Factors Associated with Peripheral Artery Disease Awareness Among Hispanic/Latino Adults: A Hispanic Community Health Study/Study of Latinos Cross-Sectional Study Restricted; Files Only

Abstract

Introduction

Peripheral artery disease (PAD) remains underdiagnosed and undertreated among Latino populations in the United States (U.S.), contributing to avoidable health disparities in vascular outcomes. Hispanic/Latino populations experience a substantial burden of PAD, yet factors associated with PAD awareness in this population remain poorly understood, particularly with respect to migration history and acculturation.

Objective

To identify sociodemographic and clinical factors associated with PAD awareness among Hispanic/Latino adults.

Methodology

A cross‑sectional analysis was conducted using baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) collected between 2008 and 2011. The analytic sample included 1,012 Hispanic/Latino adults with PAD, defined using ankle‑brachial index (ABI) and history of PAD. Aware cases were those who self-reported having been diagnosed with PAD, regardless of ABI. Unaware cases were those with abnormal ABI at baseline who have not been diagnosed with PAD. A positive ABI screening was defined as ABI ≤ 0.90 or > 1.40. All analyses incorporated survey weights to account for the complex sampling design. Survey‑weighted Poisson regression models were used to estimate prevalence ratios (PRs) for factors associated with PAD awareness, with sequential adjustment for sociodemographic characteristics and clinical factors.

Results

The mean age of participants was 59 years, and 54% were women. Based on survey‑weighted estimates, 58% of participants with PAD were aware of their diagnosis. Compared with PAD‑aware participants, the PAD‑unaware group had a higher prevalence of PAD without claudication (65% vs 52%) and a lower prevalence of claudication symptoms (32% vs 46%). The PAD‑unaware group also had a lower prevalence of cardiovascular comorbidities, including heart failure (2.6% vs 12%), diabetes mellitus (32% vs 43%), atrial fibrillation (0.7% vs 4.4%), and prior deep vein thrombosis or pulmonary embolism (2.2% vs 17%). In adjusted models, self‑identification as more than one race, intermittent claudication, heart failure, and deep vein thrombosis or pulmonary embolism were positively associated with PAD awareness.

Conclusion

PAD awareness among Hispanic/Latino adults remains suboptimal. Awareness was primarily associated with claudication and greater cardiovascular comorbidity. There is a need for proactive, risk-based strategies to improve identification of PAD, particularly among asymptomatic Hispanic/Latino individuals at high cardiovascular risk.

Table of Contents

CHAPTER 1. INTRODUCTION .................................................................................... ....1

1 Introduction .............................................................................................................. 1

1.1 Background ............................................................................................................. 1

1.2 PAD Awareness as a Public Health and Clinical Issue................................................... 2

1.3 PAD in Hispanic/Latino Populations .......................................................................... 4

1.4 Rationale for the study: Knowledge Gaps ................................................................... 5

1.5 Problem Statement .................................................................................................. 6

1.6 Study Objective ....................................................................................................... 7

1.7 Research Questions .................................................................................................. 7

1.8 Research Hypotheses ................................................................................................ 7

1.9 Significance of the Study ........................................................................................... 8

CHAPTER 2. REVIEW OF THE LITERATURE.................................................................... 10

2 Review of the Literature ............................................................................................. 10

2.1 Peripheral Artery Disease: Epidemiology and Outcomes ............................................ 10

2.2 Ankle-Brachial Index (ABI) as a Diagnostic Tool ....................................................... 10

2.3 PAD Awareness and Diagnostic Gaps ........................................................................ 12

2.4 Cardiovascular Comorbidity and PAD Recognition..................................................... 12

2.5 Hispanic/Latino Health and Vascular Disease ........................................................... 13

2.6 Migration, Acculturation, and Health System Navigation........................................... 14

2.7 Conceptual Framework ........................................................................................... 14

2.8 Summary and Rationale for Current Study ............................................................... 15

CHAPTER 3. MANUSCRIPT .......................................................................................... 16

3 Manuscript ............................................................................................................... 16

CHAPTER 4. CONCLUSIONS AND RECOMMENDATIONS ................................................. 47

4 Conclusions and Recommendations ............................................................................. 47

4.1 Summary of Key Findings.......................................................................................... 47

4.2 Interpretation of Findings ........................................................................................ 47

4.3 Clinical Implications ............................................................................................... 50

4.4 Public Health and Health System Implications .......................................................... 50

4.5 Recommendations for Practice ................................................................................. 51

4.6 Recommendations for Future Research ..................................................................... 52

4.7 Final Conclusions .................................................................................................... 53

REFERENCES .......................................................................................................... .....55

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Medicine and Surgery
Keyword	Hispanic Cross-sectional studies Cardiovascular Diseases Peripheral Arterial Disease Ankle-Brachial Index Disease Awareness
Committee Chair / Thesis Advisor	Carrillo-Larco, Rodrigo M., Emory University

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