Geographical disparities of endovascular revascularisations in ambulatory setting in France from 2015 to 2019

Objectives Despite evidences of efficiency and safety ambulatory endovascular revasculatisation for lower extremity arterial disease (LEAD) concerned only 5% of the interventions in France in 2016. Such low rate suggested temporal and geographical space disparities. The aim of this study was to describe the space-time development of ambulatory endovascular revascularisation for LEAD in France and investigates the contributions of health care services and population characteristics as potential determinants. Methods A retrospective study was conducted on discharge data from French hospitals that performed endovascular procedures for LEAD between 2015 and 2019. Space-time analyses with Moran’s Index, zero-inflated Poisson regression, and clustering approaches were applied. Spatial clusters were compared on the basis of health care services and population characteristics (including poverty and single-man household as proxies of social isolation). Results Between 2015 and 2019, the number of ambulatory interventions has tripled (1104 vs 3130). Out of the 86 French departments, the proportion with > 5% of ambulatory interventions increased from 10.7% to 28.7% over the study period. In 2019, the ambulatory activity in the French departments ranged from 0% to 39%. This evolution was accompanied by a northwest to northeast spatial trend. The clusters of 27 departments with a significant ambulatory activity differed from the others notably by the mortality rate of lower limb arterial thrombo-embolic diseases in male (OR=3.15 95%CI[1.2-8.1]), the proportion of single-man household aged 75 or more (OR=0.37 95%CI [0.2-0.8]), and the poverty rate of people aged 50- to 59-year-old (OR=0.69 95%CI[0.5-0.9]). Conclusions The development of ambulatory interventions for LEAD in France is encouraging but heterogeneous. Some determinants of this evolution are clearly population based, with a positive impact of needs to take care of the burden of LEAD but negative effects of social isolation and poverty. Research should be conducted to overcome some patients’ constraints such as isolation