Abstract Body (Do not enter title and authors here): Background/Hypothesis: Racial disparities exist in treatment of peripheral artery disease (PAD) and disproportionally affect Black patients in the United States (US). Geographical variation in amputation across the US has been shown. We hypothesized that there are geographical differences in PAD treatment disparities between Black and White Americans across US states.
Study Design, Population, Methods and Sample Size: Data on 2,376,300 Black and White Medicare Fee-For-Service beneficiaries (9.2% Black) with a first diagnosis of PAD between 2018 and 2022 were studied. Patient counts for diagnosis, revascularization, and major amputation were summarized for each US state and used to calculate revascularization and amputation rates. County-level rates of revascularization and amputation were also correlated against publicly available county-level Social Vulnerability Index (SVI).
Intervention: NA
Power Calculation: NA
Outcomes: Black vs White patients were slightly younger (75.8±7.9 years vs 76.9±7.8 years; p<0.001) and more likely women (54.7% vs 47.8%; p<0.001) with higher prevalence of comorbidities. Black patients were more likely to undergo procedures for PAD compared with White patients (3.0% vs 0.9%; p<0.001 for major amputation and 8.4% vs 7.0%; p<0.001 for revascularization). Major amputation rates were significantly higher in Black vs White patients in all states (p<0.001 for all). However, the excess of amputation in Black vs White patients differed markedly between the states, resulting in a wide variation of racial treatment disparities across the US (Figure 1). The correlation between amputation and SVI was stronger (rho 0.46, p<0.001) than the correlation between revascularization and SVI (rho 0.10, p<0.001).
Conclusion: This is the first study to show that PAD treatment disparities between Black and White patients differ markedly across the US and are mostly driven by differences in major amputation rates among Black patients between states. Community-level risk, as identified by the SVI, may play a role in certain treatment patterns and warrant further investigation.