Gender Disparities Shown in Lower Extremity PAD Therapy

January 28, 2010—The Society for Vascular Surgery announced that a new three-state study shows a slight decrease in inpatient procedures for 2.4 million patients treated for lower extremity peripheral arterial disease (PAD) between 1998 and 2007, but reveals gender disparities in emergent hospital admissions and mortality rates. Natalia N. Egorova, PhD, et al published the study in the Journal of Vascular Surgery (2010;51:372–378). In the study, the investigators analyzed the time trends in hospital care of genderrelated differences, which continue to challenge the management of lower extremity PAD in women. Data for patients with PAD from New York, New Jersey, and Florida state hospital inpatient discharge databases (1998–2007) were analyzed using univariate and multivariate regression analyses.

The investigators found that the 2.4 million PAD-related inpatient discharge records showed a slight decrease in inpatient procedures for both genders. Compared with men, women had 18% to 27% fewer PAD and 33% to 49% fewer vascular procedural hospitalizations (P < .0001). Women were persistently more likely than men to be admitted emergently (56% vs 51% in 1998 and 57% vs 53% in 2007) and discharged to a nursing home.

During the study period, the amputation rate declined by 36% in women and 21% in men with PAD, and similarly, open procedures decreased by 36% and 30%, respectively.

However, endovascular procedures increased by 150% in women and 144% in men. Procedural mortality was 4.95% versus 4.37% for men (P < .0001). Female mortality rates were persistently higher after amputations (9.89 % vs 8.9%; P < .0001), open procedures (5.49% vs 4%; P < .0001), and endovascular procedures (2.87% vs 2.1%; P < .0001). Time trends showed improved mortality for men and women, with a stable difference between the two, the investigators reported.

The analysis of representative state administrative databases of inpatient care records demonstrated improvements in mortality and amputation rates over time; however, a gender-related disparity in PAD outcomes remains, which merits further investigation, the investigators concluded.

“Endovascular treatment has continued to improve the operative management and outcomes of vascular disease in both genders, reducing the mortality gap,” commented Dr. Egorova. She noted that it is still unclear what causes gender differences in outcomes of PAD. However, early recognition of the disease in women, better understanding of gender variability in associated socioeconomic parameters, and clinical risk factors may eliminate this disparity.