Differences In Prevalence Of Disease Research Articles

Clinical epidemiology of cardiovascular disease in advanced chronic kidney disease prior to dialysis to a tertiary care centre in Bangladesh

Background: Patients with advanced CKD stages exhibit a markedly elevated risk of cardiovascular disease. Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death .The main objective of this study was to observe the clinical epidemiology of cardiovascular disease in advanced stages of CKD prior to dialysis to a tertiary care centre in Bangladesh. Methods: This was a cross-sectional observational study on 150 cases of diagnosed advanced stages (4&5) of CKD patients in the indoor Department of Medicine of Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh from July 2022to January2023 for 6 months. Data was analyzed SPSS 25. Results: Out of the total group, 62.0% are male, 38.0% are female, and the average (mean) age of the entire group was 55.2 ±10.3. Patients are compared in terms of their relative percentages and the associated cardiovascular disease (CVD) risk, with the hypothesis that lower hemoglobin levels (<9 mg/dL), common in advanced CKD, may be associated with higher CVD risk. A statistically significant P-value (0.036) indicates a significant association between lower hemoglobin levels and increased risk of CVD. Hypertension is the most common risk factor in both stages showing (80%) in stage 4 and 86.6% in Stage -5 of CKD respectively that increasing prevalence as stages of CKD increases . Other factors like diabetes 50.6%) and 53.3% , dyslipidemia 61.3% and 66.7% , and family history of cardiovascular disease (CVD) 40% and 46.6% also in prevalence from Stage 4 to Stage 5. However, the differences in the prevalence of these risk factors between the two stages are not statistically significant, as indicated by the P-values. The prevalence of Congestive Heart Failure rises from 44% in Stage 4 to 52% in Stage 5, and a similar trend is observed in Coronary Artery Disease from 40% in Stage 4 to 48% in Stage 5 and for other diseases, albeit with lesser increments. The provided pvalues, which assess statistical significance, indicate that the differences in disease prevalence between the two stages are not statistically significant, suggesting that the progression from Stage 4 to Stage 5. Conclusion: This study stated that increased prevalence and progression of cardiovascular risks in advanced CKD stages. Bangladesh J Medicine 2024; 35: 96-100

SCOPE OF AYURVEDA IN THE MANAGEMENT OF KUSHTHA (SKIN DISEASES)

Background: Skin disorders are multi-faceted and may have their origin in allergy, autoimmunity, and hereditary. Ayurveda describes skin disorders under the umbrella of Kushtha, a disease characterized by the derangement of the skin. When we take into account the prevalence of different diseases, over 20% of all people seeking medical attention each year are suffering from skin disorders globally. Kushtha is categorized as Maha Kushtha and Kshudra Kushtha by all Acharyas depending on the severity of the symptoms and its prognosis. Many different etiological factors and disease management strategies are described in the Ayurvedic system of medicine. Aim: To assess the scope of Ayurveda in the management of skin diseases. Material & Methods: Different classical Ayurvedic texts, websites, journals and research articles were referred in the above context. Discussion & Conclusion: Kushtha arises from the vitiation of Tridosha and Twak, Rakta, Mamsa and Lasika. Thus the management for Kushtha is based on the involvement of Dosha and Dushya. Though some treatment modalities are condition-specific, the fundamental principle of treatment is consistent with all forms of Kushtha. Acharya have emphasized the significance of Shodhana (detoxification) therapy to eliminate the morbid Dosha from the body, and Raktamokshana to expel Dushita Rakta which is the key Dushya in the pathology of Kushtha. The Shamana (palliative) therapy comprises both internal and external medications viz. Rasa Aushadhi, Churna, Kwath, Asav, Arishta, Guggulu, Ghrita, and Malhara, Tail, Lepa. Dietary management, Dincharya, Ritucharya, Rasayana therapy, and Sadvritta are given immense importance in Ayurveda to preserve good health and prevention of diseases. This wholesome viewpoint of detoxification, palliative care and lifestyle modification needs to be analyzed to develop guidelines for the management of skin diseases based on Ayurveda principles.

The frequency of pathogenic variation in the All of Us cohort reveals ancestry-driven disparities.

