New England Society for Vascular Surgery

The Incidence and Natural History Of Peripheral Vascular Disease In Minority Patients

Nicholas J Morrissey, James McKinsey, Roman Nowygrod, Natalya Egorova, Leila Mureebe, Peter Faries, Annetine Gelijns, Alan Moskowitz, K. Craig Kent
Columbia University Medical Center, New York, NY

Objective:
The frequency and natural history of peripheral vascular disease in minorities is poorly understood. Biological, cultural and socioeconomic factors may alter the incidence and outcomes of vascular disease in Hispanics and African Americans. We analyzed the frequency and outcome of three common vascular diseases/interventions using statewide databases to determine important differences between ethnic and racial groups.
Methods:
Data from the 2000 census for New York and Florida were used to determine the proportion of Hispanics and African Americans in each state. Hospital discharge data for New York and Florida for the years 1998-2003 were used. Databases were queried using ICD-9 codes for diagnosis and repair of abdominal aortic aneurysm (AAA), lower extremity arterial occlusive disease, and carotid artery occlusive disease. Observed and expected proportions were compared using chi-squared test for proportions.
Results:
Table 1 Vascular Disease Rates in New York State


Ethnic Group	% of population > 50	% of all AAA repairs	% of all lower extremity revascularizations	% of all lower extremity amputations	% of all carotid interventions
Hispanic	9.1%	1.8% *	6.2%	8%	1.9%*
African American	12.5%	4.1%*	14.4%	24%*	2.7%*
White	75 %	84%*	71%	59.7%	85%*

* p< .05
Table 2 Vascular Disease Rates in Florida


Ethnic Group	% of population > 50	% of all AAA repairs	% of all lower extremity revascularizations	% of all lower extremity amputations	% of all carotid interventions
Hispanic	11.6%	4.2%*	6.4%*	10.2%	3.2%*
African American	8.1%	2.3%*	10.2%	24%*	2.3%*
White	78%	91%*	59.7%*	63.7%*	93%*

*p< .05
Hispanics and African Americans underwent significantly fewer AAA repairs than would be predicted by their representation in the population. Similarly, both minorities on a per capita basis, presented less frequently with ruptured AAA than their white counterparts (p<0.05). The low incidence of elective repair and the lack of an increased rate of rupture suggest that both ethnic groups are less likely to develop aneurysms. In Florida, Hispanics underwent significantly fewer lower extremity revascularization s than predicted, while in New York a similar trend was observed which did not reach statistical significance. Interestingly, African Americans underwent amputation at a rate nearly two times that predicted by their representation in the population. Both Hispanics and African Americans underwent proportionately fewer carotid interventions compared to whites. Other published data show a twofold increase in stroke for both ethnic groups- which may be related to a failure to diagnose and treat carotid artery disease.
Conclusions:
Major vascular interventions are proportionally less frequently performed in minorities. This is particularly true of Hispanics where the per capita frequency for all three major vascular procedures is markedly diminished. Further studies will be required to determine the reasons for these ethnic disparities.