RS24 - The Impact of Neighborhood Social Disadvantage on Peripheral Artery Disease Presentation and Management

Objectives: Studies examining the relationship between socioeconomic disparities and peripheral artery disease (PAD) often focus on individual social health determinants and thus fail to account for the complex interplay between factors that ultimately impact disease severity and outcomes. Area Deprivation Index (ADI), a validated measure of neighborhood adversity, provides a more comprehensive assessment of social disadvantage. Therefore, we examined the impact of ADI on PAD severity and its management.

Methods: We identified all patients who underwent infrainguinal revascularization (open or endovascular) or amputation for symptomatic PAD in the VQI registry between 2003-2020. An ADI score of 1-100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing adversity. Patients were categorized by ADI quintiles (Q1-Q5). Outcomes of interest included indication for procedure (claudication, rest pain, or tissue loss) and rates of revascularization (vs primary amputation). Multinomial logistic regression was used to evaluate for an independent association between ADI quintile and these outcomes.

Results: Among the 79,973 patients identified, 9,604 (12%) were in the lowest ADI quintile (Q1), 14,961 (18.7%) in Q2, 19,800 (24.8%) in Q3, 21,735 (27.2%) in Q4 and 13,873 (17.4%) in Q5. There were significant trends towards lower rates of intervention for claudication (Q1 39% vs Q5 34%, p< 0.001), higher rates of intervention for rest pain (Q1 12.4% vs Q5 17.8%, p< 0.001), and lower rates of revascularization (Q1 80% vs Q5 69%, p< 0.001) with increasing ADI quintiles (Table I). In adjusted analyses, there was a progressively higher likelihood of presenting with rest pain vs claudication, with patients in Q5 having the highest probability when compared to those in Q1 (RR 2.0 95%CI 1.8-2.2, p< 0.001) (Table II). Patients in Q5, when compared to those in Q1, also had a higher likelihood of presenting with tissue loss vs claudication, (RR 1.4 95%CI 1.3-1.6; p< 0.001) (Table 2). Compared with patients in Q1, patients in Q2-5 had a lower likelihood of undergoing any revascularization procedure (Table II).

Conclusions: Among patients who underwent infrainguinal revascularization or amputation in the VQI, those with higher neighborhood adversity had more advanced disease at presentation and lower rates of revascularization. Further work is needed to better understand neighborhood factors that are contributing to these disparities in order to identify community-level targets for improvement.