227241 Racial/ethnic treatment patterns of peripheral artery disease in California, 1998-2007

Tuesday, November 9, 2010

David J. Reynen, MPPA, MPH, CPH , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
Alisa S. Kamigaki, MPH , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
David A. Rocha, BA , California Heart Disease and Stroke Prevention Program, WISEWOMAN Program, California Department of Public Health, Sacramento, CA
Lily A. Chaput, MD, MPH , California Heart Disease and Stroke Prevention Program, California Department of Public Health, Sacramento, CA
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 (19982007). 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.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Describe the types of treatment of Peripheral Artery Disease (PAD) in California, as presented in this paper. Discuss how the treatment patterns of PAD in California have changed over ten years, as presented in this paper. Recognize that the co-morbid conditions prevalent among those with PAD in California may impact treatment options, as presented in this paper.

Keywords: Treatment, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Together with my colleagues, I designed the study, analyzed the data, interpreted the results, and wrote the abstract.
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.