Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis

BACKGROUND: Previous studies have demonstrated higher rates of peripheral arterial disease (PAD) in blacks and lower in Asians compared to whites. The aim of this study is to undertake a comprehensive review of literature and identify ethnic differences in the epidemiology of PAD in general and in diabetic population.

METHODS AND RESULTS: A systemic review and meta-analysis of literature was performed for studies reporting PAD prevalence in general or diabetic populations, as well as studies that compare PAD prevalence in different ethnic groups. Mean prevalence for each ethnic group was calculated and p values and odds ratios were used to demonstrate significant differences between ethnic groups. Mean prevalence of PAD in general population for whites, blacks and Asians was 3.5%, 6.7% and 3.7% respectively. Meta-analysis of comparative studies demonstrated significantly higher prevalence of PAD in blacks (OR=1.97, 95% CI 1.92 to 2.02; p<0.001) and significantly lower prevalence amongst Asians (OR=0.66, 95% CI 0.63 to 0.70; p<0.001), when compared to white ethnicity as reference. In the diabetic population, the mean prevalence of PAD for whites, blacks, east Asians and south Asians is 17%, 25.3%, 13.5% and 7.6% respectively. In comparative studies of diabetic population, south Asians had a significantly lower prevalence of PAD (OR=0.32, 95% CI 0.28 to 0.37; p<0.001) compared to whites but there was no significant difference between blacks and whites (OR=0.87, 95% CI 0.72 to 1.06; p=0.173). Overall females have higher rates of PAD, both in general (3.8% vs 3.2%; p<0.001) and in diabetic population (13.7% vs 10%; p<0.001).

CONCLUSION: Blacks appear more vulnerable to PAD, in contrast to Asians who seem to have lower prevalence of PAD when compared to whites. Further research is needed in order to identify the factors that generate this difference.