Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis
Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis
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DOI：
10.1016/s0140-6736(13)61249-0
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发表时间：
2013-10-19
期刊：
影响因子：
168.9
通讯作者：
Criqui, Michael H.
中科院分区：
文献类型：
--
作者：
Fowkes, F. Gerald R.;Rudan, Diana;Criqui, Michael H.
背景：下肢外周动脉疾病是导致动脉粥样硬化性心血管疾病的第三大原因，仅次于冠状动脉疾病和中风。本研究首次比较了高收入国家（HIC）和低收入或中等收入国家（LMIC）外周动脉疾病的患病率，确定了这些国家外周动脉疾病的主要危险因素，并估计了区域和全球外周动脉疾病患者的数量。方法：我们对外周动脉疾病患病率的文献进行了系统回顾，检索了自1997年以来将外周动脉疾病定义为踝关节肱指数（ABI）低于或等于0.90的社区研究。我们使用流行病学模型来定义HIC和LMIC中特定年龄和性别的患病率，并将其与联合国2000年和2010年的人口数据相结合，以估计全球外周动脉疾病的患病率。在一个研究子集中，我们对15种外周动脉疾病推定危险因素相关的优势比（or）进行了荟萃分析，以估计它们在HIC和LMIC中的效应大小。然后，我们使用危险因素来预测8个WHO区域（3个高收入国家和5个低收入国家）的外周动脉疾病数量。34项研究符合纳入标准，其中22项来自HIC， 12项来自LMIC，共纳入112 027名受试者，其中9347名患有外周动脉疾病。不同性别的患病率随着年龄的增长而增加，在高收入国家和低收入国家以及男性和女性中大致相似。45 ~ 49岁女性HIC患病率为5.28% (95% CI 3.38 ~ 8.17%)，男性为5.41%(3.41 ~ 8.49%)；85 ~ 89岁女性HIC患病率为18.38%(11.16 ~ 28.76%)，男性HIC患病率为18.83%（12.03 ~ 28.25%）。LMIC男性患病率低于HIC（45-49岁为2.89%[2.04-4.07%]，85-89岁为14.94%[9.58-22.56%]）。在低收入和中等收入国家，女性的发病率高于男性，尤其是在较年轻的年龄（6.31%[4.86-8.15%]的45-49岁女性）。吸烟是HIC和LMIC的重要危险因素，当前吸烟的meta-OR在HIC中为2.72 (95% CI 2.39-3.09)，在LMIC中为1.42(1.25-1.62)，其次是糖尿病（1.88 [1.66-2.14]vs 1.47[1.29-1.68]）、高血压（1.55 [1.42-1.71]vs 1.36[1.24-1.50]）和高胆固醇血症（1.19 [1.07-1.33]vs 1.14[1.03-1.25]）。2010年，全球有2.02亿人患有外周动脉疾病，其中69.7%在中低收入国家，包括东南亚的5480万人和西太平洋区域的4590万人。在过去的十年中，患有外周动脉疾病的人数在LMIC中增加了28.7%，在HIC中增加了13.1%。在21世纪，外周动脉疾病已经成为一个全球性的问题。中低收入国家的政府、非政府组织和私营部门需要处理这种疾病的社会和经济后果，并评估最佳治疗和预防这种疾病的最佳战略。
Background Lower extremity peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity, following coronary artery disease and stroke. This study provides the first comparison of the prevalence of peripheral artery disease between high-income countries (HIC) and low-income or middle-income countries (LMIC), establishes the primary risk factors for peripheral artery disease in these settings, and estimates the number of people living with peripheral artery disease regionally and globally.Methods We did a systematic review of the literature on the prevalence of peripheral artery disease in which we searched for community-based studies since 1997 that defined peripheral artery disease as an ankle brachial index (ABI) lower than or equal to 0.90. We used epidemiological modelling to defi ne age-specific and sex-specific prevalence rates in HIC and in LMIC and combined them with UN population numbers for 2000 and 2010 to estimate the global prevalence of peripheral artery disease. Within a subset of studies, we did meta-analyses of odds ratios (ORs) associated with 15 putative risk factors for peripheral artery disease to estimate their effect size in HIC and LMIC. We then used the risk factors to predict peripheral artery disease numbers in eight WHO regions (three HIC and five LMIC).Findings 34 studies satisfied the inclusion criteria, 22 from HIC and 12 from LMIC, including 112 027 participants, of which 9347 had peripheral artery disease. Sex-specific prevalence rates increased with age and were broadly similar in HIC and LMIC and in men and women. The prevalence in HIC at age 45-49 years was 5.28% (95% CI 3.38-8.17%) in women and 5.41% (3.41-8.49%) in men, and at age 85-89 years, it was 18.38% (11.16-28.76%) in women and 18.83% (12.03-28.25%) in men. Prevalence in men was lower in LMIC than in HIC (2.89% [2.04-4.07%] at 45-49 years and 14.94% [9.58-22.56%] at 85-89 years). In LMIC, rates were higher in women than in men, especially at younger ages (6.31% [4.86-8.15%] of women aged 45-49 years). Smoking was an important risk factor in both HIC and LMIC, with meta-OR for current smoking of 2.72 (95% CI 2.39-3.09) in HIC and 1.42 (1.25-1.62) in LMIC, followed by diabetes (1.88 [1.66-2.14] vs 1.47 [1.29-1.68]), hypertension (1.55 [1.42-1.71] vs 1.36 [1.24-1.50]), and hypercholesterolaemia (1.19 [1.07-1.33] vs 1.14 [1.03-1.25]). Globally, 202 million people were living with peripheral artery disease in 2010, 69.7% of them in LMIC, including 54.8 million in southeast Asia and 45.9 million in the western Pacific Region. During the preceding decade the number of individuals with peripheral artery disease increased by 28.7% in LMIC and 13.1% in HIC.Interpretation In the 21st century, peripheral artery disease has become a global problem. Governments, non-governmental organisations, and the private sector in LMIC need to address the social and economic consequences, and assess the best strategies for optimum treatment and prevention of this disease.