Socioeconomic Status and Incidence of Hospitalization With Lower‐Extremity Peripheral Artery Disease: Atherosclerosis Risk in Communities Study

Abstract

BackgroundCompared to coronary heart disease, heart failure, and stroke, the relationship between low socioeconomic status (SES) and peripheral artery disease (PAD) is less well established. We examined the association between SES and incidence of hospitalization with PAD and explored whether this association can be explained by traditional cardiovascular risk factors and healthcare access.Methods and ResultsA total of 12 517 participants in the Atherosclerosis Risk in Communities (ARIC) Study (1987‐1989) with no prior PAD were examined. Individual‐level SES was assessed from household income (low <$12 000/year, medium $12 000 to $24 999/year, and high ≥$25 000/year [double to approximate to values in 2016]) and educational attainment (<high school, high school, and >high school), and area‐level SES from area deprivation index (quintiles). During a median follow‐up of 23.6 (Interquartile range 19.6‐24.5) years, 433 participants had a hospitalization with PAD. In Cox proportional hazards regression analysis, the demographically adjusted hazard ratio was 2.42 (1.81‐3.23) for low household income, 2.08 (1.60‐2.69) for low educational attainment, and 2.18 (1.35‐3.53) for most deprived neighborhoods, compared to their high‐SES counterparts. After adjustment for traditional cardiovascular risk factors and heath care access, the associations were attenuated but remained significant, particularly for income and education. Results were consistent when stratified by race (P‐values for interaction >0.2 for all SES parameters).ConclusionsLow individual‐ and area‐level SES are strong predictors of hospitalization with PAD, in part due to increased prevalence of cardiovascular risk factors and poor access to care in these groups. Additional risk factors may also need to be identified and acted on to eliminate SES disparities in PAD hospitalization.

Outcomes after peripheral artery disease intervention among Medicare–Medicaid dual-eligible patients compared with the general medicare population in the Vascular Quality Initiative registry

“…The suggestion that disparities in care for patients with PAD are due to differences in how that care is provided is contrary to the trends seen in our study, where we see patients, regardless of dual-eligibility status, receiving homogenous preoperative and postoperative care. Additionally, patient-related factors such as race have been attributed to increased risk of PAD and poor outcomes 13 25. We also performed subgroup analyses including by patient age (65 years and older vs under age 65 years), race and by hospital where surgery occurred.…”

“…was populated using PubMed searches, including the keywords ‘peripheral artery disease’, ‘cardiovascular disease’, ‘social determinants’, ‘socioeconomic status’, ‘mental health’ and ‘Medicare–Medicaid dual-eligible’. While table 3 is not exhaustive, it highlights the complex interactions between race,13 functional status,27 gender28 and income25 in affecting patient outcomes in PAD. Our study provides context to this prior work by adding more detail to the effect different types of insurance status can have on patient outcomes, even among those with significant comorbid illnesses.…”

The Association of Severe Hypoglycemia With Incident Cardiovascular Events and Mortality in Adults With Type 2 Diabetes

“…Prevalent atrial fibrillation at visit 4 was also identified from electrocardiograms conducted at visits 1–4 ( n = 47). Peripheral artery disease events were identified from hospitalizations on the basis of ICD-9 diagnosis codes for peripheral artery disease (440.2, 440.3, 440.4) or ICD-9 procedure codes for leg revascularization (38.18, 39.25, 39.29, 39.50) (21). Ascertainment for all events occurred through 31 December 2013.…”

Prognostic Implications of Single-Sample Confirmatory Testing for Undiagnosed Diabetes

“…This included any validated definite or probable hospitalization for myocardial infarction, death due to coronary heart disease, silent myocardial infarction detected at visit 3 or 4, a validated stroke event, or hospitalization or death due to heart failure (heart failure events after 2004 were adjudicated by an end point committee) (8–13). Incident peripheral artery disease was defined as the first hospitalization related to peripheral artery disease (14). Deaths were identified from state records and linkage to the National Death Index.…”