N. R. Barshes1, K. D. Smith3, H. Serag3, B. J. Carter2, S. O. Rogers2 1Baylor College Of Medicine,Division Of Vascular And Endovascular Surgery, DeBakey Department Of Surgery,Houston, TX, USA 2University Of Texas Medical Branch,Galveston, TX, USA 3University Of Texas Medical Branch,Center To Eliminate Health Disparities,Galveston, TX, USA
Introduction: Previous analyses of national data have suggested racial disparities in leg amputation rates. We sought to determine whether race- or insurance-based disparities in leg amputations occur among people in Texas with peripheral artery disease (PAD).
Methods: Deidentified hospital admission data from the Texas Inpatient Public Use Data File was used to identify admissions associated with the diagnosis of PAD as well as either revascularization (endovascular or surgical procedures) or leg (i.e. above-ankle) amputation from 2004 to 2010. Multivariate regression models were used to identify factors independently associated with ER admission and leg amputation. All analyses were performed using Intercooled State v8.0 (College Station, TX), with p<0.05 considered significant.
Results: 29,128 revascularization procedures and 6,482 leg amputations were performed in Texas from 2004-2009 for PAD-related diagnoses. The unadjusted incidence rates of leg amputation were 5.0 per 100,000 total population per year (per 100K/yr) for non-Hispanic white persons versus 7.2 for black persons, 3.1 for Hispanic persons, and 0.7 for Asian persons. Leg amputation rates also ranged from 2.7 per 100K/yr in zip codes in lowest quartile of poverty prevalence to 5.0 per 100K/yr in the middle two quartiles and 6.8 per 100K/yr in the highest quartile of poverty prevalence. Hospital admission through the emergency room was much more common among those without insurance (odds ratio [OR] 2.2, p<0.001) or only Medicaid coverage (OR 1.1, p=0.002) and was much less common among those with Medicare, HMO/PPO, or private insurance coverage (odds ratio [OR] 0.68-0.76, all p<0.0001). After adjustment for clinical factors (incl. foot infection, comorbidities), demographic features (incl. age, gender), and geography (viz. Texas public health region), leg amputations without antecedent revascularization attempts occurred much more frequently in patients that were categorized as black (odds ratio [OR] 2.1, p<0.001) or Hispanic (OR 1.6, p<0.001), those with Medicaid coverage (OR 2.1, p<0.001), and those that were uninsured (OR 2.0, p<0.001; Table 1). Overall model R2 was 0.16. Race/ethnicity, Medicaid coverage, or uninsured status was not associated with an increased rate of leg amputation in patients that had undergone revascularization.
Conclusion: Leg amputations among people with PAD in Texas vary widely, with higher risk-adjusted rates occuring in people who are uninsured, insured only by Medicaid, or are categorized as black or Hispanic. State-wide efforts should focus on addressing these existing health disparities.