Disparities in data underlying clinical genomic interpretation is an acknowledged problem, but there is a paucity of data demonstrating it. The All of Us Research Program is collecting data including whole-genome sequences, health records, and surveys for at least a million participants with diverse ancestry and access to healthcare, representing one of the largest biomedical research repositories of its kind. Here, we examine pathogenic and likely pathogenic variants that were identified in the All of Us cohort. The European ancestry subgroup showed the highest overall rate of pathogenic variation, with 2.26% of participants having a pathogenic variant. Other ancestry groups had lower rates of pathogenic variation, including 1.62% for the African ancestry group and 1.32% in the Latino/Admixed American ancestry group. Pathogenic variants were most frequently observed in genes related to Breast/Ovarian Cancer or Hypercholesterolemia. Variant frequencies in many genes were consistent with the data from the public gnomAD database, with some notable exceptions resolved using gnomAD subsets. Differences in pathogenic variant frequency observed between ancestral groups generally indicate biases of ascertainment of knowledge about those variants, but some deviations may be indicative of differences in disease prevalence. This work will allow targeted precision medicine efforts at revealed disparities.

Comparison of phenomic profiles in the All of Us Research Program against the US general population and the UK Biobank.

Knowledge gained from cohort studies has dramatically advanced both public and precision health. The All of Us Research Program seeks to enroll 1 million diverse participants who share multiple sources of data, providing unique opportunities for research. It is important to understand the phenomic profiles of its participants to conduct research in this cohort. More than 280000 participants have shared their electronic health records (EHRs) in the All of Us Research Program. We aim to understand the phenomic profiles of this cohort through comparisons with those in the US general population and a well-established nation-wide cohort, UK Biobank, and to test whether association results of selected commonly studied diseases in the All of Us cohort were comparable to those in UK Biobank. We included participants with EHRs in All of Us and participants with health records from UK Biobank. The estimates of prevalence of diseases in the US general population were obtained from the Global Burden of Diseases (GBD) study. We conducted phenome-wide association studies (PheWAS) of 9 commonly studied diseases in both cohorts. This study included 287012 participants from the All of Us EHR cohort and 502477 participants from the UK Biobank. A total of 314 diseases curated by the GBD were evaluated in All of Us, 80.9% (N = 254) of which were more common in All of Us than in the US general population [prevalence ratio (PR) >1.1, P < 2 × 10-5]. Among 2515 diseases and phenotypes evaluated in both All of Us and UK Biobank, 85.6% (N = 2152) were more common in All of Us (PR >1.1, P < 2 × 10-5). The Pearson correlation coefficients of effect sizes from PheWAS between All of Us and UK Biobank were 0.61, 0.50, 0.60, 0.57, 0.40, 0.53, 0.46, 0.47, and 0.24 for ischemic heart diseases, lung cancer, chronic obstructive pulmonary disease, dementia, colorectal cancer, lower back pain, multiple sclerosis, lupus, and cystic fibrosis, respectively. Despite the differences in prevalence of diseases in All of Us compared to the US general population or the UK Biobank, our study supports that All of Us can facilitate rapid investigation of a broad range of diseases. Most diseases were more common in All of Us than in the general US population or the UK Biobank. Results of disease-disease association tests from All of Us are comparable to those estimated in another well-studied national cohort.

Can polygenic risk scores help explain disease prevalence differences around the world? A worldwide investigation

Complex disorders are caused by a combination of genetic, environmental and lifestyle factors, and their prevalence can vary greatly across different populations. The extent to which genetic risk, as identified by Genome Wide Association Study (GWAS), correlates to disease prevalence in different populations has not been investigated systematically. Here, we studied 14 different complex disorders and explored whether polygenic risk scores (PRS) based on current GWAS correlate to disease prevalence within Europe and around the world. A clear variation in GWAS-based genetic risk was observed based on ancestry and we identified populations that have a higher genetic liability for developing certain disorders. We found that for four out of the 14 studied disorders, PRS significantly correlates to disease prevalence within Europe. We also found significant correlations between worldwide disease prevalence and PRS for eight of the studied disorders with Multiple Sclerosis genetic risk having the highest correlation to disease prevalence. Based on current GWAS results, the across population differences in genetic risk for certain disorders can potentially be used to understand differences in disease prevalence and identify populations with the highest genetic liability. The study highlights both the limitations of PRS based on current GWAS but also the fact that in some cases, PRS may already have high predictive power. This could be due to the genetic architecture of specific disorders or increased GWAS power in some cases.

