HCA Healthcare Graduate Medical Education 2023 Research Days
Examining Nationwide Disparities in Managing Critical Limb Threatening Ischemia among Individuals with Diabetes Mellitus or End-Stage Kidney Disease by Race and Ethnicity
Daniel Dominguez
Waseem Wahood
HCA Healthcare
01-01-2023
Please see supplemental content for full abstract with tables.
Introduction: Critical Limb Threatening Ischemia (CLTI) presents a significant challenge, particularly for individuals with diabetes mell..
Please see supplemental content for full abstract with tables.
Introduction: Critical Limb Threatening Ischemia (CLTI) presents a significant challenge, particularly for individuals with diabetes mellitus (DM) or End-Stage Kidney Disease (ESKD). Healthcare disparities related to race and ethnicity are a pressing concern. This study aims to examine a 16-year trend to assess whether the disparities in managing critical limb-threatening ischemia (CLTI) are diminishing among individuals with diabetes mellitus (DM) or End-Stage Kidney Disease (ESKD).
Methods: The analysis involved an examination of the National Inpatient Sample data from 2005 to 2020, with a focus on hospitalizations related to CLI. Identification of the types of revascularization procedures performed and the presence of comorbidities, specifically DM and ESKD, was conducted. To investigate disparities, the utilization of these procedures among different racial groups, including White, Black, Hispanic, Asian and Pacific Islander (AAPI), Native American, and Others, was compared. Hierarchical, multivariable regression models were employed, adjusted for patient and hospital demographics, as well as the Elixhauser Comorbidity Index Score, to evaluate race-related differences in procedure utilization and major amputations.
Results: Among the 5,762,426 admissions involving DM and CLTI patients, 64% were White. In comparison to White patients, Black DM patients exhibited a 0.22% higher trend in revascularization utilization (p
Conclusion: This analysis has provided compelling evidence of enduring disparities in the treatment of CLTI among patients with DM or ESKD within our nationally representative sample. A notable pattern emerged, with all racial groups, except White patients, demonstrating a higher likelihood of undergoing both major amputations and revascularization procedures for CLTI. These results highlight not only the persistence of healthcare disparities but also the critical need for more targeted and equitable approaches in managing CLTI, especially when patients contend with concurrent comorbidities. The interpretation of these findings points to the urgency of addressing disparities in CLTI treatment. It suggests that factors beyond clinical necessity may be influencing treatment decisions and access to interventions. Further investigation is warranted to explore the root causes of these disparities, potentially encompassing healthcare access, socioeconomic factors, and cultural considerations. By comprehensively understanding these dynamics, healthcare systems can tailor interventions to ensure that all patients, regardless of their racial or ethnic background, receive timely and appropriate CLTI care, ultimately striving for improved patient outcomes and healthcare equity.
Poster
64fc2d53-4ad1-416c-9204-d1aaf9d7d8a4
f6e290c0-806a-4532-b615-35fe9c2e794b
East Florida
HCA Florida Aventura Hospital
Resident/Fellow
Transitional Year
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Diseases
Health Services Administration
Medicine and Health Sciences
Pathological Conditions, Signs and Symptoms
Public Health
HCA Healthcare