Study on lower extremity PAD reveals gender disparities in hospital admissions and mortality rates

A new three-state study shows a slight decrease in inpatient procedures for 2.4 million patients treated for lower extremity peripheral arterial disease (PAD) between 1998 and 2007, but reveals gender disparities in emergent hospital admissions and mortality rates for women. New York, New Jersey, and Florida state hospital inpatient discharge databases were selected and reviewed. Details of the research were published in the February issue of the Journal of Vascular Surgery®, by the Society for Vascular Surgery®.

"Compared to men, women had 18 to 27 percent fewer lower extremity PAD hospitalizations per capita, and 33 to 49 percent fewer vascular procedural hospitalizations than men," says researcher Natalia N. Egorova, PhD, MPH, from the Department of Health Evidence and Policy, and vascular surgeon Ageliki Vouyouka, MD, from the division of vascular surgery at Mount Sinai School of Medicine in New York City. Women were persistently more likely than men to be admitted emergently: 56 percent of women vs. 51 percent men in 1998 and 57 percent vs. 53 percent in 2007, respectively.

Although there was an overall improvement in mortality rates for both genders during the study period, on average procedural mortality was higher for women (4.95 percent vs. 4.37 percent). The most pronounced gender difference in mortality rates was observed after open vascular reconstructions (5.49 percents in women vs. 4.00 percent in men). The highest overall mortality was seen after amputations (9.89 percent in women vs. 8.90 percent in men). The lowest mortality rates and the least gender disparity was observed after endovascular procedures (2.87 percent in women vs. 2.10 percent in men) according to researchers. Hospital stays were 1.4 days longer for women after procedural PAD in 1998 but was only .3 days longer in 2007.

During the decade there was a dramatic increase in endovascular procedures by 150 percent in women and by 144 percent in men. Conversely, open procedures decreased by 36 percent in women and 30 percent in men. On a positive note, the amputation rate declined by 36 percent in women and by 21 percent in men. In 1998 women with PAD were more likely than men to have an amputation. However, by the end of the study in 2007 this disparity dissipated.

"Endovascular treatment has continued to improve the operative management and outcomes of vascular disease in both genders, reducing the mortality gap," said Drs. Egorova and Vouyouka. It is still unclear what causes gender differences in outcomes of PAD. However, early recognition of the disease in women, better understanding of gender variability in associated socioeconomic parameters, and clinical risk factors may eliminate this disparity.