Diabetes Interacts with Latinx/Hispanic Ethnicity to Increase Major Amputations After Peripheral Vascular Intervention for Chronic Limb-threatening Ischemia

Latinx/Hispanic patients treated for chronic limb-threatening ischemia (CLTI) have higher amputation rates after controlling presenting Wound, Ischemia, and foot Infection (WIfI) status. We hypothesize that a incidence of diabetes mellitus (DM) in may contribute to this disparity. The Vascular Quality Initiative peripheral vascular intervention dataset (2016-2022) was queried CLTI. Inclusion criteria were reported WIfI stage White race or ethnicity. primary endpoint 1-year major (through tibia/fibula more proximally). A multivariate hierarchical Fine Gray analysis performed hospital-level variation competing risk death. stratified by stage, DM as an interaction term with Overall, 38,079 (45%) cases met inclusion 3247 (12%) (77% vs 61%; P < .01). Proportions stages similar between ethnicity, respectively: 1 (29% 30%), 2 (38% 32%), 3 (19% 21%), 4 (14% 18%). cumulative highest (Figure). On analysis, the subdistribution hazard ratio (SHR) at 1.8 (95% confidence interval [CI], 1.3-2.4; .01); 1.4; 95% CI, 0.7-2.6; = .29) without DM, 1.4 1.1-1.6; .01) compared DM. When ethnicity conferred greatest increase SHR (SHR, 1.9; 1.1-3.2; .03) 2.1; 1.2-3.7; .01), requiring insulin treatment had 2.0; 1.4-2.7; (Table). amputations CLTI is modified stepwise those treatment. This study suggests prevention cornerstone addressing disparities limb threat reducing their risk.TableSubdistribution ratios TreatmentSHR95% CIP valueWhite racea Diet controlled0.80.5-1.2.29 Noninsulin treatment1.20.9-1.6.07 Insulin treatment1.51.2-1.8<.01Latinx/Hispanic ethnicitya No diagnosis1.40.8-2.6.29 controlled1.50.6-3.8.26 treatment1.50.9-2.5.09 treatment2.01.4-2.7<.01CI, Confidence interval.Model adjusted age, insurer, end-stage renal disease, prior amputation, level. Boldface entries indicate statistical significance.aReference group all: no diagnosis. Open table new tab