Birgit Vogel, MD: Exploring Geographical Disparities in PAD Care Across US

A nationwide analysis of 2,376,300 Medicare beneficiaries with peripheral artery disease (PAD) revealed significant racial and geographic disparities in treatment, disproportionately affecting Black Americans.

Conducted between 2018 and 2022, this study, presented at the American Heart Association (AHA) Scientific Sessions 2024, found that disparities in amputation rates varied widely across states, underscoring geographical differences in PAD treatment inequities.

“There was not any correlation between revascularization and the [Social Vulnerability Index (SVI)] index, but a modest correlation between major amputation rates and SVI. That suggests that the SVI reflects socioeconomic and demographic factors like poverty and minority status,” Birgit Vogel, MD, the director of academic affairs at the Center for Interventional Cardiovascular Research and Clinical Trials at the Icahn School of Medicine at Mount Sinai, told HCPLive. “We think that community-level risk could impact these patterns of major amputation.”

In the analysis, Black patients experienced markedly higher rates of major amputations compared to White patients in every U.S. state (3.0% vs. 0.9%; P <0.001). Despite undergoing revascularization more frequently than White patients (8.4% vs. 7.0%; P <0.001), Black patients additionally consistently faced greater risks of limb loss.

Further analysis revealed that county-level Social Vulnerability Index (SVI) scores—a measure of community-level risk factors—were more strongly correlated with amputation rates (rho 0.46, p<0.001) than revascularization rates (rho 0.10, P <0.001). These data suggest the contribution of structural and community factors to the disproportionate burden of limb loss in Black patients.

Notably, Black patients were younger (75.8 years vs. 76.9 years; p<0.001), more likely to be female (54.7% vs. 47.8%; p<0.001), and had a higher prevalence of comorbidities compared to their White counterparts. These findings emphasize the urgent need for targeted interventions addressing racial and geographic disparities in PAD care, particularly focusing on preventive strategies and access to limb-preserving treatments in high-risk communities.

“By looking at regional differences and identifying areas that have the largest disparities, we could think about resource allocation and prioritize those areas to not only do research, but also when we are trialing public health initiatives, or even we could even think about health policy on a state level that might differ between certain areas,” Vogel told HCPLive.

Disclosures: Vogel reports no relevant disclosures.

Reference

_{Vogel B, Dangas K, Di Muro FM, Sartori S, et al. Geographical variations of treatment disparities between Black and White patients with peripheral artery disease across the United States. Presented at the American Heart Association (AHA) Scientific Sessions 2024. Chicago, Illinois. November 16-18, 2024.}