Predictors of Amputation in Peripheral Artery Disease

doctor with male patient
Black patients had a 43% greater risk for amputation compared with whites.

Results from a study of 208,194 veterans treated for peripheral artery disease (PAD) demonstrated that black race and poverty are both independent predictors for amputation risk.1

Shipra Ayra, MD, assistant professor of surgery at Emory School of Medicine and a vascular surgeon at the Atlanta Veterans Administration Medical Center in Decatur, Georgia, presented the findings at the 2016 American Heart Association Scientific Sessions in New Orleans.

According to an analysis of data collected from 2003 to 2014, black patients had a 43% greater risk for amputation compared with whites (hazard ratio [HR]: 1.43; 95% confidence interval [CI], 1.27-1.62).

“There may be biological mechanisms still unknown as to why black patients are at a higher risk for amputations in PAD, but access to care is an important independent contributor to the risk,” Dr Arya said in a press release.2

The researchers found that incident amputation risk was declined significantly lower for wealthier black and white patients, but not among other racial groups. Low socioeconomic status patients of any race had a 37% increased risk for amputation (HR: 1.37; 95% CI, 1.26-1.49).

“Patients living in zip codes with a high poverty burden also have incrementally higher risk of amputation, suggesting a role for access to care in determining outcomes for PAD,” Dr Arya said. “Treatment for PAD is multimodal. It includes optimal medical management of risk factors associated with cardiovascular disease, in addition to supervised exercise, which is not yet covered by insurance.”

The researchers did not find a significant interaction between race and socioeconomic status.

Dr Arya and fellow researchers analyzed data collected on veterans treated at Veterans Affairs Administration hospitals and assessed patients by race and socioeconomic status as measured by percentage of individuals below the poverty line in the patient’s zip code tabulation area. Outcomes were incident major amputation risk at 1, 3, and 5 years.

However, the study was only observational and further research is needed to identify causes for the disparities.


  1. Arya S, Long C, Binney ZO, et al. Poster T2077. Race and socioeconomic status have independent effects on amputation in peripheral arterial disease (PAD) patients. Presented at: the 2016 American Heart Association Scientific Sessions; November 12-16, 2016; New Orleans, LA.
  2. Amputation risks highest amongst poor and black PAD patients [press release].Dallas, TX: American Heart Association/American Stroke Association Newsroom; November 15, 2016.