Black Patients Have Worse Outcomes After Lower Extremity Revascularization: A Propensity-matched Analysis of Comorbidities and Socioeconomic Factors

Abstract

Racial disparities among patients with peripheral artery disease (PAD) have been described and often attributed to sociodemographic factors. We analyzed the outcomes of lower extremity bypass (LEB) and peripheral vascular intervention (PVI) between Black and non-Hispanic White (NHW) while accounting for socio-economic status using the area of deprivation index (ADI). The Vascular Quality Initiative (2016-2021) datasets were used to identify patients undergoing LEB and PVI. A probit regression model was used to generate propensity scores and perform a 5:1 match on characteristics including comorbidities, ADI, indication, urgency, and number of arteries treated (PVI) or graft target (LEB). The primary outcome was major adverse limb event (MALE)-free survival at 1 year. Kaplan-Meier survival graphs were generated for the groups and compared using log-rank testing. Cox regression analyses was used to test for interactions between race and indications as well as race and number of arteries treated (for PVI) or graft target (for LEB). A total of 44,968 PVI and 12,006 LEB were included in the analysis after matching. Black patients had significantly higher rates of MALE at 1 year for both PVI and LEB (Figs 1 and 2). On adjusted analyses Black patients with chronic limb-threatening ischemia had a higher risk of MALE at 1 year for both PVI (HR, 1.11; 95% CI, 1.04-1.17; P < .001) and LEB (HR, 1.11; 95% CI, 1.01-1.19; P = .03) compared to NHW. When adjusting for anatomical considerations, there was variability of outcomes between the groups. Black patients had a higher risk of MALE at 1 year in LEB performed to peroneal and tibial target vessels (HR, 1.17; 95% CI, 1.04-1.31; P = .007), but not for popliteal target vessels. For PVI, 1-year MALE was also higher in Black patients with one or two vessels treated at any level (HR, 1.21; 95% CI, 1.13-1.26; P < .001), but rates were similar to NHW with more vessels treated. Despite adjusting for socioeconomic factors using the validated ADI, Black patients with PAD have worse outcomes following revascularization, especially for CLTI, suggesting that other factors adversely affect outcomes in these patients. These unmeasured factors require further exploration to improve PAD outcomes in Black patients.Fig 2Major adverse limb event (MALE)-free survival at 1 year after lower extremity bypass (LEB).View Large Image Figure ViewerDownload Hi-res image Download (PPT)