Department of Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (A.K.K., S.N., R.K.W., S.C., Y.S., R.W.Y., E.A.S.), Beth Israel Deaconess Medical Center, Boston, MA.
Department of Medicine, Division of Cardiology (A.K.K., R.K.W., R.W.Y., E.A.S.), Beth Israel Deaconess Medical Center, Boston, MA.
Circulation. 2022 Jul 19;146(3):191-200. doi: 10.1161/CIRCULATIONAHA.122.058998. Epub 2022 Jun 13.
Black adults have a higher incidence of peripheral artery disease and limb amputations than White adults in the United States. Given that peripheral endovascular intervention (PVI) is now the primary revascularization strategy for peripheral artery disease, it is important to understand whether racial differences exist in PVI incidence and outcomes.
Data from fee-for-service Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine age- and sex-standardized population-level incidences of femoropopliteal PVI among Black and White adults over the 3-year study period. Patients' first inpatient or outpatient PVIs were identified through claims codes. Age- and sex-standardized risks of the composite outcome of death and major amputation within 1 year of PVI were examined by race.
Black adults underwent 928 PVIs per 100 000 Black beneficiaries compared with 530 PVIs per 100 000 White beneficiaries (risk ratio, 1.75 [95% CI, 1.73-1.77]; <0.01). Black adults who underwent PVI were younger (mean age, 74.5 years versus 76.4 years; <0.01), were more likely to be female (52.8% versus 42.7%; 0.01), and had a higher burden of diabetes (70.6% versus 56.0%; <0.01), chronic kidney disease (67.5% versus 56.6%; 0.01), and heart failure (47.4% versus 41.7%; 0.01) than White adults. When analyzed by indication for revascularization, Black adults were more likely to undergo PVI for chronic limb-threatening ischemia than White adults (13 023 per 21 352 [61.0%] versus 59 956 per 120 049 [49.9%]; 0.01). There was a strong association between Black race and the composite outcome at 1 year (odds ratio, 1.21 [95% CI, 1.16-1.25]). This association persisted after adjustment for socioeconomic status (odds ratio, 1.08 [95% CI, 1.03-1.13]) but was eliminated after adjustment for comorbidities (odds ratio, 0.96 [95% CI, 0.92-1.01]).
Among fee-for-service Medicare beneficiaries, Black adults had substantially higher population-level PVI incidence and were significantly more likely to experience adverse events after PVI than White adults. The association between Black race and adverse outcomes appears to be driven by a higher burden of comorbidities. This analysis emphasizes the critical need for early identification and aggressive management of peripheral artery disease risk factors and comorbidities to reduce Black-White disparities in the development and progression of peripheral artery disease and the risk of adverse events after PVI.
在美国,黑种成年人患外周动脉疾病和肢体截肢的发病率高于白种成年人。鉴于外周血管腔内介入(PVI)现已成为外周动脉疾病的主要血运重建策略,了解 PVI 的发病率和结果是否存在种族差异非常重要。
评估了 2016 年至 2018 年医保按服务收费计划中≥66 岁的受益人的数据,以确定在 3 年的研究期间内,黑种和白种成年人中股腘 PVI 的年龄和性别标准化人群发病率。通过索赔代码确定患者的首次住院或门诊 PVI。根据种族,检查 PVI 后 1 年内死亡和主要截肢的复合结局的年龄和性别标准化风险。
黑种成年人每 10 万黑种受益人的 PVI 为 928 例,而白种成年人每 10 万白种受益人的 PVI 为 530 例(风险比,1.75 [95%置信区间,1.73-1.77];<0.01)。接受 PVI 的黑种成年人更年轻(平均年龄为 74.5 岁,而 76.4 岁;<0.01),女性比例更高(52.8%,而 42.7%;0.01),糖尿病(70.6%,而 56.0%;<0.01)、慢性肾脏病(67.5%,而 56.6%;0.01)和心力衰竭(47.4%,而 41.7%;0.01)的负担也更高。按血运重建的适应证进行分析时,黑种成年人更有可能因慢性肢体缺血威胁而接受 PVI,而不是白种成年人(13023 例/21352 例[61.0%],而 59956 例/120049 例[49.9%];0.01)。黑种种族与 1 年时的复合结局之间存在很强的关联(优势比,1.21 [95%置信区间,1.16-1.25])。这种关联在调整社会经济地位后仍然存在(优势比,1.08 [95%置信区间,1.03-1.13]),但在调整合并症后消除(优势比,0.96 [95%置信区间,0.92-1.01])。
在医保按服务收费计划的受益人中,黑种成年人的 PVI 人群发病率明显较高,并且在接受 PVI 后发生不良事件的风险明显高于白种成年人。黑种种族与不良结局之间的关联似乎是由合并症负担加重引起的。该分析强调了迫切需要早期识别和积极管理外周动脉疾病的危险因素和合并症,以减少黑人和白人在发展和进展外周动脉疾病以及 PVI 后不良事件风险方面的差异。