Burden Estimates and Temporal Patterns Associated with Peripheral Artery Disease

描述(申请人提供)：外周动脉疾病(PAD)是一种常见的动脉粥样硬化性疾病，其特征是下肢斑块堆积。PAD造成的功能限制导致生活质量差，医疗保健利用率高，护理成本高，死亡风险增加。目前的估计表明，6.3%的美国人患有PAD，其中包括20%的65岁及以上的人。PAD的诊断提示其他血管床存在动脉粥样硬化，PAD显著增加冠状动脉和脑血管疾病事件的风险。这种疾病对与其他慢性疾病相关的发病率的直接和间接贡献是重要的，但与其他慢性心血管疾病的认识相比，卫生专业人员和公众对PAD的认识较低；高达50%的PAD患者没有意识到他们患有这种疾病，医生通常不评估PAD的存在。疾病意识是至关重要的，因为随着人口老龄化，预计PAD的负担将会增加。大多数PAD报告可能低估了PAD的负担，因为已发表的研究结果主要基于住院事件，排除了普遍存在的PAD临床情况。与PAD相关的临床护理相关的时间模式的信息同样受到缺乏将住院和门诊环境中发生的事件考虑在内的研究的限制。因此，PAD是一种未被充分研究的具有公共卫生意义的疾病。这项拟议研究的目的是：利用医疗保险和医疗补助服务中心(CMS)提供的美国四个地理定义地区的所有居民的索赔数据，估计临床诊断为PAD及其主要亚型的负担，并估计2003-2012年与PAD相关的临床遭遇的时间模式。这些声明将允许在存在大量关于共病情况和其他心血管疾病的信息的社区中对PAD进行检查。在拟议的研究中，我们还将利用ARIC研究队列的数据，这些数据与CMS Medicare索赔有关。我们将使用这两个数据源来估计CMS Medicare索赔在识别PAD时的预测值(即校准系数)。我们将使用这些校准系数来计算调整后的PAD患病率和发病率。行政索赔提供了关于在多个临床环境中发生的临床遭遇的广泛信息，因此，构成了检查PAD流行病学的丰富资源。拟议的研究结果将为未来的研究奠定基础，这些研究旨在通过人口学和共病情况比较住院或门诊诊断的临床表现PAD的不同轨迹。

DESCRIPTION (provided by applicant): Peripheral artery disease (PAD) is a prevalent atherosclerotic disorder characterized by plaque build-up in the lower extremities. Functional limitations resulting from PAD lead to poor quality of life, high health care utilization and costsof care, and an increase in mortality risk. Current estimates suggest that PAD affects 6.3% of Americans, including 20% of individuals age 65 years and older. A diagnosis of PAD suggests presence of atherosclerosis in other vascular beds, and PAD significantly increases the risk of coronary and cerebrovascular disease events. The direct and indirect contribution of this disease to the morbidity associated with other chronic disease conditions is important yet health professional and public awareness of PAD is low in comparison with awareness of other chronic cardiovascular diseases; up to 50% of those with PAD are unaware they have the disease and physicians often do not evaluate for the presence of PAD. Disease awareness is critical as the burden of PAD is expected to increase as our population ages. Most PAD reports likely underestimate PAD burden as published findings are largely based on hospitalized events, to the exclusion of the prevalent outpatient PAD clinical encounters. Information concerning the temporal patterns associated with PAD-related clinical care is likewise limited by the lack of research that would take into account events occurring in both the inpatient and outpatient settings. Thus, PAD is an understudied disease of public health significance. The aims of this proposed study are: to estimate the burden of clinically diagnosed PAD and its major subtypes and to estimate the temporal patterns associated with PAD-related clinical encounters from 2003-2012 using Center for Medicare and Medicaid Services (CMS) claims data available for all residents of four geographically defined US regions comprising the Atherosclerosis Risk in Communities (ARIC) Study, a large observational study of the etiology of atherosclerotic diseases. These claims will allow examination of PAD in the context of communities for which a wealth of information concerning comorbid conditions and other cardiovascular diseases exists. In the proposed research we will also take advantage of data from the ARIC Study cohort, which have been linked with CMS Medicare claims. We will use these two data sources to estimate the predictive value (i.e. calibration factors) of CMS Medicare claims in the identification of PAD We will use these calibration factors to calculate adjusted prevalence and incidence of PAD. Administrative claims provide extensive information on clinical encounters occurring in multiple clinical settings and, as such, constitute a rich resource for the examination of the epidemiology of PAD. Results of the proposed research will create a foundation for future studies aimed at comparing, by demographics and comorbid conditions, the different trajectories associated with clinically manifest PAD diagnosed in the inpatient or outpatient setting.