Peripheral artery disease (PAD) can lead to primary amputation, i.e., amputation without an attempt at revascularization. After a multivariable logistic regression analysis, researchers found that living in a rural community was associated with greater odds for primary amputation in nonwhite patients but not in white patients. They also determined that race had a significant effect on primary amputation in both urban and rural settings; however, the effect was significantly stronger in rural settings.
The Canadian Vascular Quality Initiative amputation data set was used for the analyses (N = 6,795). Multivariable logistic regression examined the impact of rurality and race/ethnicity (non-Latinx whites versus nonwhites) on primary amputation after adjustment for relevant covariates and included an interaction for race/ethnicity by rural status.
The analysis determined that primary amputation occurred in 49 percent of patients (n = 3,332); in 47 percent of rural patients versus 49 percent of urban patients; in 46 percent of whites versus 53 percent of nonwhites; and nonwhites had 21 percent higher odds of undergoing primary amputation overall.
On the subgroup analysis, rural nonwhites had two times higher odds of undergoing primary amputation than rural whites and 52 percent higher odds of undergoing primary amputation than urban nonwhites. In the urban setting, nonwhites had 21percent higher odds of undergoing primary amputation than urban whites.
The study’s authors concluded that since the analysis suggests that race/ethnicity has a compounding effect on rural health disparities, strategies to improve health in rural communities need to consider the particular needs of nonwhite residents to reduce disparities.
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