Peripheral Artery Disease (PAD) is a vascular condition characterized by the narrowing of arteries, leading to reduced blood flow to the arms or legs. Around 20 million Americans are affected by PAD, with the burden mostly impacting rural and underserved communities. These areas, often located in Southern and Western states, have high minority populations. Notably, Black medicare patients with PAD are three times more likely to have a limb amputated than a non-black medicare patient. This significant disparity has been a focal point for researchers Keith C. Ferdinand, Kay Sadik, Richard Browne, Urvi Desai, Patrick Lefebvre, Dominique Lejeune, Malena Mahendran, François Laliberté, Lisa Matay and David G. Armstrong. Their study shed light on the disparities in treatment of PAD patients.
ALPS Founding President Dr. David G. Armstrong highlights the importance of the research:
“This research is vital because it highlights persistent racial disparities in PAD outcomes, even within a commercially insured population. By illuminating these gaps, we can inform targeted strategies to reduce inequities and improve outcomes for all patients. Moreover, this study emphasizes the importance of examining real-world data to guide clinical and policy decisions, ensuring that no patient group is left behind.”
Furthermore, Armstrong suggested these steps to prevent disparities in health care
How do we prevent disparities in health care?
- Early Diagnosis and Risk Stratification: Enhancing access to diagnostic tools and early intervention programs in underserved communities is critical.
- Tailored Treatment Plans: Developing culturally competent care models that address social determinants of health and patient-specific risk factors.
- Policy and Advocacy: Advocating for equitable healthcare policies that prioritize preventive care and resource allocation for high-risk populations.
- Community Engagement: Partnering with community leaders and organizations to promote awareness about PAD and associated risks, particularly in Black communities.
- Furthermore, Armstrong suggested these steps to prevent disparities in health care
Dr. Keith C. Ferdinand, Professor of Medicine, co-author and researcher, remarked on the importance of the research:
“The importance of doing this research is to reveal areas which need special attention to address disparities. The results of this real-world study suggest that Black patients with PAD have a higher disease severity at the time of diagnosis and are at increased risk of experiencing adverse outcomes following diagnosis. Even more importantly, this was an insured population. If patients have no insurance, are underinsured, or lose insurance, their outcomes may be worsened. “
Research Overview
The PubMed study Real-World Racial Variation in Treatment and Outcomes Among Patients with Peripheral Artery Disease evaluates trends in diagnostic testing, treatment patterns, and outcomes after diagnosis of PAD.
The authors identified 454.382 (68%) white patients and 96.162 (14%) black patients for this study. Even though the black patients on average were younger (71.8 years vs. 74.2 years), they experienced more severe PAD-related risk factors. Results of this real-world study suggest that black patients with PAD have higher disease severity at the time of diagnosis and are at an increased risk of experiencing adverse outcomes following diagnosis
The study showed that black patients presented with higher disease severity and comorbid burdens at the time of diagnosis compared to white patients. Moreover, they had higher utilization rates of cardiovascular medications at baseline but faced an increased risk of major adverse limb events (MALE) and cardiovascular events, except for myocardial infarction.
Additionally, recent studies found that Black Americans were less likely to be offered preventive procedures to salvage affected limbs thus avoiding amputation. These findings could be linked to why black patients present with higher severity of disease at the time of diagnosis, necessitating earlier intervention. These findings point to the potential for unmet needs in comprehensive care for Black patients, despite higher rates of medication use and diagnostic testing. Notably, the study suggests that revascularization procedures, which restore the blood flow in blocked arteries or veins, are more likely to be combined with the medical therapy black patients receive contrary to earlier studies.
In conclusion, black patients experience a significantly higher disease burden compared to white patients. The authors emphasize the urgent need to address disparities in healthcare delivery and outcomes by delivering earlier diagnosis and effective medical therapy for Black patients with PAD.
Awareness of disparities in PAD
Dr. Keith C. Ferdinand said this on how to prevent PAD:
“In order to address these disparities in PAD, we need to apply evidence-based medicine with early diagnosis and evidence-based treatment to all patients, regardless of race, ethnicity, socioeconomic status, geography, sex/gender, or ability/disability. The removal of these disparities is not just a moral imperative, but a practical necessity to avoid high medical costs, chronic disability, and premature death.”
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