Abstract 28: Racial Disparities In Outcomes Of Endovascular Procedures For Peripheral Arterial Disease: An Evaluation Of California Hospitals, 2005-2009

Abstract

Background: Endovascular procedures are being increasingly performed for peripheral arterial disease (PAD), exceeding the number of open surgical bypass procedures. Previously, it had been demonstrated that there is a disparity in access to and outcomes of PAD treatment based on race/ethnicity. Blacks have been shown to be more likely to undergo amputation and less likely to undergo revascularization procedures for limb salvage compared to whites. The aim of this study was to determine if there is disparity in the outcomes of endovascular PAD procedures based on race/ethnicity in this contemporary population-based study. Methods: We used the Patient Discharge Data (PDD) from California's Office of Statewide Health Planning and Development (OSHPD) to identify all patients >35 years of age who underwent a lower extremity arterial intervention from 2005 to 2009. OSHPD has been recording ambulatory surgery data since 2005. A look back period of five years was used to exclude patients with prior lower extremity endovascular or open bypass procedures. Cox proportional hazards regression was used to compare amputation-free survival and logistic regression was used to compare 12-month reintervention rate among the racial groups adjusting for age, gender, insurance status, severity of illness, and comorbidities. Results: Between 2005 and 2009, 41,507 individuals underwent lower extremity arterial interventions; 25,635 (61.7%) underwent endovascular procedures. There were 11,389 women (44.2%) and 14,246 men. This cohort included 17,433 (68%) non-Hispanic (NH) whites, 4,417 (17.3%) Hispanics, 1,979 (7.7%) blacks, 1,163 (4.5%) Asian/Native Hawaiians, and 643 (2.5%) others. The Hazard ratio for amputation or death was 1.69 in Hispanics (95%CI 1.50-1.89) and 1.65 in blacks (95%CI 1.42-1.92) compared to NH whites ( p <0.001). The 12-month reintervention rate was significantly associated with race/ethnicity ( p =0.001). The odds ratio for 12-month reintervention was 1.18 in Hispanics (95% CI 1.06-1.31) and 1.08 in blacks (95%CI 0.95-1.22) compared to NH whites following endovascular procedures. Conclusions: Our study demonstrates that Hispanics and blacks have worse amputation-free survival than NH whites following endovascular PAD procedures in this contemporary state-wide database. However, Hispanics and blacks were more likely than NH whites to undergo reintervention. Further research is needed to understand if the higher reintervention rate is secondary to more severe illness and/or poor access to proper follow-up care and cardiovascular risk factor modifications.