Abstract
The link between peripheral artery disease and socioeconomic status is complex. The
objective of this narrative review is to explore that relationship in detail, including
how social factors affect the development, management, and outcomes of peripheral
artery disease. Although the current literature on this topic is limited, some patterns
do emerge. Populations of low socioeconomic status appear to be at increased risk
for the development of peripheral artery disease, owing to factors such as increased
prevalence of cardiovascular risk factors (eg, cigarette smoking) and decreased access
to care. However, variables that are more difficult to quantify, such as chronic stress
and health literacy, also likely play a significant role. Among those who are living
with peripheral artery disease, socioeconomic status can affect disease management
as well. Secondary prevention strategies, such as medication use, smoking cessation,
and exercise therapy, are underutilised in socially deprived populations. This underutilisation
of evidence-based management leads to adverse outcomes in these groups, including
increased rates of amputation and decreased postoperative survival. The recognition
of the importance of social factors in prognosis is an important first step toward
addressing this health disparity. Moving forward, interventions that help to identify
those who are at high risk and improve access to care in populations of low socioeconomic
status will be critical to improving outcomes.
Résumé
Le lien entre la maladie artérielle périphérique (MAP) et le statut socio-économique
est complexe. Nous présentons ici une revue narrative qui aborde ce lien en détail,
notamment sous l’angle des effets des facteurs sociaux sur la survenue, la prise en
charge et l’issue de la MAP. Bien que la littérature actuelle sur ce sujet soit limitée,
certaines tendances ressortent. Les populations à faible statut socio-économique semblent
davantage exposées à la MAP en raison de facteurs tels que la prévalence plus élevée
de facteurs de risque cardiovasculaire (p. ex., le tabagisme) et un accès restreint
aux soins. Toutefois, des variables plus difficiles à quantifier, comme le stress
chronique et la littératie en matière de santé, jouent probablement elles aussi un
rôle important. Le statut socio-économique peut également influer sur la prise en
charge de la MAP. Les stratégies de prévention secondaire, dont la médication, le
renoncement au tabac et la rééducation par l’exercice, sont sous-utilisées au sein
des populations socialement défavorisées. Une telle déficience en matière de prise
en charge fondée sur des données probantes fait en sorte que l’issue de la maladie
s’avère défavorable dans ces populations, ce qui se traduit notamment par une augmentation
des taux d’amputation et une diminution de la survie postopératoire. La reconnaissance
du rôle prépondérant des facteurs sociaux sur le plan pronostique constitue un premier
pas important dans la lutte contre la disparité en matière de santé qui ressort de
nos observations. Prospectivement, nous sommes d’avis que les interventions qui aident
à reconnaître les sujets à haut risque et à rendre les soins plus accessibles aux
populations à faible statut socio-économique seront essentielles pour améliorer l’issue
de la MAP.
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Article info
Publication history
Published online: December 28, 2021
Accepted:
December 22,
2021
Received:
October 14,
2021
Footnotes
See page 620 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
