183917 Racial variation in level of amputation among individuals with vascular disease

Sunday, October 26, 2008

Kristin M. Lefebvre, PT, PhD, CCS , Institute for Physical Therapy Education, Widener University, Chester, PA
Stephen Metraux, MA, PhD , Department of Health Policy & Public Health, University of the Sciences in Philadelphia, Philadelphia, PA
Purpose/Hypothesis : The purpose of this study was to evaluate the relationship between race and level of amputation. Number of Subjects : From the Healthcare Cost and Utilization Nationwide Inpatient Dataset (HCUP NIS) for the year 2003, N = 132,813 (weighted) individuals were identified as having an amputation. All individuals with vascular disease and who were of the Black or White race were maintained for analysis leaving an N = 80,845 (weighted). Materials/Methods : Using ICD-9-CM procedure and diagnosis codes, individuals with vascular disease who received lower extremity amputations were categorized into above and below knee. Using SPSS 15.0 complex samples software, to take into account data weights and to achieve appropriate variance estimates, both bivariate chi square and logistic regression analysis identified the relationship between race and level of amputation, including evaluation of the potential influence of covariates such as age, gender, level of illness, geographic location, primary insurance, and median income per zip code. Results : Bivariate analysis reveals a significant association between race and level of amputation (chi square = 93.972, p<.000), which is consistent with the hypothesis of this study. In addition to race, the covariates including gender (chi square = 186.960, p<.000), level of illness (chi square = 162.202, p<.000), age (chi square = 927.267, p<.000), vascular illness (chi square =29.469, p<.000), primary insurance (chi square = 492.122, p<.000) and median income per zipcode (chi square = 30.472, p<.001) were found to have a significant relationship with level of amputation. Logistic regression analysis showed that race continued to influence level of amputation (p<.000, AOR 1.511), even in the presence of other covariates. Other covariates were also significant for influencing level of amputation including age (p<.000, AOR 1.029), female gender (p<.000, AOR 1.332), Charlson co-morbidity index (p<.000, AOR 1.120), Medicare (p<.017, AOR 1.338), Medicaid (p<.003, AOR (B) 1.629), peripheral vascular disease (p<.000, AOR 1.217) and cerebrovascular disease (p<.000, AOR 1.798). Conclusions : As per the hypothesis, race does influence level of amputation, even when taking into account the covariates that could influence higher level amputation. Clinical Relevance : Higher level amputation has significant consequences. Minority patients should be screened closely for peripheral vascular disease of the lower extremities. Practitioners should incorporate the use of screening tools such as the ankle brachial index and Edinburgh Claudication questionnaire into general medical screening of minority patients.

Learning Objectives:
1) Participants will recognize the presence of a racial disparity in level or severity of lower extremity amputation. 2) Participants will be able to define the variables that lend to higher level amputation among individuals of a minority status with vascular disease. 3) Participants will understand the impact of a disparity in higher level amputation from a provider, individual and societal perspective. 4) Participants will be able to identify tests and preventative screening measures to eliminate a disparity in higher level amputation. 5) Participants will understand how the HCUP-NIS 2003 dataset was used to determine the presence of a disparity in level of amputation among minorities.

Keywords: Health Disparities, African American

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD in Health Policy from the University of the Sciences in Philadelphia. This research is a product of my doctoral dissertation work using HCUP-NIS 2003 data. I have presented on Health Disparities topics at numerous national Physical Therapy conventions and am contracted to write a chapter in a Health Disparities text. I have also published a review article in the peer reviewed literature.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Medical Care Section Poster Session: Ethnic & Racial Disparities
See more of: Medical Care