Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease
Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease
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DOI：
10.1016/j.jacc.2012.08.983
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发表时间：
2012-11-20
影响因子：
24
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Jones, W. Schuyler;Patel, Manesh R.;Peterson, Eric D.
目的本研究旨在描述研究期间下肢外周动脉疾病（LE PAD）患者截肢相关的时间趋势、患者特异性因素和地理变异。并且对于LE截肢的使用率和地理差异知之甚少。方法通过使用来自医疗保险和医疗补助服务中心的数据（CMS）从2000年1月1日至2008年12月31日，我们研究了65岁或以上PAD患者LE截肢的全国模式。多变量logistic回归用于调整其他患者人口统计学和临床factors.Results的区域结果中，2,730,742名老年患者与确定的PAD，LE截肢的总率从7258/100000 PAD患者下降到5790/100000（趋势p <0.001）。男性、黑人、糖尿病和肾脏疾病都是LE截肢的独立预测因素。2000~2008年下肢截肢率的校正比值比为0.95（95%CI：0.95-0.95，p <0.001）。然而，美国各地的截肢率仍存在显著的患者和地理差异。（J Am科尔心脏病学杂志2012; 60：2230 - 6）（C）美国心脏病学会基金会2012年
Objectives This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.Background Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.Methods By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.Results Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001).Conclusions From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States. (J Am Coll Cardiol 2012;60:2230-6) (C) 2012 by the American College of Cardiology Foundation