Abstract 18709: Disparities in Socioeconomic Metrics Associated With Adverse Outcomes Among Medicare Beneficiaries Undergoing Peripheral Endovascular Intervention

Abstract

Background Low socioeconomic status (SES) is associated with an increased incidence of peripheral artery disease, however there is a lack of granularity in the specific metrics that contribute to this discrepancy. We examine the association of community-level economic distress with adverse outcomes in patients undergoing peripheral endovascular intervention (PVI). Hypothesis: Socioeconomically distressed communities have non-healthcare-related, structural disparities that contribute to incident PVI and adverse outcomes. Methods: Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine the incidence of femoropopliteal PVI. The Distressed Community Index (DCI) was used to categorize adults as distressed (DCI ≥80) or not distressed (DCI <80). Composite outcome of death and major amputation within 1 year of PVI were examined by level of distress using individual community-level metrics. Results: Socioeconomically distressed adults underwent 158 PVIs per 100000 distressed beneficiaries compared with 109 PVIs per 100000 non-distressed beneficiaries (risk ratio, 1.45 [95% CI, 1.42-1.48]; P<0.001). Distressed adults who underwent PVI were more likely to be female (45.5% versus 43.1%; P<0.001) and Black race (21.9% versus 10.1%; P<0.001) (Table I). There was a strong association between distress and the composite outcome at 1 year (incidence rate ratio, 1.11 [95% CI 1.07-1.16; P=0.0001]). Distressed adults lacked high school diplomas (11.88% versus 11.15%; P<0.001), had higher rates of unemployment (24.11% versus 22.76%; P<0.001), and greater housing vacancy rates (9.74% versus 9.31%; P<0.001). Conclusion: Socioeconomic distress is associated with higher rates of PVI-incidence and post-PVI adverse outcomes. This may be driven by structural inadequacies inherent to low SES communities that need to be addressed in order to narrow the gap in care among distressed adults undergoing PVI.