According to, Mary L. Yost, President of THE SAGE GROUP, “The probability of undergoing major amputation depends on who you are, and where you live, ‘The Amputation Lottery’. Amputation varies by age, race, sex, socioeconomic status, type of hospital and geographic location.”

Reviewing disparities in African Americans (AA), Yost observed, “Compared to Whites, AA are more likely to be hospitalized and have a greater risk of amputation, both primary amputation and amputation following revascularization. This higher risk is not explained by disease severity or by the higher prevalence of PAD and critical limb ischemia (CLI).”

CLI, or ‘end-stage’ PAD, is the most severe and deadly form of PAD. It is characterized by rest pain, ulcers and gangrene. If the disease is so advanced that the limb cannot be revascularized, major amputation occurs. CLI is also known as critical limb threatening ischemia (CLTI).

“Black race independently predicts major amputation, increasing the risk by 1X-4X. Black women are at the highest risk of amputation with almost 8X the risk versus White women,” Ms. Yost elaborated.

“More than twenty years ago we wrote that PAD was underestimated, underdiagnosed and undertreated,” Yost declared. “Unfortunately, this is still true, particularly for women, and especially for Black, Hispanic and Native American women.”

According to Ms. Yost, “PAD is one of the most prevalent female diseases afflicting over 3X more women than breast cancer. Mortality significantly exceeds that of breast cancer. In females, 5-year PAD mortality is 27% increasing to 60% for CLI. This compares with 9% for breast cancer.”

“Women are at greater risk for amputation than men, especially above-the-knee amputations. Furthermore, females experience higher mortality after amputation,” Yost continued.

“Yet disease awareness among the public and non-specialist physicians remains low to nonexistent,” Yost observed. “The result is continued underdiagnosis, delayed diagnosis and misdiagnosis, combined with undertreatment in women. Undiagnosed PAD delays treatment until the most severe stages, significantly driving up the risk of amputation and mortality, as well as costs. Diagnostic and treatment disparities are particularly common in Black, Hispanic and Native American females.”

“Tragically, earlier diagnosis and appropriate treatment, could save lives and limbs, as well as significantly reduce costs,” stated Yost.

“PAD is not just a leg problem. It is also a heart and a brain problem, particularly for women,” declared Yost. “The risk of cardiovascular events and death is 2X-4X higher in women with PAD. While cardiovascular risk factor treatments are underutilized in all PAD patients, undertreatment of risk factors is more likely in women than men, and even more likely in Black women than White women.”

THE SAGE GROUP, a research and consulting company, specializes in peripheral vascular disease, including chronic venous disease, venous thromboembolism (VTE), PAD and CLI, as well as the economic costs and consequences of these diseases.

Additional information: www.thesagegroup.us.

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More than twenty years ago we wrote that PAD was underestimated, underdiagnosed and undertreated,” Yost declared. “Unfortunately, this is still true, particularly for women, and especially for Black, Hispanic and Native American women.”