Vogel Birgit, Dangas Katerina, Di Muro Francesca Maria, Sartori Samantha, Oliva Angelo, Dangas George, Krishnan Prakash, Yoon Harrison, Etter Katherine, Erim Daniel, Pylypchuk Yuriy, Keever Rachel, Mehran Roxana
Icahn School of Medicine at Mount Sinai, New York, New York.
Oxford University School of Medicine, Oxford, United Kingdom.
JAMA Cardiol. 2025 Aug 1;10(8):820-828. doi: 10.1001/jamacardio.2025.1714.
Racial disparities in the management of peripheral arterial disease (PAD) are well established. Analysis of the temporal trends and geographic variation in racial differences in the use of revascularization and major amputation may identify areas for targeted intervention.
To investigate differences in the treatment of PAD between Black and White patients over time and by US state.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data for Medicare fee-for-service beneficiaries with a PAD diagnosis between 2018 and 2022. Data were analyzed from November 14, 2023, to February 13, 2025.
Black and White race.
The proportions of Black and White patients with PAD undergoing revascularization and major amputation were compared over time and by state. Data were adjusted for age, sex, hypertension, diabetes, tobacco use, chronic kidney disease, and county-level Social Vulnerability Index (SVI).
The total sample size was 2 376 300 beneficiaries (1 224 537 men [51.5%]). Black patients (219 338 [9.2%]) were slightly younger than White patients (2 156 962 [90.8%]; mean [SD] age, 75.8 [7.9] years vs 76.9 [7.8] years; P < .001) and had a higher prevalence of comorbidities. A higher proportion of Black patients (8.9%) than White patients (7.6%) underwent revascularization (odds ratio, 1.19 [95% CI, 1.18-1.21]; P < .001), and a higher proportion of Black patients (2.8%) than White patients (1.0%) underwent major amputation (odds ratio, 2.91 [95% CI, 2.83-2.99]; P < .001). Higher proportions of Black patients than White patients underwent revascularization and major amputation in the majority of states, although with marked variation in these proportional differences across states. The proportions of Black and White patients who underwent revascularization decreased over time (from 8.0% to 7.4% for Black patients and from 6.8% to 6.2% for White patients). The proportion of Black patients who underwent major amputation decreased (from 2.9% to 2.5%; P < .001), but there was no change among White patients (from 0.7% to 0.7%; P = .53). Revascularization correlated weakly (ρ = 0.10), and amputation correlated moderately with SVI (ρ = 0.46).
These findings suggest that higher proportions of Black patients than White patients undergo invasive procedures for PAD, with considerable variation across states. Although the proportional difference in major amputations has narrowed over time, the persistent proportional excess of major amputations among Black patients requires further study to investigate whether this difference reflects remediable disparities in care.
外周动脉疾病（PAD）管理中的种族差异已得到充分证实。分析血管重建术和大截肢术使用方面种族差异的时间趋势和地理差异，可能会确定有针对性干预的领域。
调查不同时间以及美国各州黑人和白人患者在PAD治疗上的差异。
设计、设置和参与者：这项队列研究检查了2018年至2022年间诊断为PAD的医疗保险按服务收费受益人的数据。数据于2023年11月14日至2025年2月13日进行分析。
黑人和白人种族。
比较不同时间以及各州接受血管重建术和大截肢术的黑人和白人PAD患者的比例。数据针对年龄、性别、高血压、糖尿病、吸烟、慢性肾病和县级社会脆弱性指数（SVI）进行了调整。
总样本量为2376300名受益人（1224537名男性[51.5%]）。黑人患者（219338名[9.2%]）比白人患者（2156962名[90.8%]）年龄稍小（平均[标准差]年龄，75.8[7.9]岁对76.9[7.8]岁；P＜0.001），且合并症患病率更高。接受血管重建术的黑人患者比例（8.9%）高于白人患者（7.6%）（优势比，1.19[95%置信区间，1.18 - 1.21]；P＜0.001），接受大截肢术的黑人患者比例（2.8%）高于白人患者（1.0%）（优势比，2.91[95%置信区间，2.83 - 2.99]；P＜0.001）。在大多数州，接受血管重建术和大截肢术的黑人患者比例高于白人患者，尽管这些比例差异在各州有显著变化。接受血管重建术的黑人和白人患者比例随时间下降（黑人患者从8.0%降至7.4%，白人患者从6.8%降至6.2%）。接受大截肢术的黑人患者比例下降（从2.9%降至2.5%；P＜0.001），但白人患者无变化（从0.7%降至0.7%；P = 0.53）。血管重建术与SVI的相关性较弱（ρ = 0.10），截肢术与SVI的相关性中等（ρ = 0.46）。
这些发现表明，接受PAD侵入性治疗的黑人患者比例高于白人患者，各州之间存在相当大的差异。尽管大截肢术的比例差异随时间有所缩小，但黑人患者中大截肢术比例持续过高，需要进一步研究以调查这种差异是否反映了可补救的医疗差异。
