Neighborhood Socioeconomic Deprivation Does Not Appear to Influence Selection for Lower Extremity Revascularization versus Amputation in Maryland.

Background: Race/ethnicity, socioeconomic status and insurance status have all been reported to have an effect not only on outcomes, but also on the likelihood of whether patients presenting with Chronic Limb Threatening Ischemia (CLTI) are more likely to undergo revascularization versus amputation. The effect of neighborhood socioeconomic deprivation is increasingly being acknowledged as having a role in these sociodemographic disparities.

Objective: This study aimed to determine if neighborhood socioeconomic deprivation, as measured by the Distressed Communities Index (DCI), influences treatment selection by revascularization versus amputation for patients presenting with CLTI in the state of Maryland.

Methods: We conducted a retrospective analysis of the Maryland State Inpatient Database between January 2018 and December 2020 to assess the association between DCI and the likelihood of revascularization versus amputation for patients presenting with CLTI. Multivariate logistic regression analyses were also used to determine the odds for revascularization versus amputation.

Results: There were 4,537 hospitalizations for CLTI. Of these, 3,511 (77.4%) underwent revascularization, while 1,026 (22.6%) underwent major amputation. The median age was 67 years (Interquartile range 59-75) and 38.0% of the patients were female. By race/ethnicity, 56.4% identified as White, 38.5% were Black, 2.7% were Hispanic, and 2.4% identified as Other. We did not identify an association between DCI and the treatment received, i.e., revascularization versus amputation.

Conclusion: The DCI was not associated with a likelihood of undergoing revascularization versus amputation for patients presenting with CLTI in this Maryland statewide database.