Explaining Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease (PAD) Using Decomposition Methods
Springer Science and Business Media LLC -- Journal of Racial and Ethnic Health Disparities
DOI 10.1007/s40615-016-0261-9
Keyword(s)
  1. Racial disparities
  2. Peripheral artery disease
  3. Amputation
  4. Hospital admission
  5. Multivariate analysis 62Hxx
  6. Estimation 62H12
  7. Hypothesis testing 62H15
Abstract(s)

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.

Electronic supplementary material

The online version of this article (doi:10.1007/s40615-016-0261-9) contains supplementary material, which is available to authorized users.