Evidence map›Paper›PMID 39419322›Full record

ArticleAnnals of vascular surgery2025

Association between Regional Market Competition and Early Femoropopliteal Interventions for Claudication.

Chen Dun, M Libby Weaver, Sanuja Bose, David P Stonko, Midori White, Katherine M McDermott, James H Black, Corey A Kalbaugh, Martin A Makary, Caitlin W Hicks

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PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of vascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chen DunDepartment of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: cdun1@jhmi.edu.
M Libby WeaverDivision of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA.
Sanuja BoseDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
David P StonkoDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
Midori WhiteDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Katherine M McDermottDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
James H BlackDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
Corey A KalbaughDepartment of Epidemiology and Biostatistics, Indiana University School of Public Health- Bloomington, Bloomington, IN.
Martin A MakaryDepartment of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Carey Business School, Baltimore, MD.
Caitlin W HicksDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: chicks11@jhmi.edu.

Funding

CARDIOVASCULAR EPIDEMIOLOGY INSTITUTIONAL TRAININGT32HL007024 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Elizabeth Selvin · 1985 to 2026
$17.5M
Risk Factors and Outcomes Associated with Late-Life Diabetic Peripheral NeuropathyK23DK124515 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI HICKS, CAITLIN WHITNEY · 2020 to 2024
$898k
NHLBI NIH HHS T32 HL007024NIDDK NIH HHS K23 DK124515
6 · The paper itself

Abstract

backgroundRegional market competition is known to impact practice patterns in surgical care. We aimed to investigate the association of regional market competition with the utilization of early peripheral vascular interventions (PVIs) for the treatment of claudication, and the subsequent impact on clinical outcomes.

methodsWe conducted a retrospective analysis of 100% Medicare fee-for-service claims data from January 2019 to December 2021 to identify patients with a new diagnosis of claudication. We calculated the Herfindahl-Hirschman Index for all sites of service performing PVI according to Health Service Area. Multivariable logistic regression and Cox proportional hazards models were used to assess the association of regional market competition with early (<6 months) PVI for claudication, and progression to chronic limb-threatening ischemia, repeat PVI, and major amputation.

resultsWe identified 300,492 patients with a new diagnosis of claudication (mean age 73.8 years, 51.6% male, 11.1% Black), of which 6.1% underwent an early PVI for claudication. Most patients (72.4%) were treated in low-competition markets. After adjusting for patient characteristics, patients treated in moderate-competition markets had the highest odds of receiving an early PVI. Regional market competition was not associated with conversion to chronic limb-threatening ischemia or repeat PVI (P > 0.05), but patients treated in high- (adjusted hazard ratio [aHR] 0.70, 95% confidence interval [CI] 0.56-0.86) and moderate- (aHR 0.82, 95% CI 0.69-0.92) competition markets had lower hazards of major amputation compared to patients treated in low-competition markets. Early PVI was significantly associated with worse clinical outcomes after adjusting for all factors including market competition (all, P < 0.05).

conclusionsThere is a complex interplay between regional market competition, early PVI utilization, and subsequent clinical outcomes for patients with claudication. Early PVI continues to demonstrate a strong association with unfavorable clinical outcomes even when accounting for market competition.

Indexed as

Amputation, SurgicalFemoral ArteryIntermittent ClaudicationMedicarePeripheral Arterial DiseasePopliteal ArteryAgedAged, 80 and overChronic Limb-Threatening IschemiaDatabases, FactualEconomic CompetitionEndovascular ProceduresFemaleHumansLimb SalvageMale

Identifiers

PMID39419322
PMCPMC11634649

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.