Racial and Socioeconomic Health Disparities in Peripheral Artery Disease

Abstract

Peripheral artery disease (PAD) is a progressive atherosclerotic disease that causes lower extremity arterial stenosis or occlusion. Patients with PAD are at increased risk of myocardial infarction, stroke, limitations in ambulation, and amputation. Despite the advances in medicine and technology, the outcomes from PAD, including critical limb-threatening ischemia, acute limb ischemia amputation, and mortality, remain increased among specific racial and ethnic groups that have been historically marginalized in America, including Black, Hispanic, and American Indian individuals in the United States when compared with White persons. The purpose of this review is to summarize PAD literature that incorporates racial and ethnic disparities in PAD. There are a rising number of studies focused on the interface of racial and ethnic disparities and PAD. The majority of these studies are specifically focused on Black race, whereas there are limited studies focused on other minoritized racial and ethnic groups in the United States. The application of race and ethnicity has also been shown to play a synergistic role with socioeconomic status on PAD outcomes. Effective strategies focused on implementing policies that support quality measures and focus on social determinants of health have been shown to promote health equity and reduce disparities. Current evidence suggests that biological differences are less likely to be the leading cause of disparities in PAD between racial and ethnic groups compared with White Americans and supports a renewed focus on social determinants of health to achieve health equity.

Keywords: health disparities; patient‐centered; peripheral artery disease (PAD); quality improvement; racial disparities; social determinants of health; socioeconomic disparities.

Figure 1. Race‐based cumulative incidence of peripheral artery disease (PAD).

Incident PAD was defined by ankle‐brachial index <0.90, nontraumatic amputation, or surgical or percutaneous lower‐extremity arterial revascularization. Other race and ethnicity included individuals identified as American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander, as well as those with Hispanic ethnicity. Sample size: 13 080 (Black); 54 377 (White); 4454 (other). CIF indicates cumulative incidence function. Adapted from Matsushita et al, which was published under the terms of the CC‐BY license, which permits unrestricted use, distribution, and reproduction in any medium.

Figure 2. Strategies to alleviate peripheral artery health disparities.

A summary of key factors and stakeholders and what actions they can influence to limit peripheral artery disease (PAD) health disparities. ABI indicates ankle‐brachial index; and SES, socioeconomic status.