Persistent Racial Disparities in Chronic Limb-Threatening Ischemia Outcomes and Utilization Among US Medicare Patients

Strategic Insights -

Chronic limb-threatening ischemia (CLTI) disproportionately affects racial minority populations, particularly Black patients, who experience higher amputation rates and reduced access to vascular care. Despite national initiatives aimed at improving early screening and diagnosis of peripheral arterial disease (PAD), it is unclear whether these efforts have improved outcomes for Black patients. A recent study conducted by researchers at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, examined temporal trends in treatment, outcomes, and healthcare utilization for Black versus White Medicare beneficiaries with CLTI undergoing endovascular revascularization.

Key Takeaways:

  • The study found that Black patients with CLTI had a higher risk of major amputation (HR 1.49; 95% CI, 1.45-1.53) and lower mortality (HR 0.91; 95% CI, 0.90-0.93) compared to White patients over a median 1.7 years of follow-up.
  • Black patients were younger, had more comorbidities, and more often presented with gangrene than White patients.
  • Despite having fewer vascular visits before and after revascularization, Black patients had more emergency department visits (aRR 1.09) and hospital readmissions (aRR 1.28) than White patients.
  • The study concluded that Black patients with CLTI continue to face higher amputation risk and reduced access to longitudinal vascular care, underscoring the need for sustained, equity-focused interventions.
  • The study included 303,906 patients, with 17.2% (N=52,376) identifying as Black.
  • The median follow-up time was 1.7 years.
  • The study used Cox models to evaluate the primary outcome of major amputation or death over 4 years.
  • Healthcare utilization was assessed via adjusted rate ratios (aRRs) for vascular provider visits, emergency department use, and hospital admissions.

Statistics:

  • 17.2% of patients (N=52,376) identified as Black.
  • 1.49 times higher risk of major amputation for Black patients (HR 1.49; 95% CI, 1.45-1.53).
  • 0.91 times lower mortality rate for Black patients (HR 0.91; 95% CI, 0.90-0.93).
  • 1.09 times more emergency department visits for Black patients (aRR 1.09).
  • 1.28 times more hospital readmissions for Black patients (aRR 1.28).
  • Median follow-up time was 1.7 years.

Sources:

  • Persistent Racial Disparities in Chronic Limb-Threatening Ischemia Outcomes and Utilization Among US Medicare Patients. The American Journal of Cardiology, 2025.
  • Excerpta Medica Inc-elsevier Science Inc, 685 Route 202-206 Ste 3, Bridgewater, NJ 08807, USA.
  • Joseph M. Kim, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.