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PAD Awareness in Structurally Vulnerable Hispanic/Latino Women
Adriana Gutierrez Yllu
1, Rodrigo M. Carrillo-Larco
1, Andrew A. Gonzalez
2, Gabriela Velazquez
3, Olamide Alabi
4 1Rollins School of Public Health, Emory University, Atlanta, GA;
2Indiana University, School of Medicine, Indianapolis, IN;
3Wake Forest University School of Medicine, Department of Vascular and Endovascular Surgery., Winston-Salem, NC;
4Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA
INTRODUCTION:Peripheral artery disease (PAD) remains underdiagnosed and undertreated among Hispanic/Latinos in the United States, contributing to worse vascular outcomes. We sought to characterize PAD awareness among Hispanic/Latino adults with abnormal ankle-brachial indices (ABIs).
METHODS:The Hispanic Community Health Study/Study of Latinos is the largest study on disease prevalence among Hispanic/Latino subjects enrolled at several field centers in the US (n=16,416 between 2008-2011), including subjects over age 45 with abnormal ABIs (< 0.9 or > 1.4). Baseline questionnaires were reviewed to determine the presence of patient-reported 1) leg symptoms with exertion, 2) prior PAD diagnosis by a physician, and 3) previous operation for PAD. Subjects self-reporting a prior diagnosis of PAD were described as “Aware.” In contrast, “Unaware” subjects were those with abnormal ABIs during the baseline assessment who did not have knowledge of their PAD diagnosis. The primary exposure variable was patient-reported gender. Logistic regression was performed to identify factors associated with PAD Awareness (the outcome of interest) in crude models as well as those adjusting for demographics, insurance status, education, marital status, language preference, comorbidities, and symptoms at baseline in the multivariable model.
RESULTS:Among 1,012 Hispanic/Latino subjects with an abnormal baseline ABI (median age 57[IQR:51-63]), 57.71% were Aware of their PAD diagnosis. Place of birth varied by gender, with men more frequently born in Cuba and Puerto Rico, while women were more often from Mexico and the Dominican Republic (p=0.002). Cardiovascular comorbidities were common, including hypertension (61.9%), hypercholesterolemia (60.9%), and diabetes (36.2%). Most of the cohort (57.9%) self-reported either being asymptomatic or having atypical leg pain. Women reported a lower income level (p<0.001), more often separated, divorced, or widowed (p<0.001), preference to read/speak in Spanish-only (p=0.008), and completed fewer formal years of education (10 vs 12 years, <0.001). No differences were found regarding insurance status between men and women (p=0.219). In the unadjusted model, women (p=0.028), subjects who reported more than one race (p=0.011), Cubans (p=0.006), insured patients (p=0.009), those with fewer years of education (p<0.001), and subjects who described classic claudication symptoms (p=0.001) were more likely to have PAD Awareness. Compared to men, women were 33% more likely to be Aware of their PAD diagnosis (OR: 1.33; 95% CI: 1.03 - 1.72, p=0.028) even after controlling for demographics, comorbidities, and symptoms at baseline assessment (aOR: 1.51; 95% CI: 1.12-2.01, p=0.006).
CONCLUSIONS:Similar to other populations, PAD awareness remains low among Hispanic/Latino Americans. Patient awareness of PAD varied across sociodemographic factors, including gender, education, and insurance status with women being more likely to be aware of their PAD diagnosis than men. Future interventions to improve PAD awareness may require unique gender-specific strategies to be impactful.
