About 6.5 million Americans over the age of 40 suffer from peripheral arterial disease (PAD). In the USA, Black adults in their 50s are at least twice as likely to suffer from PAD as their white counterparts, a disparity that continues to increase with age.
In a new paper published in Circulation, researchers at the Richard A and Susan F Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC; Boston, USA) conducted a large, nationwide analysis of Medicare beneficiaries to document racial differences in revascularisation treatment for PAD, and outcomes for patients with PAD. The team found that Black adults underwent significantly more endovascular peripheral vascular interventions (PVI), were treated for more advanced disease and were also more likely to experience adverse outcomes following PVI procedures, including amputation and death.
“Black race was significantly associated with worse one-year outcomes after revascularisations, after adjusting for age and sex,” said senior corresponding author Eric Secemsky, director of Vascular Intervention at BIDMC, as well as section head of Interventional Cardiology and Vascular Research at the Smith Center for Outcomes Research at BIDMC. “This link persisted after we adjusted for individual and regional socioeconomic factors. However, the association between Black race and worse outcomes was no longer apparent after we adjusted for comorbidities, suggesting that the well documented Black-white disparities in the prevalence of PAD risk factors, including hypertension, diabetes and end-stage renal disease, explain the disproportionate development of PAD among Black adults.”
The analysis included 215,320 patients who underwent the gold-standard revascularisation procedure—PVI—between 2016 and 2018. Black adults had a higher incidence of treatment, with 0.86 percent of Black Medicare beneficiaries undergoing the procedure, compared to 0.51 percent of white Medicare beneficiaries. What is more, a greater proportion of Black adults were treated for more severe arterial disease, while more white patients were treated for a milder form of PAD. Despite their relatively greater severity of disease, a lower percentage of Black adults were prescribed key cardiovascular medications.
“Structural racism perpetuates these health disparities,” said Secemsky, who is also an associate professor of Medicine at Harvard Medical School (Boston, USA). “One important way in which these systemic and structural factors lead to worse outcomes in Black patients is through comorbidities. This suggests a critical need for targeted, upstream intervention to reduce the disproportionate burden of PAD in the Black population.”
Co-authors included Sahana Natesan, Rishi K Wadhera, Siyan Chen, Yang Song, and Robert W Yeh of the Smith Center at BIDMC; Michael R Jaff of Harvard Medical School; and Jay Giri and Howard Julien of the Perelman School of Medicine, University of Pennsylvania (Philadelphia, USA).