Abstract
Major socioeconomic disparities persist in the management and outcomes of peripheral artery disease (PAD) globally. Allostatic load, which is described as a measure of physiologic adaptation to socio-environmental stress, has been reported to partially explain higher mortality rates in US Blacks. However, it is not clear if allostatic load is associated with PAD severity. The National Health and Nutrition Examination Survey (NHANES), 2003-2004 data was used to identify individuals with PAD based on the calculated Ankle-Brachial Index (ABI). After allostatic load was calculated for each individual, the cohort was stratified into tertiles of allostatic load and survey weights were used to generate nationally representative estimates. Factors associated with increased severity of PAD were evaluated using multivariate regression analyses. There were 5589 individuals included in the survey and 239 (5.9%) had PAD (ABI ≤ 0.9). Using survey weights, this corresponded to 5.9 million individuals. Individuals with PAD were more likely in the highest tertile of allostatic load (71%) compared to the middle (28%) or lowest (6%) tertiles. However, when severity of PAD was examined, the odds of moderate-to-severe PAD were not significantly different among individuals in the middle [adjusted Odds Ratio: 2.02 (0.52 - 7.80)] or highest [adjusted Odds Ratio: 2.53 (0.69 - 9.26)] tertiles compared to those in the lowest tertile. This study suggests that PAD severity is not associated with allostatic load. Increased efforts are necessary to identify factors that explain the socioeconomic disparities observed in the management and treatment of PAD. Key words: Allostatic load, outcomes, peripheral arterial disease, severity, socioeconomic.
Highlights
Major disparities persist in the management of peripheral artery disease (PAD) around the world
Despite the suggestion that a major cause of this disparity may be because Blacks tend to seek care at low-volume institutions with inadequate vascular surgical capabilities, our group and others have documented that these differences persist among patients seeking care at institutions with significant vascular surgical capability (Hughes et al, 2014; Regenbogen et al, 2009) data indicates that a high-volume practice while offering a decrease in the number of amputations for Whites does not confer the same advantage to Blacks
Since there are no well-defined cut-offs for allostatic load burden, the National Health and Nutrition Examination Survey (NHANES) subjects were divided up into three equal groups based on their allostatic load scores and three tertiles of allostatic load severity were created: 1.5 to 3.5, 4 - 4.5 and 5 - 8.5
Summary
Major disparities persist in the management of peripheral artery disease (PAD) around the world. It is reported that Blacks presenting with PAD are more likely to undergo a major amputation as compared to Whites, sometimes as high as three to four times more likely (Feinglass et al, 2008, 2000; Guadagnoli et al, 1995; Huber et al, 1999). The higher the percentage of Black patients a surgeon sees, the more likely the surgeon is to perform a revascularization procedure rather than an amputation on a Black patient (Stapleton et al, 2018)
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