Peripheral Artery Disease in US Primary Care Practices: A Retrospective EHR-Based Analysis from 2018 to 2022

Background Peripheral artery disease (PAD) affects > 10 million adults over age 40, causing high morbidity, mortality, and healthcare costs in the USA. Primary care settings are critical for early detection of PAD, and understanding the landscape of PAD diagnosis patterns can help identify high-risk populations and inform screening strategies to address disparities. Objective To characterize the epidemiological patterns of PAD diagnosis and examine the clinical and socioeconomic characteristics of patients diagnosed with PAD in US primary care settings. Design Retrospective cohort study utilizing electronic health record data from the American Family Cohort (AFC) from 2018 to 2022. Subjects Patients over 40 years old with at least two primary care visits during the study period. Main Measures The primary outcome was documented PAD diagnosis. The secondary outcome was the cumulative incidence of PAD. Covariates included sociodemographic characteristics, comorbidities, body mass index, smoking status, and social deprivation index. Results A total of 18,405 patients had a new diagnosis of PAD among 2,313,650 eligible patients. PAD patients were more likely to be male (49% vs. 43%), older (64% of patients aged 60–79), current smokers (17% vs. 11%), from racial/ethnic minority groups, and residing in areas with higher social deprivation. PAD patients also had a significantly higher burden of medical comorbidities than non-PAD patients (CVD 10% vs. 3%; CAD 22% vs. 8%; heart failure 11% vs. 4%; hypertension 74% vs. 52%; diabetes 33% vs. 19%; hyperlipidemia 65% vs. 50%). Non-Hispanic Black and Hispanic individuals had higher odds of PAD diagnosis compared to non-Hispanic Whites across all comorbidity groups. Unlike CAD and hyperlipidemia with decreased incidence, PAD incidence increased notably in 2021. Conclusions PAD diagnosis patterns across racial, ethnic, and neighborhood socioeconomic groups reveal significant differences in burden of disease. Optimized screening in the primary care setting targeting these high-risk groups is important to improve early detection and reduce PAD-related disparities.