Exploring Racial Differences in Disease Prevalence in a Preclinical Curriculum.

Exploring Racial Differences in Disease Prevalence in a Preclinical Curriculum.

A randomized study on the effect of an extended voluntary waiting period in primiparous dairy cows on fertility, health, and culling during first and second lactation

When the voluntary waiting period (VWP), defined as the days between calving and when the cow is eligible to receive the first insemination, is extended, high-yielding dairy cows may have better opportunities to regain energy balance before first insemination. This study investigated the effect of an extended (145-215 days in milk [DIM], n = 280) or conventional (25-95 DIM, n = 251) VWP treatment on fertility, disease incidence, and culling rate in cows during their first lactation. The cows were also followed through a second lactation without intervention regarding VWP, during which the farmers could decide when they wished to start the inseminations. This was done in a randomized-controlled study on 16 high-yielding commercial herds in southern Sweden, containing a total of 531 primiparous cows of the Holstein and Red Dairy Cattle breeds. Data from the Swedish national dairy herd recording scheme collected between August 2018 and September 2021 were used in the analysis, including records on breed, calvings, estrus intensity, inseminations, disease, somatic cell count, culling date, and culling reason. During first lactation, more cows receiving the extended VWP treatment showed strong estrus intensity (score 4-5, 55% vs. 48%) and fewer showed moderate estrus intensity (score 3, 35% vs. 43%) at first insemination, compared with cows receiving the conventional VWP treatment. First service conception rate (FSCR) was higher (67% vs. 51%) and number of inseminations per conception (NINS) was lower (1.6 vs. 2.0) during the first lactation for cows receiving the extended compared with the conventional VWP treatment. For disease incidence rate or culling rate expressed as number of events per cow-time in the study, we found no differences between the cows receiving the 2 VWP treatments in any lactation. Calving to first service interval during second lactation was longer (86 vs. 74 d) for cows with extended compared with conventional VWP. In conclusion, primiparous cows with extended VWP showed improved reproductive functions, in the form of higher estrus intensity, greater FSCR, and lower NINS, during the first lactation. However, we observed no apparent effect on these fertility measures during the following lactation (without VWP intervention) and no differences in disease prevalence or culling between cows receiving the 2 different VWP treatments in either lactation. Compliance with the planned VWP treatment was lower for cows with planned extended compared with planned conventional VWP treatment. We studied the "intention-to-treat" effect (i.e., the results for all cows randomized to each treatment regardless of whether the planned VWP was achieved or not) to identify any bias arising due to degree of compliance. However, we found no difference in culling rate between cows randomized to an extended VWP compared with those randomized to a conventional VWP. These findings can be used to support management decisions on VWP length in high-yielding dairy herds.

Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases.&#x0D; Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age &lt;15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented.&#x0D; Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient.&#x0D; Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.

Major Genetic Risk Factors for Dupuytren's Disease Are Inherited From Neandertals.

Dupuytren's disease is characterized by fingers becoming permanently bent in a flexed position. Whereas people of African ancestry are rarely afflicted by Dupuytren's disease, up to ∼30% of men over 60 years suffer from this condition in northern Europe. Here, we meta-analyze 3 biobanks comprising 7,871 cases and 645,880 controls and find 61 genome-wide significant variants associated with Dupuytren's disease. We show that 3 of the 61 loci harbor alleles of Neandertal origin, including the second and third most strongly associated ones (P = 6.4 × 10-132 and P = 9.2 × 10-69, respectively). For the most strongly associated Neandertal variant, we identify EPDR1 as the causal gene. Dupuytren's disease is an example of how admixture with Neandertals has shaped regional differences in disease prevalence.

