Abstract P152: Racial Disparities In The Prevalence Of Peripheral Artery Disease And Diabetes And Amputation Rates Among Medicare Patients

Abstract

Background: Patients with peripheral artery disease (PAD) and diabetes are at increased risk for nontraumatic amputations. The associations of race with amputation risk among patients with both PAD and diabetes is not well understood in recent national patient cohorts. Methods: Using data from the Centers for Medicare and Medicaid Services from 2007-2016, we identified a cohort of patients concurrently diagnosed with both PAD and diabetes (N= 10,506,254). Patients were followed from time of diagnosis to identify major and minor amputation events, and stratified by race (Black, White, Hispanic) in order to determine differences in outcomes. We examined associations between the regional prevalence of PAD and diabetes and amputation rates, at the level of the state and the hospital referral region (HRR). Results: The average rate of amputation between 2007 and 2016 was 0.3 amputations per 1000 Medicare patients. When analyzed by race, Black patients had an almost 3-fold higher rate of amputation as compared to White patients (0.89 v 0.36 per 1000 patients, P<0.001) and a 2-fold higher rate as compared to Hispanic patients (0.89 v 0.39 per 1000 patients, P<0.001). States with larger populations of Black patients with diabetes and PAD had higher rates of amputation. We also observed a direct and significant association between regional prevalence of PAD and diabetes and amputation risk for both White and Black patients (R 2 =0.36 and 0.25 respectively); some states such as Mississippi had disproportionately higher amputations rates among Black patients for a given prevalence of PAD and diabetes (Figure 1). Conclusion: Black patients with PAD and diabetes are at disproportionally higher risk for amputation. Moreover, regional prevalence of concomitant PAD and diabetes is closely related to amputation risk across races.