Community Distress and Risk of Adverse Outcomes Following Peripheral Vascular Intervention.

INTRODUCTION: Community distress is associated with adverse outcomes in patients with cardiovascular disease, however, its impact on clinical outcomes following peripheral vascular intervention (PVI) is uncertain. The Distressed Communities Index (DCI) is a composite measure of community distress measured at the zip code level. We evaluated the association between community distress, as measured by the DCI, and 24-month mortality and major amputation following PVI.

METHODS: We used the Vascular Quality Initiative (VQI) database, linked with Medicare claims data, to identify patients who underwent initial femoropopliteal PVI between 2017 and 2018. DCI scores were assigned using patient-level zip code data. The primary outcomes were 24-month mortality and major amputation. We used time-dependent ROC curve analysis to determine an optimal DCI value to stratify patients into risk categories for 24-month mortality and major amputation. Mixed Cox regression models were constructed to estimate the association of DCI with 24-month mortality and major amputation.

RESULTS: The final cohort consisted of 16,864 patients, of whom 4,734 (28.1%) were classified as having high community distress (DCI ≥70). At 24 months, mortality was elevated in patients with high community distress (30.7% vs 29.5%, p-value = 0.02), as was major amputation (17.2% vs 13.1%, p-value < 0.001). After adjusting for demographic and clinical characteristics, a 10-point higher DCI score was associated with increased risk of mortality (HR: 1.01; 95% CI: 1.00-1.03) and major amputation (HR: 1.02; 95% CI: 1.00-1.04).

CONCLUSIONS: High community distress is associated with increased risk of mortality and major amputation after PVI.