Interplay of Race and Community Characteristics on Health Disparities Among Medicare Beneficiaries With Peripheral Artery Disease.

Research on disparities in peripheral artery disease (PAD) often examines factors individually. However, complex interactions between sex, race, and geography likely influence outcomes and treatment use. This study investigates the combined effects of race and community characteristics on outcomes and treatment utilization among Medicare beneficiaries with PAD. This retrospective cohort study analysed 100% Medicare Standard Analytic Files from 2017 to 2023. Primary outcomes included death, major amputation, and endovascular and surgical revascularization. Kaplan-Meier and Cox proportional hazards regression were used to examine the associations between outcomes and individual-level race (Black vs White) and county-level minority population percentage (the percentage that was not non-Hispanic White, using the Distressed Community Index). Black patients had an increased risk of death and major amputation than White patients (death: Hazard Ratio [HR] = 1.13, 95% Confidence Interval [CI] 1.12 to 1.13; major amputation: HR = 2.79, 95% CI 2.72 to 2.86). These risks were exacerbated in counties with a higher percentage of minority populations. While Black patients were more likely to receive endovascular revascularization treatment than White patients overall (HR = 1.06, 95% CI 1.05 to 1.08), those residing in counties in the highest quartile of minority population percentage were significantly less likely to receive endovascular revascularization (HR = 0.95, 95% CI 0.94 to 0.97) compared to those in the lowest quartile of minority population percentage. This study highlights the combined impact of race and community characteristics on health disparities in PAD populations. More access to appropriate interventions among Black patients residing in areas with high-minority populations could significantly improve health outcomes and advance equity.