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April 26, 1993

Variation in Utilization of Procedures for Treatment of Peripheral Arterial Disease: A Look at Patient Characteristics

Author Affiliations

From the Johns Hopkins Program for Medical Technology and Practice Assessment (Drs Tunis, Bass, and Steinberg); Welch Center for Prevention, Epidemiology and Clinical Research (Dr Klag); and Division of General Internal Medicine, Department of Medicine (Drs Tunis, Bass, Klag, and Steinberg), The Johns Hopkins University School of Medicine, Baltimore, Md. Dr Tunis is now with the Health Program, Office of Technology Assessment, Washington, DC.

Arch Intern Med. 1993;153(8):991-998. doi:10.1001/archinte.1993.00410080053008

Objective:  To examine associations between demographic characteristics and use of interventional procedures in patients with peripheral arterial disease.

Design:  Case series drawn from a statewide hospital discharge database.

Setting:  Nonfederal acute-care hospitals in Maryland.

Patients and Interventions:  A total of 7080 cases of angioplasty, bypass surgery, or amputation for lower-extremity peripheral arterial disease in 1988 through 1989.

Main Outcome Measure:  Use of angioplasty, bypass surgery, and lower-extremity amputation.

Results:  A total of 1185 angioplasties, 4005 bypass operations, and 1890 amputations were identified. Population-based annual rates showed that angioplasty use peaked at about 70 per 100 000 at the age of 65 to 74 years, bypass surgery use peaked at more than 250 per 100 000 at 75 to 84 years of age, and amputation use peaked at about 225 per 100 000 at 85 years of age and older. The age-adjusted likelihood of having a procedure for peripheral arterial disease was 1.7 times higher in men than in women and 1.6 times higher in blacks than in whites. Compared with patients who had angioplasty or bypass surgery, patients who had amputations were more likely to be more than 65 years old, to be black (odds ratio, 2.5), to have Medicaid or no insurance (odds ratio, 1.7), to have diabetes mellitus (odds ratio, 3.0), and not to have hypertension (odds ratio, 3.1). Compared with patients who had bypass surgery, patients who had angioplasty were more likely to be under 65 years old, to be white (odds ratio, 1.7), and not to have diabetes mellitus (odds ratio, 1.3).

Conclusion:  Patient race is associated with differences in the frequency with which angioplasty, bypass surgery, and amputation are performed for peripheral arterial disease, and insurance status is associated with the likelihood of having amputation.(Arch Intern Med. 1993;153:991-998)