ArticleJournal of vascular surgery2020
The effect of rurality on the risk of primary amputation is amplified by race.
Article in Journal of vascular surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- 2026 ACC/AHA Clinical Performance and Quality Measures for Patients With Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures.Journal of the American College of Cardiology · 2026Guideline
- 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Guideline
- Outcomes among patients with peripheral artery disease in the Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE) study.Vascular medicine (London, England) · 2023Trial
- Trends and racial-geographic disparities in mortality among US older adults with peripheral artery disease, 1999 to 2020.Proceedings (Baylor University. Medical Center) · 2026Article
- Racial and/or ethnic and rural disparities in health care utilization before major lower extremity amputation in patients with peripheral artery disease.Journal of vascular surgery · 2026Article
- Peripheral Artery Disease: New Concepts, Treatments, and Disparities.Annual review of medicine · 2026Review
- Primary Care Providers Describe Barriers and Facilitators to Amputation Prevention in Oklahoma.Journal of clinical medicine · 2025Article
- 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.Circulation · 2025Review
- Exploring diabetic foot screening programs with integrated consolidated framework for implementation: Rapid review protocol.HRB open research · 2025Article
- Association Between Diagnosis-to-Limb Revascularization Time and Clinical Outcomes in Outpatients With Chronic Limb-Threatening Ischemia: Insights From the CLIPPER Cohort.Journal of the American Heart Association · 2024Article
- 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.Circulation · 2024Review
- Review
- Article
- Vascular surgeons are positioned to fight healthcare disparities.Journal of vascular surgery. Venous and lymphatic disorders · 2024Review
- Assessing equity in the uptake of remote foot temperature monitoring in a large integrated US healthcare system.PloS one · 2024Article
- Racial Differences in Presentation and Outcomes After Peripheral Arterial Interventions: Insights From the NCDR-PVI Registry.Circulation. Cardiovascular interventions · 2023Article
- The use of telemedicine in peripheral artery disease and limb salvage.Seminars in vascular surgery · 2023Review
- Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association.Circulation · 2023Review
- Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation.Frontiers in rehabilitation sciences · 2023Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivePrimary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship.
methodsThe national Vascular Quality Initiative amputation data set was used for analyses (N = 6795). The outcome of interest was primary amputation. Independent variables were race/ethnicity (non-Latinx whites vs nonwhites) and rural residence. Multivariable logistic regression examined impact of rurality and race/ethnicity on primary amputation after adjustment for relevant covariates and included an interaction for race/ethnicity by rural status.
resultsPrimary amputation occurred in 49% of patients overall (n = 3332), in 47% of rural vs 49% of urban patients (P = .322), and in 46% of whites vs 53% of nonwhites (P < .001). On multivariable analysis, nonwhites had a 21% higher odds of undergoing primary amputation overall (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.05-1.39). On subgroup analysis, rural nonwhites had two times higher odds of undergoing primary amputation than rural whites (AOR, 2.06; 95% CI, 1.53-2.78) and a 52% higher odds of undergoing primary amputation than urban nonwhites (AOR, 1.52; 95% CI, 1.19-1.94). In the urban setting, nonwhites had a 21% higher odds of undergoing primary amputation than urban whites (AOR, 1.21; 95% CI, 1.05-1.39).
conclusionsIn these analyses, rurality was associated with greater odds for primary amputation in nonwhite patients but not in white patients. The effect of race on primary amputation was significant in both urban and rural settings; however, the effect was significantly stronger in rural settings. These findings suggest that race/ethnicity has a compounding effect on rural health disparities and that strategies to improve health of rural communities need to consider the particular needs of nonwhite residents to reduce disparities.
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Registered trials
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