http://archsurg.jamanetwork.com/ en-us Wed, 20 Mar 2013 00:00:00 GMT Wed, 20 Mar 2013 15:48:58 GMT Silverchair editor@archsurg.jamanetwork.com webmaster@archsurg.jamanetwork.com http://archsurg.jamanetwork.com/article.aspx?articleID=1669979 Wed, 20 Mar 2013 00:00:00 GMT Durazzo TS, Frencher S, Gusberg R. <span class="paragraphSection"><div class="boxTitle">Importance</div>Among patients presenting with critical lower extremity ischemia, it has been previously documented that white individuals are more likely to undergo revascularization than nonwhite individuals, with the disparity largely attributed to differences in resources and access to care.<div class="boxTitle">Objective</div>To investigate the amputation disparity between white and nonwhite patients with critical lower extremity ischemia in more detail using a larger data set than previous studies, with a focus on the role of confounding factors such as access and hospital resources.<div class="boxTitle">Design, Setting, and Patients</div>All hospital discharge records from the Nationwide Inpatient Sample of adult patients with the primary diagnosis of critical lower extremity ischemia from 2002-2008 were examined in detail using multiple logistic regression (n = 774 399).<div class="boxTitle">Main Outcomes and Measures</div>Rates of amputation and revascularization for peripheral vascular disease across race/ethnicity.<div class="boxTitle">Results</div>Controlling for confounding factors, black patients were found to have 1.77 times the odds of receiving an amputation compared with white patients (95% CI, 1.72-1.84; P < .001). Further analysis revealed the black to white odds ratio paradoxically increased with increasing revascularization capacity of the presenting hospital, from a low of 1.43 (95% CI, 1.23-1.65) to a high of 1.98 (95% CI, 1.83-2.24). The amputation disparity also paradoxically increased for patients living in wealthier zip codes.<div class="boxTitle">Conclusions and Relevance</div>Black patients have greater odds of undergoing amputation than white patients, even after correcting for an array of confounding parameters. Contrary to current beliefs that the disparity is mainly secondary to differences in access, this study found that the disparity was magnified in settings where resources were greatest. Whether the explanation lies primarily in patient-specific, physician-specific, or institutional-specific factors remains to be determined but is critical to better understanding our health care system and maintaining approaches that are consistently fair and equitable.</span> 1 6 10.1001/jamasurg.2013.1436 http://archsurg.jamanetwork.com/article.aspx?articleID=1669979 http://archsurg.jamanetwork.com/article.aspx?articleID=1669980 Wed, 20 Mar 2013 00:00:00 GMT Illig KA. <span class="paragraphSection">There is a compelling amount of data showing that amputation and revascularization rates between white and nonwhite patients are different. What accounts for this? The current analysis suggests that access to care, socioeconomic status, and clinical category of disease at presentation do not account for such differences. In their discussion, the authors suggest 3 general factors to consider: (1) differing access to care, (2) patient factors such as noncompliance, and (3) physician factors including bias and prejudice; however, they ultimately cite reasonably good arguments against most. Nowhere do they claim that health care provider bias is the reason, but this seems to be the only factor that cannot be excluded.</span> 1 1 10.1001/jamasurg.2013.1450 http://archsurg.jamanetwork.com/article.aspx?articleID=1669980