Background:Black adults have a higher incidence of peripheral artery disease and limb amputations than White adults in the United States. Given that peripheral endovascular intervention (PVI) is now the primary revascularization strategy for peripheral artery disease, it is important to understand whether racial differences exist in PVI incidence and outcomes.Methods:Data from fee-for-service Medicare beneficiaries ≥66 years of age from 2016 to 2018 were evaluated to determine age- and sex-standardized population-level incidences of femoropopliteal PVI among Black and White adults over the 3-year study period. Patients’ first inpatient or outpatient PVIs were identified through claims codes. Age- and sex-standardized risks of the composite outcome of death and major amputation within 1 year of PVI were examined by race.Results:Black adults underwent 928 PVIs per 100 000 Black beneficiaries compared with 530 PVIs per 100 000 White beneficiaries (risk ratio, 1.75 [95% CI, 1.73–1.77]; P<0.01). Black adults who underwent PVI were younger (mean age, 74.5 years versus 76.4 years; P<0.01), were more likely to be female (52.8% versus 42.7%; P<0.01), and had a higher burden of diabetes (70.6% versus 56.0%; P<0.01), chronic kidney disease (67.5% versus 56.6%; P<0.01), and heart failure (47.4% versus 41.7%; P<0.01) than White adults. When analyzed by indication for revascularization, Black adults were more likely to undergo PVI for chronic limb-threatening ischemia than White adults (13 023 per 21 352 [61.0%] versus 59 956 per 120 049 [49.9%]; P<0.01). There was a strong association between Black race and the composite outcome at 1 year (odds ratio, 1.21 [95% CI, 1.16–1.25]). This association persisted after adjustment for socioeconomic status (odds ratio, 1.08 [95% CI, 1.03–1.13]) but was eliminated after adjustment for comorbidities (odds ratio, 0.96 [95% CI, 0.92–1.01]).Conclusions:Among fee-for-service Medicare beneficiaries, Black adults had substantially higher population-level PVI incidence and were significantly more likely to experience adverse events after PVI than White adults. The association between Black race and adverse outcomes appears to be driven by a higher burden of comorbidities. This analysis emphasizes the critical need for early identification and aggressive management of peripheral artery disease risk factors and comorbidities to reduce Black–White disparities in the development and progression of peripheral artery disease and the risk of adverse events after PVI.

中文翻译：

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合并症的差异解释了股腘血管内介入治疗后结果的黑白差异

背景：在美国，黑人成年人外周动脉疾病和肢体截肢的发生率高于白人成年人。鉴于外周血管内介入治疗 (PVI) 目前是外周动脉疾病的主要血运重建策略，了解 PVI 发生率和结果是否存在种族差异非常重要。方法：数据来自年龄≥66 岁的按服务付费医疗保险受益人对 2016 年至 2018 年的研究进行了评估，以确定 3 年研究期间黑人和白人成人股腘动脉 PVI 的年龄和性别标准化人口水平发病率。患者的首次住院或门诊 PVI 是通过索赔代码识别的。按种族检查 PVI 1 年内死亡和大截肢综合结果的年龄和性别标准化风险。结果：黑人成年人每 100 000 名黑人受益人接受 928 次 PVI，而每 10 万名白人受益人接受 530 次 PVI（风险比） ，1.75 [95% CI，1.73–1.77]；P <0.01）。接受 PVI 的黑人成年人更年轻（平均年龄，74.5 岁 vs 76.4 岁；P <0.01），更有可能是女性（52.8% vs 42.7%；P< 0.01），并且糖尿病负担较高（70.6%）与白人成年人相比，白人成年人的患病率分别为 56.0%和 56.0%； P < 0.01 ）、慢性肾病（67.5% 和 56.6%；P < 0.01）和心力衰竭（47.4% 和 41.7%；P < 0.01）。根据血运重建指征进行分析时，黑人成人比白人成人更有可能因慢性肢体威胁性缺血而接受 PVI（每 21 352 人中有 13 023 人[61.0%]，而每 120 049 人中有 59 956 人[49.9%]；P < 0.01 ）。黑人种族与 1 年综合结果之间存在很强的相关性（比值比，1.21 [95% CI，1.16-1.25]）。在调整社会经济地位后，这种关联仍然存在（优势比，1.08 [95% CI，1.03–1.13]），但在调整合并症后被消除（优势比，0.96 [95% CI，0.92–1.01]）。结论：费用之间- 对于服务医疗保险受益人来说，黑人成年人的人口水平 PVI 发生率明显高于白人成年人，并且在 PVI 后经历不良事件的可能性明显更大。黑人种族与不良后果之间的关联似乎是由较高的合并症负担驱动的。该分析强调了早期识别和积极管理外周动脉疾病危险因素和合并症的迫切需要，以减少外周动脉疾病发生和进展的黑人与白人之间的差异以及 PVI 后不良事件的风险。