Natour AK, Shepard A, Nypaver T, Weaver M, Peshkepija A, and Kabbani L. Socioeconomic Disparities Do Not Affect Outcomes in Acute Limb Ischemia. Journal of Vascular Surgery 2021; 74(4):E372-E373.
J Vasc Surg
Objective: The association between socioeconomic status (SES) and outcome after acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI.
Methods: We performed a retrospective review of a prospectively collected database containing all patients who had presented with ALI between April 2016 and October 2020 to a tertiary care center. SES was quantified using individual variables (median household income, level of education, employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data, with a higher number indicating lower SES status. The NDI summarizes eight domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The associations between SES and the severity of ALI at presentation and between SES and the outcomes were analyzed using bivariate analysis of variance, an independent t test, and multivariate logistic regression, as appropriate.
Results: During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. Their mean age was 64 years; 55% were men and 57% were white. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8%, respectively. Patients with a low SES status using the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation (Table). The etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation ( P = .96) or the treatment modality ( P = .80). We found no association between SES and either 30-day or 1-year limb loss or mortality (Table). Lower SES (higher NDI) was associated with increased 30-day readmissions ( P = .021). This association persisted on multivariate analysis ( P = .023).
Conclusions: SES was not associated with the severity of ALI at presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation and higher readmission rates for patients with ALI, SES was not a predictor of short-term or 1-year limb loss or mortality. In the present study, ALI presentation and treatment outcome were independent of SES.