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 社会弱势、获得保健的机会不平等和系统性种族主义被确定为主要问题 导致美国黑人健康状况不佳的罪魁祸首。使问题进一步恶化的是 削减用于医疗保健和社会服务项目的公共卫生资金的预算， 黑人社区的一部分。实证研究结果证实了黑人患者医疗保健的差异 并发PAD和下肢缺血文献很好地解释了糖尿病的发病过程 导致PAD并确定那些最有可能发生灾难性后果的人，截肢。 研究中的一个空白是确定导致早期并发症的因素 糖尿病患者的PAD和促成因素的识别（患者方面 和卫生保健提供者），导致决定截肢更经常在黑人患者 比其他人群。拟议的研究解决了这两个差距。 拟议的研究旨在利用糖尿病合并PAD和截肢的病例 流行病不仅为一个长期存在和有据可查的问题提供了新的线索，而且还 提供证据，支持遵守实践指南和预防性努力，以改善PAD， 最大限度地减少肢体损失，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，临床实践中的指南是， 糖尿病伴PAD黑人患者肢体过度截肢的心脏一般而言， 公认的实践和预防指南支持使用简单的诊断措施， 筛选和监测PAD进展，然而，我们的研究记录，肢体疾病的发生率， 截肢继续攀升，特别是在美国的地理区域， 黑人的比例。这是特别不幸的，因为血运重建和其他 在作出决定之前，应考虑可用的替代治疗方案， 截肢 使用我们所有人（AoU）数据，这项研究旨在了解文化，环境和 导致PAD伴糖尿病诊断和治疗差异的决策因素 以及随后的肢体缺失目的1：比较影响早发性（45岁以前）、共病性 黑人和白色人糖尿病患者的外周动脉疾病 目的2：检查筛查实践与截肢患者之间的关系， 糖尿病和伴随的外周动脉疾病。目标3：审查影响实践的因素 在美国黑人和非黑人患者中截肢的决定。

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.