Urban residents have smaller risk of mortality from chronic limb-threatening ischaemia


A new study using data from millions of patients hospitalised across the USA has determined whether population density and associated urban versus suburban versus rural environments predispose patients with peripheral vascular disease for chronic poor blood flow in their lower extremities. The findings were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2023 Scientific Sessions (18–20 May, Phoenix, USA).

Advanced and chronic peripheral arterial disease can significantly increase a patient’s risk for all-cause mortality including myocardial infarction (MI), stroke, and heart failure. The study aimed to identify the role that sociodemographics, including population density in a patient’s hometown affect outcomes including mortality from chronic limb-threatening ischaemia (CLTI).

In the study, deidentified patient data from the National Inpatient Sample (NIS) from 2001–2013 were queried. Inclusion criteria included a diagnosis of CLTI. Data were analysed using SPSS software in a binary logistic regression model, a p value <0.001 was considered statistically significant, and samples were standardised for comparison using predicted probabilities.

Of the 100m+ patients in the NIS, there were 1,907,089 patients identified with CLTI. Patients living in an urban setting with a population greater than one million people were found to be at a statistically significant decreased risk of mortality from CLTI (odds ratio [OR]=0.647, p<0.001). Females were also at a statistically significant decreased risk of mortality (OR=0.846, p<0.001). There was no statistically significant increase in mortality among different age groups, races, insurance carriers, median household income, or elective admission status (p<0.001).

“We now know that we need to ambulate our patients and encourage aggressive physical activity earlier and more frequently, especially for men,” said Harsh Jain (Montefiore Health System, New York, USA), lead author of the study. “This is a very low cost, low barrier to adoption that has significant ramifications including improved mortality for millions of people, decreased burden on healthcare resources, and millions of dollars in healthcare spending. Furthermore, men should be more vigilantly monitored when diagnosed with peripheral vascular disease, as they seem to fare worse regardless of where they are across the nation.”

Based on the findings, researchers suggest that patients with CLTI should be encouraged to maintain an active lifestyle and engage in vigorous exercise regimens earlier in their disease course to prevent progression and decrease their risk of mortality.


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