Socioeconomic, ethnic and geographical disparities in revascularization rates for peripheral arterial disease in England

Background

There are disparities in the prevalence of peripheral arterial disease (PAD). This study examined socioeconomic, ethnic, and geographical variations in population-based revascularization rates for PAD and the associations between these rates and PAD-related major lower limb amputation.

Methods

Hospital admissions in England (April 2008–March 2018) for revascularization for moderate and severe PAD, and for major lower limb amputation, were examined using a population-based study design and Poisson and logistic regression.

Results

In the 10-year time span, there were 309 839 revascularization admissions (44% severe PAD, 56% moderate PAD; > 90% White ethnicity) and 38 601 major lower limb amputations from a population aged ≥ 25 years of 36 million. Overall, 39.9% of patients with amputation had previously had revascularization. Revascularization rates for moderate and severe PAD and amputation rates increased with increasing socioeconomic deprivation. The ratio of amputations to revascularizations also increased with increasing deprivation, and patients admitted for revascularization from more deprived areas had more severe PAD. Revascularization rates for patients of Black ethnicity were generally substantially lower than those for patients of White ethnicity, the only exception being for severe PAD in patients aged ≥ 65 years. The amputation rate was also lower but the ratio of amputations to revascularizations, and the percentage of revascularization admissions with severe PAD, were higher for patients of Black relative to White ethnicity. Revascularization and amputation rates were substantially lower, and the ratio of amputations to revascularizations was also lower, for patients of Asian relative to White ethnicity, but patients of Asian ethnicity admitted for revascularization had a marginally higher percentage of severe PAD. There was substantial variation in revascularization and amputation rates across Integrated Care Board areas, with high rates in the North and in parts of the Midlands and South West. There was also wide variation in the ratio of amputations to revascularizations.

Conclusion

There were substantial socioeconomic, geographical and ethnic disparities in revascularization rates in England.