Burden Estimates, Post-diagnosis Care, and Outcomes Associated with Peripheral Artery Disease in the Atherosclerosis Risk in Communities Study

Peripheral artery disease (PAD) is a progressive atherosclerotic disorder of the lower extremities that causes adverse individual- and health care system-level consequences as populations age. This doctoral dissertation research estimated the annual period prevalence and incidence of PAD as well as the frequency of care and mortality following diagnosis in the outpatient or inpatient setting. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI: 11.5, 12.1) and 22.4 (95% CI: 20.8, 24.0) per 1000 person-years, respectively. Blacks had a higher mean weighted mean age-standardized prevalence (15.6%; 95% CI: 14.6, 16.4) as compared to whites (11.4%; 95% CI: 11.1, 11.7). Blacks also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI: 27.3, 35.4) as compared to whites (25.4 per 1000 person-years; 95% CI: 23.5, 27.3). PAD prevalence and incidence did not differ by gender alone. One-thousand eighty six incident cases of PAD were identified from 2002-2010. PAD-related post-diagnosis encounters were 2.15 (95% CI: 2.10, 2.21) and 1.02 (95% CI: 0.94, 1.10) among those with an incident PAD diagnosis in the outpatient and inpatient setting, respectively. Participants with PAD had an average of 6-8 primary care encounters per person-year over the course of our study. PAD-related and all-cause hospitalization was 6.4% (95% CI: 4.8, 8.1) and 32.2% (95% CI: 29.0, 35.2) at one year among those with incident outpatient PAD. Approximately 14% (95% CI: 9.3, 18.7) of participants diagnosed with inpatient PAD had a PAD-related rehospitalization at one year while 43.4% (95% CI: 36.3, 49.7) had an all-cause rehospitalization at one year. One year age-standardized case fatality was 7.1% (95% CI: 5.4, 8.7) and 16.0% (95% CI: 11.0, 21.1) among those diagnosed in the outpatient and inpatient setting, respectively. Peripheral artery disease and utilization of outpatient health care services was common among men and women 65 years of age and older with enrollment in a Medicare fee-for-service program sampled of four US communities.Doctor of Philosoph