We need to do better: Real-World Racial Variation in Treatment and Outcomes Among Patients with Peripheral Artery Disease ActAgainstAmputation #DiabeticFoot @ALPSlimb @USC @USC_vascular @ResearchatUSC @KeckSchool_USC @CouncilPVD

This study from our combined Tulane and USC teams. In summary: Black patients with PAD and health insurance were nearly 50% more likely not to receive a bypass. We need to collectively do better.

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Real-World Study Reveals Racial Disparities in Peripheral Artery Disease Diagnosis, Treatment, and Outcomes

A study conducted by a team of researchers from Tulane University, the Keck School of Medicine at the University of Southern California, Janssen Scientific Affairs, Analysis Group, and Groupe d’analyse in Montreal has uncovered significant racial disparities in the diagnosis, treatment, and outcomes of peripheral artery disease (PAD) among commercially insured Black and White patients in the United States. The study, recently published in Advances in Therapy, analyzed data from Optum’s de-identified Clinformatics® Data Mart Database between January 2016 and June 2021.

The research team identified a total of 669,939 patients with PAD, including 454,382 White patients and 96,162 Black patients. Black patients were found to be younger on average (71.8 years vs. 74.2 years) but had higher comorbid burden, concomitant risk factors, and cardiovascular (CV) medication use at baseline.

Notably, Black patients had a higher prevalence of diagnostic testing, revascularization procedures, and medication use, likely because they had more disease burden when getting initial treatment. They were also more likely than White patients to receive medical therapy without a revascularization procedure [adjusted odds ratio with 95% confidence interval (CI) = 1.47 (1.44–1.49)]. However, Black patients with PAD experienced a higher incidence of major adverse limb events (MALE) and CV events than White patients [adjusted hazard ratio for composite event (95% CI) = 1.13, (1.11–1.15)]. The hazards of individual components of MALE and CV events, except for myocardial infarction, were also significantly higher among Black patients with PAD.

David G. Armstrong, Professor of Surgery and Director of Limb Preservation at Keck School of Medicine of USC, stated, “The bottom line is that people of color – even when insured – were nearly 50% less likely to receive potentially limb-saving vascular intervention. They consequently were more likely to have a stroke, heart attack, or major amputation. We can do better.”

The study’s findings highlight the need for increased awareness and improved strategies to address the racial disparities in PAD diagnosis, treatment, and outcomes. The authors emphasize the importance of early diagnosis, optimized treatment, and close monitoring of PAD patients, particularly among Black individuals, to reduce the risk of adverse outcomes following diagnosis.

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