Racial and/or ethnic and rural disparities in health care utilization before major lower extremity amputation in patients with peripheral artery disease.

Abstract

The aim of this study was to evaluate inpatient health care utilization in the year preceding major lower extremity amputation (MLLA) among patients with chronic limb-threatening ischemia (CLTI), focusing on differences by race, ethnicity, and rurality using a large, multi-state inpatient dataset. A retrospective cohort study of Healthcare Cost and Utilization Project State Inpatient Databases for five states was conducted. Hospitalizations for Black, Hispanic, and White patients aged ≥40 years with a present-on-admission diagnosis of peripheral artery disease (PAD) or CLTI who underwent MLLA from 2017 to 2019 were included, and health care utilization in the year preceding their MLLA hospitalization was assessed. Differences in prior hospitalizations, minor lower limb amputations, and revascularization procedures were compared across race and/or ethnicity and rurality. The cohort comprised 21,233 people who underwent MLLA. Most patients (>70%) underwent MLLA without prior revascularization or minor lower limb amputation, irrespective or race and/or ethnicity and rurality. Over one-half of all MLLA patients were hospitalized at least twice in the year preceding (once for PAD/CLTI specifically). Non-rural Black and Hispanic patients were more likely to be hospitalized in the year prior, with one-half of non-rural Black patients experiencing three or more hospitalizations in the year before amputation. Significant racial and/or ethnic and non-rural/rural disparities exist in inpatient preamputation health care utilization among patients with PAD. Regardless of race and/or ethnicity or rurality, most underwent MLLA without prior limb-sparing care. Findings underscore the need for targeted primary prevention interventions to reduce repeated hospitalizations and preventable amputations.