| Total (n=1,012) | Women (n=633) | Men (n=379) | p-value |
| Age, median (IQR) | 57 (51 - 63) | 57 (51 - 63) | 57 (51 - 64) | 0.79 |
| Race | | | | 0.29 |
| American Indian Alaskan native | 45 (4.45%) | 21 (3.32%) | 24 (6.33%) | |
| Asian | 3 (0.30%) | 2 (0.32%) | 1 (0.26%) | |
| Native Hawaiian, pacific islander | 40 (3.95%) | 23 (3.63%) | 17 (4.49%) | |
| Black | 401 (39.62%) | 250 (39.49%) | 151 (39.84%) | |
| White | 192 (18.97%) | 125 (19.75%) | 67 (17.68%) | |
| More than 1 race | 321 (31.72%) | 206 (32.54%) | 115 (30.34%) | |
| Unknown or Not reported | 10 (0.99%) | 6 (0.95%) | 6 (0.95%) | |
| Place of birth | | | | 0.002 |
| Cuba | 224 (22.13%) | 122 (19.27%) | 102 (26.91%) | |
| Dominican Republic | 137 (13.54%) | 99 (15.64%) | 38 (10.03%) | |
| Mexico | 226 (22.33%) | 152 (24.01%) | 74 (19.53%) | |
| Puerto Rico | 175 (17.29%) | 99 (15.64%) | 76 (20.05%) | |
| United States | 102 (10.08%) | 58 (9.16%) | 44 (11.61%) | |
| South America | 62 (6.13%) | 45 (7.11%) | 17 (4.49%) | |
| Central America | 77 (7.61%) | 53 (8.37%) | 24 (6.33%) | |
| Europe | 4 (0.40%) | 1 (0.16%) | 3 (0.79%) | |
| Other, unknown, or refused | 5 (0.49%) | 4 (0.63%) | 1 (0.26%) | |
| Marital status | | | | <0.001 |
| Single | 185 (18.28%) | 107 (16.90%) | 78 (20.58%) | |
| Married | 394 (38.93%) | 221 (34.91%) | 173 (45.65%) | |
| Separated | 112 (11.07%) | 77 (12.16%) | 35 (9.23%) | |
| Divorced | 159 (15.71%) | 116 (18.33%) | 43 (11.35%) | |
| Widow | 100 (9.88%) | 81 (12.80%) | 19 (5.01%) | |
| Living with partner | 58 (5.73%) | 28 (4.42%) | 30 (7.92%) | |
| Unknown or Not reported | 4 (0.40%) | 3 (0.47%) | 1 (0.26%) | |
| Income, $ | | | | <0.001 |
| <30,000 | 732 (72.33%) | 466 (73.62%) | 266 (70.18%) | |
| ≥30,000 | 198 (19.57%) | 103 (16.27%) | 95 (25.07) | |
| Unknown or Not reported | 82 (8.10%) | 64 (10.11%) | 18 (4.75%) | |
| | | | |
| Insurance status | | | | 0.22 |
| Yes | 622 (61.46%) | 376 (59.40%) | 246 (64.91%) | |
| No | 372 (36.76%) | 245 (38.70%) | 127 (33.51%) | |
| Unknown or Not reported | 18 (1.78%) | 12 (1.90%) | 6 (1.58%) | |
| Symptoms | | | | 0.76 |
| Classic claudication | 399 (39.43%) | 244 (38.55%) | 155 (40.90%) | |
| Different than claudication or asymptomatic | 586 (57.91%) | 372 (58.77%) | 214 (56.46%) | |
| Unknown or Not reported | 27 (2.67%) | 17 (2.69%) | 10 (2.64%) | |
| Previous operation for PAD | 43 (4.25%) | 21 (3.32%) | 22 (5.80%) | 0.058 |
| Language preference | | | | 0.008 |
| Only Spanish | 546 (53.95%) | 367 (57.98%) | 179 (47.23%) | |
| Spanish better than English | 233 (23.02%) | 133 (21.01%) | 100 (26.39%) | |
| Both equal | 131 (12.94%) | 79 (12.48%) | 52 (13.72%) | |
| English better than Spanish | 76 (7.51%) | 42 (6.64%) | 34 (8.97%) | |
| Only english | 24 (2.37%) | 10 (1.58%) | 14 (3.69%) | |
| Unknown or Not reported | 2 (0.20%) | 2 (0.32%) | 0 (0.00%) | |
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