Abstract 4371400: Disparities in Healthcare Access and Treatment Outcomes for Patients with Chronic Limb-Threatening Ischemia

Background: Chronic limb-threatening ischemia (CLTI) is clinically identified by the presence of a severe form of peripheral arterial disease that significantly affects the patient's quality of life. Despite improvements in medical and surgical interventions, social disparities in health care access remain a major determinant in clinical outcomes. We aim to explore the association between social determinants of health and hospital outcomes in CLTI among different socioeconomic groups. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2021. ICD 10 codes were used to identify and compare different interventions, including surgical bypass, endoscopic revascularization, and non-traumatic amputation among different socioeconomic groups. Major adverse limb events (MALE) and major adverse cardiovascular and cerebrovascular events (MACCE) were compared during the period of hospitalization. Multivariate regression adjusted for hypertension, diabetes, and hyperlipidemia. The trends of utilizing revascularization and amputation were examined within the six-year period. Results: The study reveals a rising prevalence of CLTI over the 6-year period. Meanwhile, the use of surgical bypass and amputation has been declining, while endovascular repair is increasingly utilized: as a treatment approach. There were 425,259 admissions, with the rate of admission in Caucasians, Blacks, Hispanics, and Asians being 60%, 20%, 12%, and 2%, respectively. Major comorbidities like hyperlipidemia, hypertension, cigarette use, and diabetes were similar across race. The prevalence of surgical bypass and endoscopic revascularization remains greater among Caucasians, while the prevalence of amputation is highest among Blacks and Hispanics. Using multivariate analysis comparing outcomes with the Caucasian population, the study shows Black patients were 18% (aOR 0.82, C.I.: 0.7- 0.8, P-value 0.00) less likely to undergo surgical bypass. Blacks and Hispanics were more likely to undergo amputation, with rates of 24% and 18%, respectively, both of which were statistically significant. Mortality was 30% more likely among Asians. Cardiac and ventricular arrhythmias were more likely among blacks. Conclusion: The study reveals that Blacks and Hispanics are at increased risk of adverse MALE and MACCE. This emphasizes the importance of understanding these disparities and their influence on management strategies, as it is crucial for improving patient care and ensuring equitable treatment.