Med
Care 2002 Jan;40(1 Suppl):106-116
Lower Extremity Nontraumatic Amputation Among Veterans With Peripheral
Arterial Disease: Is Race an Independent Factor?
Collins TC, Johnson M, Henderson W, Khuri SF, Daley J.
Center for Health Systems Design and Evaluation, Institute for Health
Policy, Massachusetts
General Hospital/Partners Health Care System, Harvard Medical School,
Boston, Massachusetts.
OBJECTIVES: To determine if race/ethnicity is independently
associated with an increased risk
for nontraumatic lower extremity amputation versus lower extremity bypass
revascularization among patients with peripheral arterial disease (PAD).
METHODS: Data were analyzed from the National VA Surgical
Quality Improvement Program (NSQIP) and from the Veterans Affairs Patient
Treatment File (PTF). Race/ethnicity was defined as non-Hispanic white,
black, or Hispanic. Variables that were univariately associated (P </=0.05)
with the outcome of amputation were placed into a multiple logistic regression
model to determine independent predictors for the dependent variable,
lower extremity amputation versus lower extremity bypass revascularization.
RESULTS: Three thousand eighty-five lower extremity amputations
and 8409 lower extremity bypass operations were identified. Among all
cases included, there were 416 Hispanic patients (3.6%), 2337 black patients
(20.3%), and 8741 non-Hispanic white patients (76.1%). Among all variables
within the model, Hispanic and black race were each associated with a
greater risk for amputation than a history of rest pain/gangrene (Hispanic
race 1.4, 95% CI 1.1, 1.9; black race 1.5, 95% CI 1.4, 1.7; rest pain/gangrene
1.1, 95% CI 1.0, 1.3). The final model had a c statistic of 0.83.
CONCLUSION: Hispanic race and black race were independent
risk factors for lower extremity amputation in patients with PAD. Although
the burden of certain atherosclerotic risk factors (eg, diabetes and hypertension)
is higher in minority patients, the impact of this burden does not account
for the increased risk for the outcome of lower extremity amputation in
these two populations. Further research is needed to better understand
the reason(s) why race/ethnicity is independently associated with poor
outcomes in PAD.
PMID: 11802078 [PubMed - as supplied by publisher]
