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Providing Vascular Surgical Care for Lower Extremity Ischemia from a Socioeconomic Perspective
Daniel J. Torrent, MD1, Michael C. Stoner, MD2, Frank M. Parker, M.D.1, William M. Bogey, M.D.1, C. Steven Powell, M.D.1, David W. Barham1, Nishika S. Patel1, Avery G. Colomb1, Dean J. Yamaguchi, M.D.1.
1East Carolina University, Greenville, NC, USA, 2University of Rochester, Rochester, NY, USA.
OBJECTIVES:
Socioeconomic status as it influences vascular patient care has not been studied. The purpose of this study is to evaluate the impact of socioeconomic status on patients with lower limb ischemia in eastern North Carolina.
METHODS:
All referrals through clinic and hospital transfer over an eight month period from 2013 through 2014 were recorded. Patient demographics, diagnosis, comorbidities, payer source, county of residence, and date of transfer were also recorded. Age and comorbidities were used to calculate Charlson Comorbidity Index (CCI). Census data described the median income per capita for each county. Univariate statistics were used for the associations between day of week of transfer and payer source. For patients transferred with lower extremity ischemia, the percentage transferred with critical limb ischemia was calculated. Univariate and multivariate statistics describing the association between mean per capita income and county of residence as well as race were calculated.
RESULTS:
There were a total of 1299 patients with the majority of transfers taking place on Monday (312), Tuesday (234), Wednesday (335), and Thursday (301). There were a total of 440 patients transferred for lower extremity ischemia with 30.7% having critical limb ischemia. Factors associated with presenting with critical limb ischemia were having a federal payer source (P = 0.04) compared to a private payer, being from a county with a median income per capita before the median for the region (P = 0.02), and per capita income of the county as a linear variable (P = 0.05), being non-Caucasian (P = 0.01), age (P = 0.02), CCI (P = 0.01). By logistic regression, a federal payer source increased the odds of presenting with CLI by 2.3 times (95% CI 1.11-5.28) when controlling for race (P = 0.002), age (P = 0.03), and relation to the median county of residence income (P = 0.14).
CONCLUSIONS:
Lower income patients residing in eastern North Carolina who rely upon federally funded insurance trend towards seeking vascular care at a later stage of disease (i.e. critical limb ischemia). This is probably a result of economic strain as well as limited resources and education.
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