Variation in the recorded incidence of amputation of the lower limb in England
Variation in the recorded incidence of amputation of the lower limb in England
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DOI：
10.1007/s00125-012-2468-6
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发表时间：
2012-07-01
期刊：
影响因子：
8.2
通讯作者：
Jeffcoate, W. J.
中科院分区：
文献类型：
--
作者：
Holman, N.;Young, R. J.;Jeffcoate, W. J.
目的/假设本研究旨在探讨英国截肢率的变化。方法根据英国151家初级护理信托基金(PCT)截至2010年3月31日的3年住院时间统计数据，统计成人糖尿病患者和非糖尿病患者截肢发生率。结果共截肢34,109例，其中糖尿病患者16,693例，占48.9%。糖尿病患者的发病率为2.51/1000人年，非糖尿病患者为0.11/1000人年(相对糖尿病风险为23.3)。糖尿病患者(每千人年0.64-5.25)和非糖尿病患者(每千人年0.03-0.24)的PCT发病率相差八倍。糖尿病患者的截肢率有十倍之多--既有重大截肢(每1000人年截肢0.22-2.20)，也有轻微截肢(每1000人年截肢0.30-3.25)。糖尿病患者和非糖尿病患者的小截肢和大截肢的发生率呈正相关(r=0.537，p<；0.0005)和(r=0.611，p<；0.0005)。截肢的发生率在糖尿病患者和非糖尿病患者之间也有关联(截肢总数r=0.433，p<0.0005；大腿截肢r=0.528，p<0.0005)。截肢的发生率和估计的亚裔流行率之间存在负相关。全截肢的PCT发生率与社会剥夺(r=-0.138，p=0.092)或吸烟(r=0.137，p=0.096)的总体人群患病率之间没有发现关联。结论/解释英格兰截肢发生率存在差异。由于糖尿病患者和非糖尿病患者的截肢差异相似，这种差异可能反映了当地医疗保健服务的普遍差异，尽管种族因素也可能起到作用。
Aims/hypothesis The study aimed to explore the variation in recorded incidence of lower limb amputation in England.Methods The incidences of amputations in adults with and without diabetes were determined from hospital episode statistics over 3 years to 31 March 2010 and compared between the 151 Primary Care Trusts (PCTs) in England.Results There were 34,109 amputations, including 16,693 (48.9%) in people with diabetes. The incidence was 2.51 per 1,000 person-years in people with diabetes and 0.11 per 1,000 person-years in people without (relative diabetes risk 23.3). Incidence varied eightfold across PCTs in people both with diabetes (range 0.64-5.25 per 1,000 person-years) and without (0.03-0.24 per 1,000 person-years). Amputations in people with diabetes varied tenfold-both major (range 0.22-2.20 per 1,000 person-years) and minor (range 0.30-3.25 per 1,000 person-years). The incidences of minor and major amputations were positively correlated both in those with (r = 0.537, p < 0.0005) and without (r = 0.611, p < 0.0005) diabetes. Incidences of amputations were also correlated between people with and without diabetes (total amputations r = 0.433, p < 0.0005; major amputations r = 0.528, p < 0.0005). There was a negative correlation between the incidence of amputation and estimated prevalence of ethnic Asians. No association was found between the PCT incidence of either total amputations and general population prevalence of social deprivation (r = -0.138, p = 0.092) or smoking (r = 0.137, p = 0.096).Conclusions/interpretation Variation in amputation incidence occurs across England. Because of the similarity in amputation variation between people with and without diabetes the variation may reflect generic differences in local healthcare delivery, although racial factors may also contribute.