Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods

Introduction While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects...

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Bibliographic Details
Published in:Journal of racial and ethnic health disparities 2017-10, Vol.4 (5), p.784-795
Main Authors: Mustapha, J. A., Fisher, Bryan T., Rizzo, John A., Chen, Jie, Martinsen, Brad J., Kotlarz, Harry, Ryan, Michael, Gunnarsson, Candace
Format: Article
Language:English
Subjects:
African Americans
Amputation
Cultural differences
Epidemiology
Ethnic differences
Health care access
Health status
Hospitalization
Inpatient care
Latin American cultural groups
Medical diagnosis
Medicine
Medicine & Public Health
ORIGINAL PAPERS
Patient admissions
Patients
Peripheral arterial disease
Quality of Life Research
Race factors
Racial inequality
Regression analysis
Regression models
Social Inequality
Social Structure
Vascular diseases
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Summary:Introduction While studies have documented racial and ethnic disparities in amputation rates for patients with peripheral artery disease (PAD), the importance of specific factors has not been quantified. This research seeks to provide such evidence and to quantify how much of the difference reflects observable versus unexplained factors. Methods This study used the nationally representative HCUP inpatient database from 2006 to 2013 for patients with a primary diagnosis of PAD who were either Caucasian, African-American, or Hispanic. Multivariable logistic regression models were estimated to identify the determinants of amputation rates. Results Multivariable results revealed that African-Americans and Hispanics are approximately twice as likely to be amputated as are Caucasians. Observed factors in the models collectively account for 51 to 55 % of the disparities for African-Americans and 64 to 69 % for Hispanics. The results suggest that African-Americans and Hispanics have less access to care, because they are being admitted when sicker and more likely on an emergent basis. Conclusions Racial and ethnic disparities in amputation rates are substantial, with disease severity and hospital admission source being key factors.
ISSN:2197-3792
2196-8837
DOI:10.1007/s40615-016-0261-9