Abstract

Background: Racial disparities exist regarding treatment and outcomes of peripheral artery disease (PAD) in the United States (US). Black versus White Americans are more likely to have delayed PAD diagnosis and are at higher risk of lower limb amputation. Aim: To investigate regional differences in PAD treatment disparities between Black and White Americans. Methods: Data on 2,376,300 Black and White Medicare Fee-For-Service beneficiaries with a first diagnosis of PAD between 2018 and 2022 were studied. Patient counts for diagnosis, revascularization, and amputation were summarized for each state and used to create forest plots of revascularization and amputation rates. County-level rates of revascularization and amputation rates by race were also correlated against publicly available county-level Social Vulnerability Index (SVI). Results: Black versus White patients were slightly younger (75.8±7.9 years vs 76.9±7.8 years; p<0.001) and more likely female (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 with marked variation between states (Figure 1). Black patients were also more likely to have revascularizations or amputations compared with White patients (8.4% vs 7.0%; p<0.001 and 3.0% vs 0.9%; p<0.001, respectively). Correlations between county-level SVI and revascularization rates were stronger among white patients (rho = 0.08, p-value = 0.005) compared to Black patients (rho = 0.04, p-value = 0.40). Similarly, correlations between county-level SVI and amputation rates were stronger among White patients (rho = 0.27, p-value <0.01) compared to Black patients (rho = 0.12, p-value = 0.17). Conclusion: Treatment disparities between Black and White patients with PAD differed markedly in the US by state with largest racial differences in amputation rates occurring among Southern states. Community-level risk, as identified by the SVI, may play a role in certain treatment patterns and warrant further investigation. Full data on this will be presented.