Understanding Race-Based Medicine and Its Impact on Radiology

Although race is widely accepted as a social construct, the practice of medicine is embedded with the assumption of race as a genetic marker that explains differences in disease prevalence, presentation, and health outcomes and encourages the “correction” for race in interpreting certain test results and values. This false premise, which is fundamental to the theory of race-based medicine, is integrated into clinical practice and has resulted in inequitable care among communities of color. The impact of race-based medicine in radiology might be less apparent but is nonetheless considerable because it affects the entire continuum of radiology practice. In this review, we discuss historical perspectives, examine various incriminated scenarios relevant to radiology, and offer mitigation strategies.

Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California

BackgroundCardiovascular disease (CVD) remains the leading cause of death in the US. CVD incidence is influenced by many demographic, clinical, cultural, and psychosocial factors, including race and ethnicity. Despite recent research, there remain limitations on understanding CVD health among Asians and Pacific Islanders (APIs), particularly some subgroups and multi-racial populations. Combining diverse API populations into one study group and difficulties in defining API subpopulations and multi-race individuals have hampered efforts to identify and address health disparities in these growing populations.MethodsThe study cohort was comprised of all adult patients at Kaiser Permanente Hawai’i and Palo Alto Medical Foundation in California during 2014–2018 (n = 684,363). EHR-recorded ICD-9 and ICD-10 diagnosis codes were used to indicate coronary heart disease (CHD), stroke, peripheral vascular disease (PVD), and overall CVD. Self-reported race and ethnicity data were used to construct 12 mutually exclusive single and multi-race groups, and a Non-Hispanic White (NHW) comparison group. Logistic regression models were used to derive prevalence estimates, odds ratios, and confidence intervals for the 12 race/ethnicity groups.ResultsThe prevalence of CHD and PVD varied 4-fold and stroke and overall CVD prevalence varied 3-fold across API subpopulations. Among Asians, the Filipino subgroup had the highest prevalence of all three CVD conditions and overall CVD. Chinese people had the lowest prevalence of CHD, PVD and overall CVD. In comparison to Native Hawaiians, Other Pacific Islanders had significantly higher prevalence of CHD. For the multi-race groups that included Native Hawaiians and Other Pacific Islanders, the prevalence of overall CVD was significantly higher than that for either single-race Native Hawaiians or Other Pacific Islanders. The multi-race Asian + White group had significantly higher overall CVD prevalence than both the NHW group and the highest Asian subgroup (Filipinos).ConclusionsStudy findings revealed significant differences in overall CVD, CHD, stroke, and PVD among API subgroups. In addition to elevated risk among Filipino, Native Hawaiian, and Other Pacific Islander groups, the study identified particularly elevated risk among multi-race API groups. Differences in disease prevalence are likely mirrored in other cardiometabolic conditions, supporting the need to disaggregate API subgroups in health research.

Highlighting the value of Alzheimer's disease-focused registries: lessons learned from cancer surveillance.

Like cancer, Alzheimer's disease and related dementias (ADRD) comprise a global health burden that can benefit tremendously from the power of disease registry data. With an aging population, the incidence, treatment, and mortality from ADRD is increasing and changing rapidly. In the same way that current cancer registries work toward prevention and control, so do ADRD registries. ADRD registries maintain a comprehensive and accurate registry of ADRD within their state, provide disease prevalence estimates to enable better planning for social and medical services, identify differences in disease prevalence among demographic groups, help those who care for individuals with ADRD, and foster research into risk factors for ADRD. ADRD registries offer a unique opportunity to conduct high-impact, scientifically rigorous research efficiently. As research on and development of ADRD treatments continue to be a priority, such registries can be powerful tools for conducting observational studies of the disease. This perspectives piece examines how established cancer registries can inform ADRD registries' impact on public health surveillance, research, and intervention, and inform and engage policymakers.

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

PD39-08 INTER-CENTER VARIABILITY IN POSITIVE PREDICTIVE VALUES OF PIRADS SCORE IN PATIENTS UNDERGOING PROSTATE BIOPSY: RESULTS FROM THE PROMOD STUDY GROUP

Prevalence of different diseases and growth performance of broilers vary with environmental variation

Abstract Broiler meat is known for its nutritional value, widespread availability, and low price. However, broilers are sensitive to environmental conditions and need a specific environment for optimum production. Global warming and natural disasters are important obstacles to broiler production. Therefore, we conducted this study during analysed the years 2019, 2020, and 2021, to reveal the broiler production status throughout the year in a subtropical region. The study area included Noakhali and Lakshimpur, located in the southern part of Bangladesh. We selected 10 smallholder broiler farms following specific conditions and collected information at the end of each month for analysis. The body weight of broilers was significantly lower in July than in other months. However, the mortality was significantly lower in July than in other months of the year. Nonetheless, the prevalence of viral disease was higher in the winter season (December, January and February). Although, the prevalence of metabolic diseases was higher in October, a high prevalence of bacterial disease was found in April. These results suggest that high temperatures decrease broiler performance while broilers are more susceptible to viral disease in the winter season.

