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East Florida


HCA Florida Aventura Hospital


Transitional Year

Document Type


Publication Date



healthcare disparities, patient outcomes


Health Services Administration | Medicine and Health Sciences | Pathological Conditions, Signs and Symptoms


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<0.001), while Hispanic DM patients showed a 0.24% higher trend (p<0.001). Major amputation utilization was 0.21% lower for Black DM patients (p<0.001) and 0.13% lower for Hispanic DM patients (p<0.001), with AAPI patients also experiencing a 0.23% lower trend (p<0.001). All racial groups had higher odds of receiving revascularization and major amputations. Among 856,188 admissions involving ESKD and CLTI patients, 46% were White. In comparison to White patients, Black DM patients exhibited a 0.14% higher trend in major amputation utilization (p=0.023), and Hispanic DM patients showed a 0.27% higher trend (p=0.001). Conversely, for ESKD, Black patients exhibited a 0.26% lower trend in major amputation utilization (p<0.001), Hispanic patients a 0.13% lower trend (p=0.030), and AAPI patients a 0.37% lower trend (p=0.005). All racial groups, except Native Americans, had higher odds of receiving revascularization and major amputations.

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.

Examining Nationwide Disparities in Managing Critical Limb Threatening Ischemia among Individuals with Diabetes Mellitus or End-Stage Kidney Disease by Race and Ethnicity



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