Peripheral arterial disease

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What is peripheral arterial disease?

Peripheral arterial disease (PAD), also known as peripheral vascular disease, is the reduced circulation of blood to a body part outside of the heart or brain.

PAD occurs most commonly in the arteries leading to the legs and feet. It is often the result of atherosclerosis, where fatty deposits build up in the walls of arteries. In some people it does not present any symptoms, while others may experience pain at rest or while walking. In severe cases it can lead to tissue loss, and the amputation of a limb.

A notable form of PAD is abdominal aortic aneurysm. This is abnormal widening of the aorta (the main artery leading from the heart) below the level of the diaphragm. It can be a life-threatening condition if the arterial wall ruptures. Surgery is necessary in some cases.

Tobacco smoking and diabetes are primary risk factors for PAD. Type 2 diabetes in people with PAD can accelerate atherosclerosis, and increase the risk of amputation, of other cardiac events such as stroke, and death.

Other PAD risk factors include abnormal blood lipids, high blood pressure, overweight or obesity, and family history of the disease. PAD has increasingly been associated with other chronic conditions such as atrial fibrillation, heart failure, obstructive sleep apnoea and chronic kidney disease.

How many Australians have peripheral arterial disease?

Currently, there are no national data on the number of Australians who have PAD.

PAD has been estimated to affect up to 10% of patients in primary care settings, and over 20% when studied in populations aged 75 and over (Aitken 2020, Conte & Vale 2018). Over half of all people with PAD show no symptoms, leading to under-diagnosis and under-treatment.

Hospitalisations

Peripheral arterial disease often occurs alongside other chronic diseases, so both the principal and additional diagnoses of PAD should be counted when estimating its contribution to hospitalisations.

There were around 59,100 hospitalisations where PAD was recorded as the principal and/or additional diagnosis in 2020–21. This represents 0.5% of all hospitalisations in Australia.

PAD was recorded as the principal diagnosis in 56% (33,200) of these hospitalisations.

Over half of all hospitalisations where PAD was the principal diagnosis (60%) were for atherosclerosis of the peripheral arteries, while abdominal aortic aneurysm accounted for a further 9%. The remainder was comprised largely of embolisms and other aneurysms.

Age and sex

Where PAD was recorded as the principal and/or additional diagnosis, hospitalisation rates:

  • were overall twice as high for males as females (age-standardised rates of 251 and 127 per 100,000 population). Age-specific rates were higher among males than females in all age groups, except for age 35–44 (48 and 49 per 100,000 population)
  • increased with age, with rates highest for males and females aged 85 and over (2,500 and 1,600 per 100,000 population)―at least 1.4 times as high as those aged 75–84 (1,800 and 910 per 100,000) (Figure 1).

Figure 1: Peripheral arterial disease hospitalisation rates, principal and/or additional diagnosis, by age and sex, 2020–21

The bar chart shows in 2020–21, peripheral arterial disease hospitalisation rates were highest among males and females aged 85 and over (2,500 and 1,600 per 100,000 population, respectively).

Trends

Between 2000–01 and 2020–21, the age-standardised rate of hospitalisations with a principal and/or additional diagnosis of PAD declined by almost half (47%)—from 350 to 185 per 100,000 population.

The number of PAD hospitalisations declined by 8% for males and 15% for females, while rates fell by 49% for males (from 492 to 251 per 100,000 population) and 47% for females (from 237 to 127) (Figure 2).

Figure 2: Peripheral arterial disease hospitalisation rates, principal and/or additional diagnosis, by sex, 2000–01 to 2020–21

The line chart shows that age-standardised peripheral arterial disease hospitalisation rates declined between 2000–01 and 2020–21, from 492 to 251 and 237 to 127 per 100,000 population for males and females, respectively.

Variation among population groups

Aboriginal and Torres Strait Islander people

In 2020–21, there were 1,453 hospitalisations with a principal and/or additional diagnosis of PAD among Aboriginal and Torres Strait Islander people.

After adjusting for differences in the age structure of the populations:

  • the rate among Indigenous Australians was 1.7 times as high as the non-Indigenous rate (298 and 180 per 100,000 population)
  • the disparity between Indigenous and non-Indigenous Australians was greater for females than males—1.9 times as high for females (234 and 122 per 100,000 population) and 1.5 times as high for males (375 and 244 per 100,000 population) (Figure 3).

Socioeconomic area

In 2020–21, age-standardised PAD hospitalisation rates were 30% higher for people living in the lowest socioeconomic areas compared with those in the highest socioeconomic areas—214 and 165 per 100,000 population.

