Abstract 14644: The Association Between Neighborhood Distress and Outcomes Following Peripheral Vascular Intervention

Abstract

Introduction: Peripheral arterial disease (PAD) is associated with an elevated risk of mortality. Low socioeconomic status (SES) is associated with increased prevalence and severity of PAD, and low SES has been associated with poor post procedural outcomes in cardiovascular disease. The Distressed Communities Index (DCI) uses seven common proxies of SES, such as educational attainment, housing stability, median income, and employment rate, to generate an aggregate score at a zip code level. Hypothesis: We hypothesized that increased levels of neighborhood distress, as measured by the DCI, is associated with an increased risk of mortality and amputation after PVI. Methods : We queried the Vascular Quality Initiatives (VQI) database, linked with Medicare claims data for patients who had undergone PVI. A total of 16,980 patients with PVI were found and 53 Excluded because ≥ 1 missing data for covariate used in modelling and 381 because DCI Missing. Patient 5-digit zip codes were used to obtain a DCI score (range 1-100, with higher scores indicating greater distress) from the Economic Innovation group. We examined the association between DCI and 2-year mortality and major amputation. Results: At 24 months, 2 964 (17.5%) had died 1 669 (9.9%) and had a major amputation DCI score was positively associated 2-year mortality risk. A 10-point higher DCI score was associated with increased mortality risk (unadjusted HR=1.02; 95%CI [1.01,1.03]) and a higher risk of amputation (unadjusted HR=1.05; 95%CI [1.04,1.07]). Fig. Conclusions: Higher level of community deprivation was associated with increased risk of short-and long-term mortality and amputation outcomes following PVI. PAD care pathways should integrate improved risk assessments and integrated care models for patients from distressed communities to help address health disparities.