RS14. Rurality Is a Risk Factor for Primary Amputation and Is Compounded by Race

Abstract

Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. Rural residents face significant barriers to accessing care and have worse health outcomes than their urban counterparts. Recent studies also suggest that race-related health disparities are magnified in rural communities. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship. The Vascular Quality Initiative amputation data set was used for analyses of first-time major amputation patients (N = 6795). The outcome of interest was defined as no previous revascularization attempt on the amputation side. Primary independent variables were race/ethnicity (non-Hispanic whites vs nonwhites) and rural status (defined by rural-urban commuting area codes). Multivariable logistic regression examined impact of rurality and race/ethnicity on primary amputation, after adjustment for relevant covariates and including an interaction for race/ethnicity by rural status. Mean age was 65.6 ± 12.8 years, 36% were female, 57% were white, and 11% were rural. Primary amputation occurred in 49% of patients (n = 3332), including 47% from rural areas vs 49% from urban areas (P = .322) and 46% of whites vs 53% of nonwhites (P < .001). Univariate comparisons found that in nonwhites, primary amputation was more likely for rural patients (59% vs 52%; P = .033), whereas in whites, primary amputation was less likely for rural patients (42% vs 47%; P = .040). After multivariable adjustment, nonwhite race/ethnicity (odds ratio, 1.19; P = .002) and rural location (odds ratio, 1.35; P = .042) were associated with greater odds for primary amputation. The interaction of race/ethnicity by rural status was significant (P = .018), indicating that for nonwhites, the odds for primary amputation in rural patients were increased compared with whites (Fig). In these analyses, rurality was associated with greater odds for primary amputation. However, this effect was moderated by race/ethnicity, such that the relationship was found only for nonwhites. These findings are consistent with current literature demonstrating the compounding effect of race/ethnicity on rural health disparities and suggest that strategies to improve health of rural communities need to consider the particular needs of nonwhite residents to reduce disparities.