Evaluating Disparities in Clinical Outcomes Among Medicare Beneficiaries With Peripheral Artery Disease (PAD): A Call To Action for Health Equity

Speaker(s)

Monteleone P1, Sato R2, Williams A3, Duval S4, Greenberg-Worisek A5, Wifler W5, Jaff MR5, Giri J6
1Ascension, Austin, TX, USA, 2Boston Scientific, Weymouth, MA, USA, 3Boston Scientific, Marlborough, MA, USA, 4University of Minnesota, Minneapolis, MN, USA, 5Boston Scientific, Maple Grove, MN, USA, 6Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Presentation Documents

OBJECTIVES: Existing research has demonstrated that significant diagnosis and treatment disparities exist among patients with peripheral artery disease (PAD), including disparities related to race/ethnicity, sex, and geographical location. However, these studies have primarily examined each factor individually. This study investigated the treatment patterns of US Medicare beneficiaries diagnosed with PAD by focusing on the combined effects of race and location characteristics.

METHODS: The 100% Medicare Standard Analytical Files were used to identify patients diagnosed with PAD between 2016 and 2022. The primary outcomes evaluated were death within two years of PAD diagnosis, amputation, and endovascular revascularization (ER) treatment after PAD diagnosis. All US counties were categorized based on the percentage of the non-White population, and outcomes were compared between the lowest and highest quartiles for each race/ethnicity (Black vs. White, Hispanic, and other race). Multivariable logistic regression was used to assess the differences in these outcomes while controlling for age, sex, and comorbidities.

RESULTS: Black patients had the highest mortality (27.9% vs. 25.0% [all other race], p<0.001) and amputation rate (4.1% vs. 1.5% [all other race], p<0.001). Patients in high non-White counties, regardless of race, had an increased risk of death (27.7% vs. 24.6%, p<0.001) and amputation (2.3% vs. 1.5%, p<0.001) than patients in low non-White counties. Black patients had the highest probability of ER (4.8% vs. 4.2% [all other race], p<0.001). However, patients in high non-White counties had a lower probability of ER (3.9% vs. 4.4%, p<0.001) than patients in low non-White counties. This pattern was consistent for each race/ethnic group.

CONCLUSIONS: This study highlights the combined impact of race and location characteristics in explaining health disparities among PAD populations. Geographically targeted interventions in high non-White areas could improve treatment access and may contribute to the advancement of sustainable health equity.

Code

CO121

Topic

Clinical Outcomes, Epidemiology & Public Health

Topic Subcategory

Clinical Outcomes Assessment, Public Health

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Medical Devices