Rural living linked to higher revascularization risk in peripheral artery disease patients in France

Background

Living environment can have an impact on clinical outcomes. This leads to health inequities among patients with chronic disease, including those with lower limb peripheral artery disease (LLPAD).

Objectives

To evaluate the association between urban–rural areas and clinical outcomes among patients with LLPAD.

Methods

This was a nationwide cohort using medico-administrative data from France’s National Health Data System, representing over 99% of the population. Patients registered for LLPAD between January 1 and December 31, 2021, were included and grouped based on urban and rural areas. We then compared these groups for lower limb revascularization until December 31, 2024. Other endpoints included major limb amputation, cardiovascular events, and all-cause death.

Results

A total of 47,861 patients were analyzed. There were 32,380 and 15,481 patients living in urban and rural areas, respectively. After a median follow-up of 3 years, the incidence of revascularization was higher in the rural group (21.3%), compared to the urban group (19.4%). The adjusted hazards ratio (aHR) for revascularization was 1.10 (95% CI 1.05–1.14), comparing the rural group to the urban group. An interaction between living environment and accessibility to general practitioners (GPs) was found (interaction P = 0.02), where the increased risk was no longer observed among those living in rural areas with ≥4 accessible visits to GPs per year (aHR 1.01, 95% CI 0.93–1.11). The incidences of major amputation, myocardial infarction, stroke, and death were not different.

Conclusions

Patients with LLPAD living in rural areas had a higher risk of revascularization compared to those living in urban areas. The increased risk was no longer observed if patients living in rural areas had access to ≥ 4 accessible visits to GPs per year.

Key messages

• Rural LLPAD patients face higher revascularization risk than urban patients, but ≥4 accessible GP visits annually mitigates this risk, highlighting the importance of healthcare accessibility.

• Our study shows urban-rural equity is vital. Better rural healthcare infrastructure is needed for equitable outcomes.