among those patients with access to soph isticated care (hospital with arteriographic capabilities), and multivariat e predictors of surgical bypass graft type (aortoiliac vs infrainguinal). Results: A total of 51,819 procedures (9.1 per 10,000 population) were perf ormed for PAOD during the study period and included 15,579 major lower extr emity amputations (30.1%) and 36,240 revascularizations (69.9%). Although t he incidence of a procedure for PAOD was comparable between African America ns and whites (9.0 vs 9.6 per 10,000 demographic group), the incidence of a mputation (5.0 vs 2.5 per 10,000 demographic group) was higher and the inci dence of revascularization (4.0 vs 7.1 per 10,000 demographic group) was lo wer among African Americans. Furthermore, multivariate analysis results sho wed that African Americans (odds ratio, 3.79; 95% confidence interval [CI], 3.34 to 4.30) were significantly more likely than whites to undergo amputa tion as opposed to revascularization. The secondary multivariate analyses r esults revealed that African Americans (odds ratio, 2.29; 95% CI, 1.58 to 3 .33) were more likely to undergo amputation among those patients (n = 9193) who underwent arteriography during the procedural admission and to under-g o infrainguinal bypass grafting (odds ratio, 2.00; 95% CI, 1.48 to 2.71) am ong those patients (n = 27,796) who underwent surgical bypass grafting. Conclusion: There is a marked racial disparity in the treatment of patients with PAOD that may be caused in part by differences in the severity of dis ease or disease distribution.