AHA Publishes Spotlight Issue on Amputation Rates and Other Cardiovascular Health Disparities in Diverse Populations

August 25, 2021—The American Heart Association announced that an analysis of peripheral artery disease (PAD)–related amputations is one of 16 new research studies highlighting health disparities among people from diverse population groups that were published in a special spotlight issue of Journal of the American Heart Association (JAHA).

“Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas” by Alexander C. Fanaroff, MD, et al is an analysis of national Medicare claims data to determine ZIP code–level variation in rates of amputation among Medicare beneficiaries.

The study concluded that poverty and Black race were associated with higher rates of lower leg amputation among people with PAD who live in metropolitan areas.

The investigators found that ZIP codes with a higher proportion of Black residents had higher amputation rates than ZIP codes with lower proportions of Black residents. In addition, ZIP codes with lower median household income, more residents eligible for Medicaid, and worse scores on the Distressed Communities Index scale (a composite marker of socioeconomic status), had higher amputation rates compared to ZIP codes with higher socioeconomic status, even after adjusting for clinical and demographic characteristics.

“Limb amputation can be delayed and or prevented by timely and aggressive treatment,” commented Dr. Fanaroff in the AHA press release. “However, lack of access to specialized care may delay PAD diagnosis and limit efforts to save the limbs if it has progressed to the advanced disease stage.”

Dr. Fanaroff continued, “Though amputation rates are generally higher in rural areas, this finding shows that the association between lower socioeconomic status, race, and amputation rate extends to major metropolitan areas as well as rural regions. We found that closer proximity to specialized PAD care within metropolitan areas does not ensure access to high quality care. Strategies targeted to communities with high amputation rates are also needed in urban areas to reduce these disparities.” Dr. Fanaroff is an interventional cardiologist and Assistant Professor of Medicine in the Cardiovascular Medicine Division at the University of Pennsylvania in Philadelphia, Pennsylvania.

The announcement noted that an August 2019 publication of an AHA scientific statement stated that that sex and ethnic disparities exist in the diagnosis and treatment of critical limb ischemia (CLI), the most severe form of PAD. That statement addressed noninvasive techniques and devices for assessing blood flow and other diagnostic considerations for patients with CLI. “Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association” by Sanjay Misra, MD, et al, was published in the AHA journal Circulation (2019;140:e657-e672).

The other research featured in the JAHA spotlight issue, Racial and Ethnic Disparities in Cardiovascular Medicine, can be accessed in full online.

In discussing the special issue of JAHA, senior associate editor Pamela Peterson, MD, and associate editor Sula Mazimba, MD, observed that although management of cardiovascular disease has reduced death rates over time, there are still “striking disparities” in the United States that have widened along racial, ethnic, socioeconomic, and geographical lines.

The editors stated in the AHA announcement, “We hope that this issue of JAHA will reinforce the recent America Heart Association’s presidential advisory statement urging all stakeholders to a committed path toward transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education and health care, and enhancing allyship among racial and ethnic groups.”