Print this pageSocioeconomic Factors That Adversely Affect the Rate Of Amputation In Patients Presenting With Lower Extremity Ischemia: The Effects Of Race, Insurance Status, and Low Income
Mohammad H. Eslami1, Maksim Zayaruzny2, Michael J. Rohrer1, Elias Arous3, Bruce S. Cutler1
1Division of Vascular Surgery; University of Massachusetts Medical School, Worcester, MA;2Division of General Surgery, University of Massachusetts Medical School, Worcester, MA;3University of Massachusetts Medical School, Worcester, MA
Objectives:
A consequence of delay in the diagnosis of peripheral vascular disease (PVD) is limb loss. This study was undertaken to determine the correlation of low socioeconomic status (low income and lack of private insurance) and race on the severity of ischemic presentation and the subsequent amputation rate.
Methods:
Data from the Nationwide Inpatient Sample (NIS) on all patients with the diagnosis of lower extremity ischemia (LEI) was evaluated from 1998-2000. NIS is a 20% stratified random sample of all the United States Hospital. The initial presentation (presence or absence of tissue loss) and the primary surgical intervention (lower extremity revascularization [LER], or amputation) during the index admission were compared among the patients of different races (white vs. non-white[NW]), insurance status (No/non-private insurance [NPI]: self-pay, Medicaid and Medicare or private/HMO insurance [PHI]) and income status. Multi-variate and univariate analyses of the data were performed.
Results:
During the study period, 691,833 patients presented with LEI to all urban hospitals. 425,187 procedures were performed (269,729: 63.4% LER, 155,458: 36.6% amputation). Significantly lower rate of tissue loss was noted among patients with PHI (18.4 vs. 32.5%; p<0.01). Univariate analysis of the association between amputation and covariates uniformly showed statistically significant higher rate of amputation was performed on non-white, those from low-income bracket and NPI group (p<0.0001).
Conclusions:
Amputation was performed at a higher rate on NW, those from low-income bracket or with NPI who presented with LEI. As the presentation of ischemia was more advanced among these patients, this study suggests that the diagnosis of PVD was often delayed among this disadvantaged group of patients. This suggests lack of access to adequate primary care/ vascular surgery providers. Better education of the general population of symptoms and the consequences of PVD my lead to a decrease in the amputation rate in patients with PVD. 