Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease.
Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease.
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DOI：
10.1161/jaha.117.007425
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发表时间：
2018-01-12
影响因子：
5.4
通讯作者：
Wilson PWF
中科院分区：
文献类型：
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作者：
Arya S;Binney Z;Khakharia A;Brewster LP;Goodney P;Patzer R;Hockenberry J;Wilson PWF
黑人种族已被证明是外周动脉疾病（PAD）截肢的危险因素；然而，种族被认为是社会经济地位（SES）的标志，而不是真正的差异。本研究的目的是研究种族和社会经济地位对 PAD 患者截肢风险的影响。 2003 年至 2014 年期间，国家退伍军人事务部公司数据仓库中发现了发生 PAD 事件的患者 (N=155 647)。风险敞口包括种族和社会经济地位（以住宅邮政编码的收入中位数衡量）。结果是严重截肢。黑人退伍军人更有可能居住在社会经济地位低的社区，并患有高级的 PAD。与白人患者相比，黑人患者在各个 SES 阶层中的截肢风险更高。在 Cox 模型中（调整协变量），与白人相比，黑人种族的截肢风险高出 37%（风险比：1.37；95% 置信区间，1.30–1.45），而低 SES 可以独立预测截肢风险增加（风险比：1.12；95% 置信区间，1.06–1.17），并且没有证据表明与种族存在相互作用。在预测截肢风险分析中，无论 PAD 表现如何，黑人种族和低社会经济地位仍然是截肢的重要风险因素。与白人种族相比，黑人种族在同一 SES 阶层内截肢的风险显着增加，并且在控制合并症、就诊时 PAD 的严重程度和药物使用后，对肢体丧失具有独立影响。
Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients. Patients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low‐SES neighborhoods and to present with advanced PAD. Black patients had a higher amputation risk in each SES stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30–1.45), whereas low SES was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06–1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low SES continued to be significant risk factors for amputation regardless of PAD presentation. Black race significantly increases the risk of amputation within the same SES stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of PAD at presentation, and use of medications.