Racial/ethnic treatment patterns of peripheral artery disease in California, 1998-2007

Background: Peripheral Artery Disease (PAD) is associated with considerable morbidity, necessitating a range of in-hospital surgical procedures. The present study examines PAD treatment, overall and by race/ethnicity, using 10 years of California Patient Discharge Data (CPDD).

Methods: First, patients with a primary diagnosis of PAD were selected from the CPDD (1998–2007). Next, for each patient, it was determined whether s/he received any number of the following surgical procedures: angioplasty (AN); peripheral vascular bypass (B); amputation (AM); endarterectomy (E). Finally, treatment patterns were observed, and co-morbid conditions were assessed.

Results: Over the 10 year study period, there were 117,990 PAD discharges, with a peak in 1999 (13,201). This total patient population (n=117,990) was 45.4% female and 68.5% white. Overall, the proportion of patients receiving any kind of treatment increased; however, the racial/ethnic treatment patterns differed over the study period. For whites in 1998, less than 20% received AN or AM or E, while 44.5% received B; by 2007, B dropped to 30.5%, and AN increased to 40.5%. For African Americans, who also experienced an increase in AN (from 8.7% in 1998 to 35.3% in 2007), AM was performed at a much higher rate (34.5% in 1998; 24.4% in 2007). Asian/PIs and Hispanics similarly experienced increases in their AN rates and had relatively high rates of AM across the study period (compared to whites). For these non-white subgroups, co-morbid diabetes (age-adjusted Odds Ratio for AM=2.13; 95% CI: 1.92-2.35) was very prevalent (2007), relative to whites (34.9% white; 47.9% African American; 63.8% Asian/PI; 68.2% Hispanic).

Conclusions: Treatment patterns for PAD differed by race/ethnicity, with non-whites undergoing amputation more frequently than their white counterparts. Public education campaigns that focus on actions to control risk factors, early detection, and early treatment should be targeted at high-risk non-white populations.