Black Bodies Matter: An examination of Diabetes, Peripheral Artery Disease and Limb Amputation Disparities in Black and White participants of the All of Us Research Program.

项目摘要 社会劣势、获得护理的机会不平等和系统性种族主义被确定为主要原因 导致美国黑人健康状况不佳的元凶。使问题进一步恶化的是 削减公共卫生资金，用于医疗保健和社会服务项目，这些项目为 黑人社区的一部分。经验发现证实了黑人患者在医疗保健方面的差异 伴有复杂的PAD和下肢缺血。文献很好地解释了糖尿病的发病过程。 这导致了PAD，并确定了那些最有可能出现毁灭性后果的人，即截肢。 研究中的空白之一是确定导致更早发生共生的因素 糖尿病患者的PAD和致病因素的识别(部分患者 和医疗保健提供者)导致决定在黑人患者中更频繁地截肢 而不是其他种群。拟议的研究解决了这两个差距。 拟议的研究试图利用糖尿病合并PAD和截肢的病例。 流行病不仅对一个长期存在的和有充分记录的问题有了新的认识，而且还 提供证据，支持遵守实践指南和预防工作以改善PAD； 最大限度地减少肢体丧失，提高黑人患者的整体生活质量。不一致地遵守 根据美国预防服务工作组的说法，临床实践的指南位于 患有糖尿病和伴发PAD的黑人过度截肢的心脏。一般来说， 公认的做法和预防指南支持使用简单的诊断性措施 PAD进展的筛查和监测，然而，我们的研究记录了肢体的比率 截肢人数继续攀升，特别是在美国拥有大量 黑人的比例。这特别不幸，因为血运重建和其他 在做出决定之前，应该考虑的治疗替代方案是可用的 截肢。 使用我们所有人(AOU)的数据，本研究旨在了解文化、环境和 导致糖尿病合并PAD诊断和治疗差异的决策因素 以及随后的肢体丧失。目的1：比较影响早发(45岁前)、合并症的因素 黑人和白人糖尿病患者的外周动脉疾病。 目的2：研究筛查方法与截肢的关系。 糖尿病及其伴发的外周动脉疾病。目标3：检查影响实践的因素 美国黑人和非黑人患者截肢的决定。

Project Summary Social disadvantage, unequal access to care and systemic racism are identified as primary culprits leading to poor health outcomes among Black Americans. Further exacerbating the problem are budget cuts to public health funding for health care and social service programs that serve a large segment of the Black community. Empirical findings confirm disparities in health care for Black patients with complicated PAD and lower limb ischemia. The literature well-explains the diabetes disease process that leads to PAD and identifies those at greatest risk for the devastating outcome, limb amputation. One of the gaps in the research is the identification of factors leading to the earlier onset of co-occurring PAD in individuals with diabetes and the identification of contributing factors (on the part of patients and health care providers) that lead to the decision to amputate a limb more often in Black patients than other populations. The proposed research addresses these two gaps. The proposed research seeks to utilize the case of diabetes with PAD and a limb amputation epidemic to not only shed new light on a long-established and well-documented problem, but also to provide evidence in support of adherence to practice guidelines and preventive efforts to improve PAD, minimize loss of limb, and enhance overall quality of life for Black patients. Inconsistent adherence to guidelines in clinical practice is, according to the United States Preventive Services Task Force, at the heart of excessive limb amputation among Blacks with diabetes and concomitant PAD. Generally, accepted practice and prevention guidelines support the use of simple, diagnostic measures for screening and monitoring of PAD progression, and yet, documented by our research, the rate of limb amputation continues to climb, particularly in geographic regions of the United States with large proportions of Black persons. This is particularly unfortunate because revascularization and other therapeutic alternatives are available that should be considered before the decision is made to amputate a limb. Using the All of Us (AoU) Data, this study aims to understand cultural, environmental, and decision-making factors that contribute to disparities in diagnosis and treatment for PAD with diabetes and subsequent limb loss. Aim 1: Compare the factors influencing early onset (before age 45), co-morbid peripheral artery disease in Black and White patients with diabetes. Aim 2: Examine the relationship between the screening practices and limb amputation in patients with diabetes and concomitant peripheral artery disease. Aim 3: Examine factors influencing practice decisions to amputate a lower limb in Black and nonblack patients in the United States.