Race-dependent Variability in Rates of Amputations and Revascularization: A Contemporary Trend Analysis of Hospitalized Patients from 2003 to 2017

Historically, it has been demonstrated that nonwhite patients with peripheral artery disease (PAD) have undergone revascularization at a decreased rate and amputation at a higher rate compared with white patients. Our study objective was to assess the current trends in the rates of amputation and revascularization among hospitalized patients with PAD. The Nationwide Inpatient Sample was queried from 2003 to 2017 to review trends of revascularization and amputation rates per 100,000 hospitalizations among patients with PAD. From 2003 to 2017, 1,478,863 amputations and 1,268,279 revascularizations were performed in hospitalized patients. Although an overall decrease had occurred in the rate of amputations for PAD patients during the study period (Fig 1; 13,131 per 100k in 2003 vs 10,238 per 100k in 2017; P < .01), the rates between white and nonwhite populations remain disparate. The overall rate of amputations for white patients in 2017 was 8946 per 100k; however, for nonwhite patients, the rate was 12,591 per 100k (P < .01). The overall rate of revascularization in hospitalized patients with PAD also decreased during the study period (Fig 2; 12,627 per 100k in 2003 vs 8654 per 100k in 2017; P < .01). The revascularization rates were higher in nonwhite patients in 2017 (9020 per 100k vs 8435 per 100k; P < .01), and the overall trends in-hospital revascularization remained higher in nonwhite patients during the study period. In 2017, the endovascular revascularization rates were higher for the nonwhite patients (6398 per 100k vs 5227 per 100k; P < .01), and the open revascularization rates were higher for the white patients (3208 per 100k vs 2622 per 100k; P < .01). The overall rates of amputations and revascularizations have been decreasing in hospitalized patients. However, the disparate trends based on race have continued in the contemporary era. Nonwhite patients have continued to have higher rates of amputation and are more likely to undergo endovascular revascularization.Fig 2Revascularization procedures in patients with peripheral artery disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)