Hemoglobin A1c Testing and Amputation Rates in Black, Hispanic, and White Medicare Patients.
Hemoglobin A1c Testing and Amputation Rates in Black, Hispanic, and White Medicare Patients.
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DOI：
10.1016/j.avsg.2016.03.035
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发表时间：
2016-10
影响因子：
1.5
通讯作者：
Goodney, Philip P.
中科院分区：
文献类型：
--
作者：
Suckow, Bjoern D.;Newhall, Kartha A.;Bekelis, Kimon;Faerber, Adrienne E.;Gottlieb, Daniel J.;Skinner, Jonathan S.;Stone, David H.;Goodney, Philip P.
主要（膝盖以上或膝盖以下）截肢是糖尿病的并发症，在黑人和西班牙裔患者中更为常见。虽然在过去十年中，糖尿病患者的截肢率有所下降，但这些改善是否在种族群体中公平地延伸，以及糖尿病护理措施（如血红蛋白A1c检测）是否与这些改善有关，仍不得而知。我们开始描述黑人、西班牙裔和白人患者截肢率的长期变化，并确定血红蛋白A1c检测与截肢风险之间的关系。我们在2002年至2012年间确定了11942840名65岁以上的糖尿病患者（55%为女性），并对他们进行了平均6.6年的随访。其中，86%是白人，11.5%是黑人，2.5%是西班牙裔。我们记录了这段时间内主要截肢的发生情况和血红蛋白A1c检测，并研究了不同种族（黑人、西班牙裔和白人）截肢率的长期变化。最后，我们研究了截肢风险与血红蛋白A1c检测之间的关系。我们使用3个类别来测量任何检测的存在和检测一致性：低一致性（血红蛋白A1c检测在0-50%的年份），中等一致性（检测在50-90%的年份）和高一致性（检测在>90%的年份）。2002年至2012年间，糖尿病医保患者的平均下肢截肢率为黑人患者每年1.78 / 1000，西班牙裔患者每年1.15 / 1000，白人患者每年0.56 / 1000 （P < 0.001）。在研究期间，Medicare糖尿病患者的主要截肢发生率下降了54%，从2002年的1.15 / 1000下降到2012年的0.53 / 1000（比率比= 0.53,95% CI = 0.51-0.54）。不同种族的截肢率降低相似：黑人患者为52%，西班牙裔患者为61%，白人患者为55%。在调整患者特征（包括种族）的多变量分析中，任何使用血红蛋白A1c检测与截肢风险下降15%相关（风险比0.85;95% CI, 0.83-0.87; P < 0.001）。高一致性血红蛋白A1c检测与截肢率降低39%相关（风险比0.61;95% CI, 0.59-0.62; P < 0.0001）。虽然在少数种族中更为常见，但在过去十年中，黑人、西班牙裔和白人患者的下肢截肢率也有类似的下降。血红蛋白糖化血红蛋白检测，特别是检测随时间的一致性，可能是所有种族限制截肢的纵向质量测量的有效组成指标。
Major (above-knee or below-knee) amputation is a complication of diabetes and is seen more common among black and Hispanic patients. While amputation rates have declined for patients with diabetes in the last decade, it remains unknown if these improvements have equitably extended across racial groups and if measures of diabetic care, such as hemoglobin A1c testing, are associated with these improvements. We set out to characterize secular changes in amputation rates among black, Hispanic, and white patients, and to determine associations between hemoglobin A1c testing and amputation risk. We identified 11,942,840 Medicare patients (55% female) with diabetes over the age of 65 years between 2002 and 2012 and followed them for a mean of 6.6 years. Of these, 86% were white, 11.5% were black, and 2.5% were Hispanic. We recorded the occurrence of major amputation and hemoglobin A1c testing during this time period and studied secular changes in amputation rate by race (black, Hispanic, and white). Finally, we examined associations between amputation risk and hemoglobin A1c testing. We measured both the presence of any testing and testing consistency using 3 categories: poor consistency (hemoglobin A1c testing in 0–50% of years), medium consistency (testing in 50–90% of years), and high consistency (testing in >90% of the years in the cohort). Between 2002 and 2012, the average major lower-extremity amputation rate in diabetic Medicare patients was 1.78 per 1,000 per year for black patients, 1.15 per 1,000 per year for Hispanic patients, and 0.56 per 1,000 per year for white patients (P < 0.001). Over the study period, the incidence of major amputation in Medicare patients with diabetes declined by 54%, from 1.15 per 1,000 in 2002 to 0.53 per 1,000 in 2012 (rate ratio = 0.53, 95% CI = 0.51–0.54). The reduction in amputation rate was similar across racial groups: 52% for black patients, 61% for Hispanic patients, and 55% for white patients. In multivariable analysis adjusting for patient characteristics, including race, any use of hemoglobin A1c testing was associated with a 15% decline in amputation risk (hazard ratio, 0.85; 95% CI, 0.83–0.87; P < 0.001). High consistency hemoglobin A1c testing was associated with a 39% decline in amputation (hazard ratio, 0.61; 95% CI, 0.59–0.62; P < 0.0001). Although more frequent among racial minorities, major lower-extremity amputation rates have declined similarly across black, Hispanic, and white patients over the last decade. Hemoglobin A1c testing, particularly the consistency of testing over time, may be an effective component metric of longitudinal quality measures toward limiting amputation in all races.
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影响因子：
37.8
作者：
Nguyen LL;Hevelone N;Rogers SO;Bandyk DF;Clowes AW;Moneta GL;Lipsitz S;Conte MS
通讯作者：
Conte MS
影响因子：
4.9
作者：
Dansky, KH;Dirani, R
通讯作者：
Dirani, R
影响因子：
4.3
作者：
Goldberg, Joshua B.;Goodney, Philip P.;Baker, Frank
通讯作者：
Baker, Frank
影响因子：
16.2
作者：
McCall, DT;Sauaia, A;Barton, P
通讯作者：
Barton, P
影响因子：
120.7
作者：
Elam, MB;Hunninghake, DB;Brinton, EA
通讯作者：
Brinton, EA