Genetic Polymorphism in Angiotensinogen and Its Association with Cardiometabolic Diseases.

Angiotensinogen (AGT) is one of the most significant enzymes of the renin-angiotensin-aldosterone system (RAAS) which is involved in the regulation and maintenance of blood pressure. AGT is involved in the production of angiotensin I which is then converted into angiotensin II that leads to renal homeostasis. However, various genetic polymorphisms in AGT have been discovered in recent times which have shown an association with various diseases. Genetic polymorphism increases the level of circulating AGT in blood which exaggerates the effects produced by AGT. The associated diseases occur due to various effects produced by increased AGT levels. Several cardiovascular diseases including myocardial infarction, coronary heart disease, heart failure, hypertrophy, etc. are associated with AGT polymorphism. Other diseases such as depression, obesity, diabetic nephropathy, pre-eclampsia, and liver injury are also associated with some variants of AGT gene. The most common variants of AGT polymorphism are M235T and T174M. The two variants are associated with many diseases. Some other variants such as G-217A, A-6G, A-20C and G-152A, are also present but they are not as significant as that of M235T and T174M variants. These variants increase the level of circulating AGT and are associated with prevalence of different diseases. These diseases occur through various pathological pathways, but the initial reason remains the same, i.e., increased level of AGT in the blood. In this article, we have majorly focused on how genetic polymorphism of different variants of AGT gene is associated with the prevalence of different diseases.

Results of Anorectal Physiological Testing in Patients with Limited English Proficiency.

Patients with limited English proficiency (LEP) experience barriers to healthcare. These include language barriers and difficulty accessing medical subspecialties. Consequently, patients with LEP may be underrepresented, and may be more likely to have abnormal results, among individuals referred for anorectal testing. To explore whether differences exist in the results of high-resolution anorectal manometry (HRM), rectal sensory testing (RST), and balloon expulsion testing (BET) between patients with LEP and English proficiency (EP). The electronic health records at Mayo Clinic, Rochester were used to identify constipated patients without organic anorectal disease who had undergone anorectal testing in 2018, 2019, and 2020. The language spoken by the patients was determined. HRM, RST, and BET results were compared. Nominal logistic regression explored the influence of age, gender, test operator, and LEP on the likelihood of abnormal findings. Among 3298 patients (80% female, mean age ± standard deviation 46 ± 16years), 67 (2%) had LEP. HRM measurements were similar in LEP and EP patients. However, LEP patients were more likely to have abnormal BET and RST. Logistic regression revealed that age (older than 50years), gender, test operator, and LEP influenced the results of BET and RST, with LEP having the strongest influence. Results of anorectal testing in constipated patients differ between LEP and EP patients. This is likely to represent a difference in disease prevalence between these groups, for example, due to referral bias, rather than a difference in physiology or a language barrier.

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

The Epidemiological Characteristics of Noncommunicable Diseases and Malignant Tumors in Guiyang, China: Cross-sectional Study.

