Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants.
Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants.
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DOI：
10.2147/clep.s146484
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发表时间：
2018
影响因子：
3.9
通讯作者：
Icks A
中科院分区：
文献类型：
--
作者：
Claessen H;Narres M;Haastert B;Arend W;Hoffmann F;Morbach S;Rümenapf G;Kvitkina T;Friedel H;Günster C;Schubert I;Ullrich W;Westerhoff B;Wilk A;Icks A
糖尿病患者的下肢截肢(LEA)与生活质量下降和医疗费用增加有关。截肢率(ARs)的详细知识对未来的卫生保健和经济战略至关重要。我们进行这项队列研究是为了估计LEA的发生率以及糖尿病引起的相对和归因风险，并调查2008-2012年期间的时间趋势。基于德国法定健康保险公司三大分支机构的管理数据，覆盖全国约3400万参保人(约占德国人口的40%)，我们估计了患有和不患有糖尿病的人群中任何、主要和轻微LEA的年龄-性别标准化AR(首次截肢/年)。时间趋势用泊松回归分析。共有108,208人(糖尿病：67.3%；平均年龄72.6岁)至少接受过一次截肢。在糖尿病患者中，我们观察到2008年至2012年期间，主要和次要急性呼吸窘迫综合征的发生率分别从每100,000人年81.2%(95%可信区间77.5-84.9)降至58.4%(55.0-61.7)，从206.1(197.3-214.8)降至177.0(169.7-184.4)。在非糖尿病人群中，大AR由14.3(13.9~14.8)降至11.6(11.2~12.0)，而小AR由15.8(15.3~16.3)升至17.0(16.5~17.5)/10万人年。糖尿病人群与非糖尿病人群相比，主要和轻微LEA的相对危险度(RR)均显著降低(每年分别减少4%和5%)。在这一庞大的全国人口中，我们仍然发现，与非糖尿病患者相比，糖尿病患者的主要和次要ARS更高。然而，与非糖尿病人群相比，糖尿病患者主要和轻微LEA的AR和RR在研究期间显著下降，证实了近年来在较小规模和区域性研究中观察到的积极趋势。
Lower-extremity amputations (LEAs) in people with diabetes are associated with reduced quality of life and increased health care costs. Detailed knowledge on amputation rates (ARs) is of utmost importance for future health care and economics strategies. We conducted the present cohort study in order to estimate the incidences of LEA as well as relative and attributable risk due to diabetes and to investigate time trends for the period 2008–2012. On the basis of the administrative data from three large branches of German statutory health insurers, covering ~34 million insured people nationwide (about 40% of the German population), we estimated age-sex-standardized AR (first amputation per year) in the populations with and without diabetes for any, major, and minor LEAs. Time trends were analyzed using Poisson regression. A total of 108,208 individuals (diabetes: 67.3%; mean age 72.6 years) had at least one amputation. Among people with diabetes, we observed a significant reduction in major and minor ARs during 2008–2012 from 81.2 (95% CI 77.5–84.9) to 58.4 (55.0–61.7), and from 206.1 (197.3–214.8) to 177.0 (169.7–184.4) per 100,000 person-years, respectively. Among people without diabetes, the major AR decreased significantly from 14.3 (13.9–14.8) to 11.6 ([11.2–12.0], 12.0), whereas the minor AR increased from 15.8 (15.3–16.3) to 17.0 (16.5–17.5) per 100,000 person-years. The relative risk (RR) comparing the diabetic with the nondiabetic populations decreased significantly for both major and minor LEAs (4% and 5% annual reduction, respectively). In this large nationwide population, we still found higher major and minor ARs among people with diabetes compared with those without diabetes. However, AR and RR of major and minor LEAs in the diabetic compared with the nondiabetic population decreased significantly during the study period, confirming a positive trend that has been observed in smaller and regional studies in recent years.