Tulane University School of Medicine, New Orleans, LA, USA.
Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Adv Ther. 2023 Apr;40(4):1850-1866. doi: 10.1007/s12325-023-02465-6. Epub 2023 Mar 6.
Prior studies have found considerable disparities in prevalence and outcomes for patients with peripheral arterial disease (PAD). This study compared rates of diagnostic testing, treatment patterns, and outcomes after diagnosis of PAD among commercially insured Black and White patients in the United States.
Optum's de-identified Clinformatics Data Mart Database (1/2016-6/2021) were used to identify Black and White patients with PAD; first PAD diagnosis was deemed study index date. Baseline demographics, markers of disease severity, and healthcare costs were compared between cohorts. Patterns of medical management and rates of major adverse limb events (MALE; including acute or chronic limb ischemia, lower-limb amputation) and cardiovascular (CV) events (stroke, myocardial infarction) during the available follow-up period were described. Outcomes were compared between cohorts using multinomial logistic regression models, Kaplan-Meier survival analysis, and Cox proportional hazards models.
A total of 669,939 patients were identified, with 454,382 White patients and 96,162 Black patients. Black patients were younger on average (71.8 years vs. 74.2 years), but had higher comorbid burden, concomitant risk factors, and CV medication use at baseline. Prevalence of diagnostic testing, revascularization procedures, and medication use was numerically higher among Black patients. Black patients were also more likely than the White patients to receive medical therapy without a revascularization procedure [adjusted odds ratio with 95% confidence interval (CI) = 1.47 (1.44-1.49)]. However, Black patients with PAD had higher incidence of MALE and CV events than White patients [adjusted hazard ratio for composite event (95% CI) = 1.13, (1.11-1.15)]. Except myocardial infarction, the hazards of individual components of MALE and CV events were also significantly higher among Black patients with PAD.
Results of this real-world study suggest that Black patients with PAD have higher disease severity at the time of diagnosis and are at increased risk of experiencing adverse outcomes following diagnosis.
先前的研究发现，外周动脉疾病（PAD）患者的患病率和结局存在相当大的差异。本研究比较了美国商业保险的黑人和白人 PAD 患者在诊断后的诊断检测、治疗模式和结局。
使用 Optum 的去识别 Clinformatics Data Mart 数据库（2016 年 1 月至 2021 年 6 月）确定 PAD 患者；首次 PAD 诊断被视为研究索引日期。在队列之间比较了基线人口统计学特征、疾病严重程度标志物和医疗保健费用。描述了在可用的随访期间，医疗管理模式的模式和主要不良肢体事件（MALE；包括急性或慢性肢体缺血、下肢截肢）和心血管（CV）事件（中风、心肌梗死）的发生率。使用多项逻辑回归模型、Kaplan-Meier 生存分析和 Cox 比例风险模型比较队列之间的结局。
共确定了 669939 名患者，其中 454382 名白人患者和 96162 名黑人患者。黑人患者的平均年龄较小（71.8 岁与 74.2 岁），但基线时合并症负担、并存危险因素和 CV 药物使用较高。黑人患者的诊断检测、血运重建手术和药物使用的患病率在数值上较高。与白人患者相比，黑人患者更有可能接受不进行血运重建手术的药物治疗[调整后的优势比（95%置信区间）=1.47（1.44-1.49）]。然而，患有 PAD 的黑人患者发生 MALE 和 CV 事件的发生率高于白人患者[复合事件的调整后风险比（95%置信区间）=1.13，（1.11-1.15）]。除心肌梗死外，PAD 黑人患者的 MALE 和 CV 事件的各个组成部分的风险也明显更高。
这项真实世界研究的结果表明，PAD 黑人患者在诊断时的疾病严重程度更高，并且在诊断后发生不良结局的风险增加。