Studies that address the changing characteristics of diseases are of great importance for preventing and controlling the occurrence and development of diseases and for improving health. However, studies of the epidemiological characteristics of noncommunicable diseases (NCDs) and malignant tumors (MTs) of the residents in Guiyang, China, are lacking. The aim of this study was to evaluate the prevalences of NCDs and MTs in residents of Guiyang, Guizhou Province, China, and analyze differences among ages, genders, and regions. A multistage stratified cluster sampling method was used. Based on the inclusion and exclusion criteria, 81,517 individuals were selected for the study. Of these, 77,381 (94.9%) participants completed the study. Structured questionnaires were used to collect information on demographic characteristics, NCDs, and MTs. The chi-square test (with 95% confidence intervals) was used to analyze differences in disease prevalence among genders, ages, and geographical regions. The major chronic NCDs of Guiyang residents are obesity, hypertension, and diabetes. MTs in women are mostly breast cancer, cervical cancer, and endometrial cancer, whereas in men, MTs are mainly lung cancer, rectal cancer, and gastric cancer. The prevalences of hypertension and diabetes in women are higher than in men, but the prevalences of lung cancer and gastric cancer in men are higher than in women. The epidemiological characteristics of individuals in different life stages are dissimilar. In terms of regional distribution, the prevalences of the above diseases in the Baiyun and Yunyan districts of Guiyang are relatively high. Several NCDs (obesity, hypertension, and diabetes) and MTs (women: breast cancer, cervical cancer, and endometrial cancer; men: lung cancer, rectal cancer, and gastric cancer) should be the focus for the prevention and control of chronic diseases in the future. In particular, the Baiyun and Yunyan districts of Guiyang are the important regions to emphasize.

Antibiotic Use in European Pig Production: Less Is More.

The goal of this study is to describe the current use of antibiotics in the European pig industry based on an extensive literature review. To achieve this, an overview of results from national (n = 15) and multi-country (n = 2) cross-sectional and longitudinal (n = 2) surveys, which describe antimicrobial use in pigs, is presented. Results are further linked to the outcome of the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project. Overall, it was found that weaned piglets received the most antibiotics, followed by suckling piglets resulting in over 80% of the treatments being administered to animals before 10 weeks of age. Furthermore, it was observed that antibiotic use (ABU) was significantly associated across age categories, indicating that farms with a high use in piglets also used more antibiotics in their finishers. This may, among other things, be explained by farmers' habits and behavior. However, above all, the studies showed surprisingly large differences in ABU between the countries. These differences may be related to the differences in disease prevalence and/or differences in the level of biosecurity. However, they may also reflect variations in rules and regulations between countries and/or a difference in attitude towards ABU of farmers and veterinarians that are not necessarily linked to the true animal health situation. Furthermore, it was observed that already a substantial proportion of the European pig production is able to successfully raise pigs without any group treatments, indicating that it is possible to rear pigs without systematic use of antibiotics. Based on the ESVAC data, a decline of 43.2% was observed in sales of antibiotics for animals in Europe between 2011 and 2020. To enable efficient antimicrobial quantification and stewardship, 15 European countries have already established systems for herd level monitoring ABU in pigs.

Racial Disparities among Patients Undergoing Infrainguinal Revascularization: An Analysis of Nationwide Inpatient Sample and Vascular Quality Initiative Databases 2012 - 2017

Introduction: A previous Vascular Quality Initiative (VQI) study conducted at our institution reported a surprising low number of Asian patients undergoing infrainguinal bypasses (IIBs). This may denote a potential racial disparity in access to care. We aimed to investigate the race-based differences among Asian, black, and white patients who underwent IIBs comparing the Nationwide Inpatient Sample (NIS) to VQI databases. Methods: NIS and VQI databases were queried from 2012-2017 for all peripheral arterial disease (PAD) patients undergoing IIBs. A multivariable model estimated the adjusted effects of race on in-hospital mortality rates. Results: Compared with NIS, VQI had a modestly higher proportion of black patients and lower white representation (P <.001). Asians are rare in both datasets and their representation in NIS is nearly double that seen in VQI (0.9% vs 0.5%; P <.001). Despite this, both datasets reflect a significant Asian under-representation compared with their US population of 5.6%. In NIS, Asians had the highest median income and were more likely to be on private insurance with the lowest smoking rates (P <.001 for all). However, they had higher in-hospital mortality (aOR, 2.96; [1.35-6.49]). Conclusion: In NIS and VQI, Asian patients are under-represented and this appears to be more pronounced in VQI. Additionally, the Asian population has higher in-hospital mortality rates despite their higher income and higher odds of having private insurance. This finding may reflect differences in disease prevalence, access to care, choice of therapy, delayed presentation, or provider biases. Further analysis of these data may guide efforts to mitigate race-based disparities in PAD management.