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From 2007 to 2011 among Medicare beneficiaries with diabetes and PAD, the amputation rate for black patients was nearly three times the rate for nonblack patients.1
When it comes to equity in the healthcare system, there are glaring differences in the prevalence of peripheral arterial disease (PAD) in minority patients as well as the medical treatment they often receive.
Approximately 8-12 million Americans are affected by PAD, including 1 in 3 diabetics over the age of 50.2 PAD is caused by fatty deposits that restrict blood flow in the arteries outside the heart, most commonly occurring in the legs. If left untreated, PAD can lead to gangrene, diabetic foot ulcers, and amputation.
According to a study by Eraso et al,3 PAD occurs at the highest rate in non-Hispanic black women 70+ years (25.3%), non-Hispanic Black women with chronic kidney disease (21.7%), and Mexican American men 70+ years (20.85%).
Every year, diabetic Americans with foot ulcers undergo about 85% of non-traumatic amputations.4
A majority of the estimated 200,0004 annual non-traumatic amputations can be avoided with early detection and proper care.
Pauli Escobedo, Cook global communication manager, interviewed Dr. Bryan Fisher, vascular surgeon at Centennial Medical Center in Nashville, Tenn., about education, accountability, and proposed legislation that can change outcomes in healthcare inequity. Watch the discussion.
Drs. Paul J. Rochon, Bryan T. Fisher, Charles Bailey, and John Rundback participated in a webinar on racial disparities in PAD amputation rates. Watch the video.
Early detection is the key to helping prevent the most serious complications of PAD, including amputation. An ankle-brachial index (ABI) test is a simple test that compares blood pressure in the arms with blood pressure in the legs. The difference in the numbers determines if there is PAD as well as its severity.
Data “suggest African-Americans… have less access to care because they are being admitted when sicker and more likely on an emergent basis.5 Angiogram were at a 90% lower odds of having an amputation.”6
Common risk factors include:
Most people with PAD don’t show any warning signs. Only one-quarter to one-third7 of people who are diagnosed with PAD have any symptoms at all. People who have symptoms often mistake them for signs of aging.
The most common symptom of PAD is leg pain that occurs when walking but goes away during rest. Other symptoms include:
Society of Interventional Radiology (SIR)
Society for Vascular Surgery (SVS)
CDC Cardiovascular Coalition