Racial and Ethnic Disparities in the Diagnosis and Care of Peripheral Artery Disease in the United States: A Systematic Review

Abstract

Peripheral artery disease (PAD) commonly affects the lower extremity and occurs due to the narrowing or blockage of vessels carrying blood from the heart to the legs. This review aims to examine racial and ethnic disparities in the diagnosis and management of PAD among adults in the United States by summarizing differences in diagnostic evaluation, treatment utilization, and management outcomes. A search was done from inception to the 18th of November 2025 across PubMed and Google Scholar, and 1,372 articles were generated. Eight articles were included for the final analysis after applying the pre-defined eligibility criteria. We included an original article published in a peer-reviewed journal that discusses racial/ethnic disparities in the diagnosis and/management of peripheral artery disease among adults of different races in the United States of America. Joanna Briggs Institute (JBI) risk of bias critical appraisal tool for cohort studies. Across the included studies, a total of 5,512,632 participants were reported, comprising 4,784,099 (86.78%) White patients, 576,711 (10.46%) Black patients, 51,408 (0.93%) Hispanic patients, and 100,414 (1.82%) patients from other racial and ethnic groups across the United States. Only one article discussed diagnostic testing among different racial groups and found that Black patients were more likely to undergo diagnostic evaluation for PAD. The majority of White patients underwent revascularization, revascularization combined with medical therapy, vascular bypass surgery, and medical therapy, whereas Black patients more frequently underwent amputation as the treatment for PAD. In this review, Black patients consistently experienced higher rates of lower-limb amputation and lower utilization of revascularization and evidence-based medical therapies compared with White patients. Furthermore, limited data on diagnostic practices and the underrepresentation of Hispanic patients and patients from other racial and ethnic groups highlight an important research gap.