期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 7, 期 2, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.117.007425
关键词
amputations; disparities; race; socioeconomic position
资金
- Arya: American Heart Association Mentored Clinical and Population Research Award [15MCPRP25580005]
- National Institutes of Health-National Institute of Aging (NIH-NIA) [1R03AG050930]
- American Geriatric Society/Society for Vascular Surgery Foundation Jahnigen Career Development Award
- Brewster: NIH-National Heart, Lung, and Blood Institute (NHLBI) [KO8HL119592]
- Society for Vascular Surgery Foundation/American College of Surgeons Mentored Clinical Scientist Research Career Development Award
- Wilson: Veteran Affairs Merit [I01-CX001025]
Background-Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients. Methods and Results-Patients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low-SES neighborhoods and to present with advanced PAD. Black patients had a higher amputation risk in each SES stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30-1.45), whereas low SES was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06-1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low SES continued to be significant risk factors for amputation regardless of PAD presentation. Conclusions-Black race significantly increases the risk of amputation within the same SES stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of PAD at presentation, and use of medications.
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