Yale University: Yale researchers call for strategies to eliminate inequities in access to peripheral artery disease care among adults who share a Hispanic background

Adults who share a Hispanic background and who get hospitalized for symptoms of peripheral artery disease (PAD) are more likely to only receive care at later stages of their disease, and get their treatment through the emergency department (ED) instead of early stage disease care, elective care as compared with non-Hispanic white patients, according to a Yale-led study published Aug. 26 in the Journal of Vascular Surgery.

For the new study, the Yale team — which is led by first author Paulina Luna-Martinez, MD, SOM ’22, under mentorship of Carlos Mena-Hurtado, MD, associate professor of medicine (cardiology) and Kim Smolderen, PhD, associate professor of medicine (cardiology and psychiatry) and co-directors of the Vascular Medicine OutcomeS (VAMOS) research program — evaluated the socioeconomic profile, risk factors, process of care, and outcomes in patients with PAD who have a Hispanic background.

PAD affects an estimated 8.5 million Americans. Prior studies have shown that undetected and undertreated PAD greatly reduces a person’s mobility and quality of life. The Yale study suggests that patients’ PAD care for those with a Hispanic background may get underdiagnosed and undertreated, and only gets noticed when they present at a late stage of their disease, which may greatly impact their amputation risk.

Using a national database, the research team identified 1,018,220 PAD hospitalizations. Between 2011-2017, they discovered that compared with non-Hispanic patients, Hispanics adults with severe PAD had longer hospitalizations. These patients were more often admitted through the emergency department and received less revascularization procedures and underwent more amputations.

Demographics are also quickly changing with patients sharing a Hispanic background, representing a larger segment of the PAD population. It is therefore important to document current gaps in their care and outcomes.

Carlos Mena-Hurtado, MD
The findings indicate that earlier targeted screening and management strategies for PAD care are needed among vulnerable populations, aimed at improving access to outpatient care and expanding health care coverage.

“The prevalence of peripheral artery disease is growing, especially among younger patients with a diverse risk profile and those with minority backgrounds. Demographics are also quickly changing with patients sharing a Hispanic background, representing a larger segment of the PAD population. It is therefore important to document current gaps in their care and outcomes and come with multipronged approaches to reduce access to care barriers and provide high quality care across the spectrum of PAD,” said Mena-Hurtado.

“We are learning that timely and integrated care models, with an eye for whole person care, cultural sensitive care, including behavioral health care, has the potential to improve patient outcomes and promote more inclusive care,” said Smolderen.

Yale’s Kristie Harris, and Miguel Algara contributed to this study. Yulanka Castro-Dominguez at Case Western Reserve University and Carolina Severiche-Mena at Universidad Pontificia Bolivariana are co-authors of this study.