For males, the rate of PAD hospitalisations among people living in the lowest socioeconomic areas was 1.3 times as high as in the highest socioeconomic areas (292 and 221 per 100,000 population), and for females 1.2 times as high (142 and 116 per 100,000 population) (Figure 3).

Remoteness area

In 2020–21, age-standardised PAD hospitalisation rates among those living in Remote and very remote areas were similar to those in Major cities (201 and 177 hospitalisations per 100,000 population) (Figure 3).

Figure 3: Peripheral arterial disease hospitalisation rates, principal and/or additional diagnosis, by population group and sex, 2020–21

The horizontal bar chart shows that age-standardised peripheral arterial disease hospitalisation rates in 2020–21 were higher among Indigenous Australians, people living in the lowest socioeconomic areas and people living in Remote and very remote areas.

Deaths

PAD was the underlying cause of 1,933 deaths in 2019—equating to 1.2% of all deaths, and 4.6% of all cardiovascular disease deaths.

Abdominal aortic aneurysm accounted for 26% of PAD deaths with the remainder resulting from atherosclerosis of peripheral arteries, other aneurysms, embolisms and unspecified PAD.

Leading causes of death in people diagnosed with PAD, however, were chronic ischaemic heart disease (12%), acute myocardial infarction (9.3%) and type 2 diabetes mellitus (7.8%).

Age and sex

In 2019, PAD death rates:

  •  were 1.5 times as high for males as for females (age-standardised rates of 7.3 and 4.8 per 100,000 population). Age-specific rates for males were higher than for females across all age groups
  •  increased with age, with three-quarters (74%) of PAD deaths occurring in persons aged 75 and over. PAD death rates for males and females were highest in the 85 and over age group (187 and 145 per 100,000 population)—3.3 times as high for males and 3.5 times as high for females aged 75–84 (57 and 41 per 100,000 population) (Figure 4).

Figure 4: Peripheral arterial disease death rates, by age and sex, 2019

The bar chart shows the age-standardised peripheral arterial disease death rates in 2019 were highest among males and females aged 85 and over (187 and 145 per 100,000 population, respectively).

Trends

Between 1980 and 2019:

  • the annual number of PAD deaths declined by almost 40%, from 3,229 to 1,933
  • age-standardised PAD death rates declined by over 80%—falling from 44 to 7.3 per 100,000 population for males and 28 to 4.8 per 100,000 for females (Figure 5).

Figure 5: Peripheral arterial disease death rates, by sex, 1980–2019

The line chart shows the decline in age-standardised peripheral arterial disease death rates between 1980 and 2019 for both males and females, from 44 to 7 and 28 to 5 per 100,000 population, respectively.

Variation among population groups

Aboriginal and Torres Strait Islander people

In 2017–2019, there were 66 deaths from PAD as an underlying cause among Aboriginal and Torres Strait Islander people in jurisdictions with adequate Indigenous identification.

After adjusting for differences in the age structure of the populations, the rate of death from PAD for Indigenous Australians was 1.4 times as high as for non-Indigenous Australians (8.0 and 5.7 per 100,000 population).

Indigenous males and females both had PAD death rates 1.4 times as high as non-Indigenous males and females (Figure 6).

Socioeconomic area

In 2017–2019, the age-standardised PAD death rate was 1.5 times as high for people living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas (6.9 and 4.6 per 100,000 population).

The difference was similar for males and females (both 1.5 times as high) (Figure 6).

Remoteness area

In 2017–2019, the age-standardised PAD death rate was similar in Remote and very remote areas compared with Major cities (5.6 and 5.5 per 100,000 population).

The male rate in Remote and very remote areas was 1.1 times as high as that in Major cities (7.2 and 6.8 deaths per 100,000 population) The female rate was higher in Major cities compared to Remote and very remote areas (4.4 and 3.9 deaths per 100,000 population) (Figure 6).

Figure 6: Peripheral arterial disease death rates, by population group and sex, 2017–2019

The horizontal bar chart shows in 2017–2019 age-standardised peripheral arterial disease death rates were higher among Indigenous Australians and people living in the lowest socioeconomic areas but did not differ significantly by remoteness area.

References

Aitken SJ 2020. Peripheral artery disease in the lower limbs. Australian Journal of General Practice 49: 239–44.

Conte SM & Vale PR 2018. Peripheral arterial disease. Heart, Lung and Circulation 27: 427–432.