Healthcare inequities in PAD therapy

From 2007 to 2011 among Medicare beneficiaries with diabetes and PAD, the amputation rate for black patients was nearly three times the rate for nonblack patients.¹

When it comes to equity in the healthcare system, there are glaring differences in the prevalence of peripheral arterial disease (PAD) in minority patients as well as the medical treatment they often receive.

Approximately 8-12 million Americans are affected by PAD, including 1 in 3 diabetics over the age of 50.² PAD is caused by fatty deposits that restrict blood flow in the arteries outside the heart, most commonly occurring in the legs. If left untreated, PAD can lead to gangrene, diabetic foot ulcers, and amputation.

According to a study by Eraso et al,³ PAD occurs at the highest rate in non-Hispanic black women 70+ years (25.3%), non-Hispanic Black women with chronic kidney disease (21.7%), and Mexican American men 70+ years (20.85%).

Every year, diabetic Americans with foot ulcers undergo about 85% of non-traumatic amputations.⁴

A majority of the estimated 200,000⁴ annual non-traumatic amputations can be avoided with early detection and proper care.

Early detection through an ABI screening or angiogram can help save legs

Early detection is the key to helping prevent the most serious complications of PAD, including amputation. An ankle-brachial index (ABI) test is a simple test that compares blood pressure in the arms with blood pressure in the legs. The difference in the numbers determines if there is PAD as well as its severity.

Data “suggest African-Americans… have less access to care because they are being admitted when sicker and more likely on an emergent basis.⁵ Angiogram were at a 90% lower odds of having an amputation.”⁶

Common risk factors include:

• Smoking
• Diabetes
• Obesity
• High blood pressure
• Lack of exercise
• Family history of atherosclerosis (hardening of the arteries)
• High cholesterol

What are the symptoms of PAD?

Most people with PAD don’t show any warning signs. Only one-quarter to one-third⁷ of people who are diagnosed with PAD have any symptoms at all. People who have symptoms often mistake them for signs of aging.

The most common symptom of PAD is leg pain that occurs when walking but goes away during rest. Other symptoms include:

• Numbness or weakness in the legs
• Aching pain in the feet or toes while at rest
• Ulcers or sores in the leg or foot that don’t heal
• Cold legs or feet
• Skin-color changes in the legs or feet

Resources

Society of Interventional Radiology (SIR)
Society for Vascular Surgery (SVS)
CDC Cardiovascular Coalition

References

1. Goodney PP, Dzebisashvilli N, Goodman DC, et al. Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease. Hanover, New Hampshire: The Dartmouth Atlas; 2014:1–60.
2. Facts about peripheral arterial disease (P.A.D.). National Heart, Lung, and Blood Institute Web site. https://www.nhlbi.nih.gov/health-topics/peripheral-artery-disease. Published August 2006. Accessed September 3, 2019.
3. Eraso LH, Fukaya E, Mohler ER III, et al. Peripheral arterial disease, prevalence and cumulative risk factor profile analysis. Eur J Prev Cardiol. 2014 Jun; 21(6): 704–711.
4. Mind the gap: the case for screening high-risk communities for PAD. 2019. CardioVascular Coalition.
5. Mustapha JA, Fisher BT Sr, Rizzo JA, et al. Explaining racial disparities in amputation rates for the treatment of peripheral artery disease (PAD) using decomposition methods. J Racial Ethn Health Disparities. 2017 Feb 15;4(5):784-795.
6. Henry AJ, Hevelone ND, Belkin MB, et al. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. J Vasc Surg. 2011;53:330-9.e1.
7. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(suppl 1):S1-S75.