Burden Estimates and Temporal Patterns Associated with Peripheral Artery Disease

描述（由申请人提供）：外周动脉疾病（PAD）是一种以下肢斑块积聚为特征的常见动脉粥样硬化性疾病。PAD导致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，PAD影响6.3%的美国人，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，并且PAD显著增加冠状动脉和脑血管疾病事件的风险。这种疾病对其他慢性疾病相关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患者不知道他们患有这种疾病，医生通常不评估PAD的存在。疾病意识是至关重要的，因为随着我们人口的老龄化，PAD的负担预计会增加。大多数PAD报告可能低估了PAD负担，因为已发表的研究结果主要基于住院事件，排除了流行的门诊PAD临床遭遇。关于与PAD相关临床护理相关的时间模式的信息同样受到缺乏研究的限制，这些研究将考虑住院和门诊环境中发生的事件。因此，PAD是一种未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：估计临床诊断的PAD及其主要亚型的负担，并使用医疗保险和医疗补助服务中心（CMS）索赔数据估计2003-2012年PAD相关临床遭遇的时间模式，这些数据适用于四个地理定义的美国地区的所有居民，包括社区动脉粥样硬化风险（ARIC）研究，动脉粥样硬化性疾病病因学的大型观察性研究。这些声明将允许在社区的背景下检查PAD，其中存在大量关于合并症和其他心血管疾病的信息。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医疗保险索赔有关。我们将使用这两个数据源来估计CMS医疗保险索赔在PAD识别中的预测值（即校准因子）。我们将使用这些校准因子来计算PAD的校正患病率和发病率。行政索赔提供了广泛的信息，在临床上遇到发生在多个临床环境，因此，构成了丰富的资源，为检查的PAD的流行病学。拟议研究的结果将为未来的研究奠定基础，旨在通过人口统计学和共病状况比较与住院或门诊诊断的临床表现PAD相关的不同轨迹。

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.