Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer
Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer
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DOI：
10.1186/s13047-020-00383-2
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发表时间：
2020-03-24
影响因子：
2.9
通讯作者：
Bus, Sicco A.
中科院分区：
文献类型：
--
作者：
Armstrong, David G.;Swerdlow, Mark A.;Bus, Sicco A.
背景2007年，我们报告了一份比较糖尿病足并发症与癌症的数据摘要。这份简短报告的目的是用现有的最佳数据更新这一点。从那时起，出现了更多关于癌症死亡率和与糖尿病足溃疡（DFU）、夏科关节病和糖尿病相关下肢截肢相关的死亡率的报告。方法我们收集了2007年以后发表的研究报告的5年死亡率数据，并计算了汇总平均值。我们评估了DFU、Charcot关节病和下肢截肢的数据。我们将高位截肢和低位截肢分别分为踝关节近端和远端。这与美国癌症协会和国家癌症研究所报告的癌症死亡率进行了比较。结果Charcot、DFU、小截肢和大截肢的5年死亡率分别为29.0%、30.5%、46.2%和56.6%。相比之下，乳腺癌为9.0%，肺癌为80.0%。所有报告癌症的5年合并死亡率为31.0%。2017年，糖尿病的直接护理费用为2370亿美元。相比之下，2015年癌症的治疗费用为800亿美元。由于糖尿病护理的直接费用中有三分之一可能归因于下肢，因此这些费用也很容易比较。结论糖尿病下肢并发症仍然是巨大的负担。最值得注意的是，DFU和莱亚似乎不仅仅是健康状况不佳的标志。它们是与过早死亡相关的独立危险因素。虽然进展继续改善DFU和截肢患者的护理结果，但应努力进行一级预防以及糖尿病足溃疡缓解患者的预防，以最大限度地增加无溃疡，无住院和活动丰富的天数。
Background In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation. Methods We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute. Results Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable. Conclusion Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.