F-11 | Disparities in Peripheral Artery Disease Inpatient Endovascular Interventions

A recent Scientific Statement published in the Journal of American College of Cardiology in December 2023 highlighted racial and sex-specific disparities in treatment for peripheral artery disease (PAD) using data from up to 20 years ago. We sought to evaluate disparities in endovascular PAD treatment with more recent data from 2016 to 2020. Bayesian machine learning-augmented propensity score translational (BAM-PS) statistics with multivariable regression was conducted for the largest US all-payor inpatient dataset, the National Inpatient Sample (NIS), from 2016 to 2020. Of 148,755,036 adult hospitalizations from 2016-2020, there were 17,173,000 (11.54%) with PAD, of whom 680,025 (3.96%) underwent inpatient endovascular revascularization (ER). ER prevalence from 2016-2020 increased steadily (0.46% to 0.49%) (p <0.001). In BAM-PS multivariable regression adjusting for several clinical and demographic variables, female sex (OR 0.54, 95% CI 0.53-0.56) and Asian versus Caucasian race (OR 0.66, 95% CI 0.60-0.73) significantly decreased the odds of ER. Medicare versus commercial insurance (OR 1.17, 95% CI 0.13-1.22) significantly increased the odds of ER (p<0.001). There were no significant differences in ER mortality and cost when analyzed by sex, race, and income (p>0.05 for all). This nationally representative analysis suggests that significant racial and sex-specific disparities persist in ER for PAD. Clinicians must actively strive to alleviate these disparities using a multidisciplinary approach.