Department of Health Evidence and Policy, Mount Sinai Medical Center, New York, NY 10029, USA.
J Vasc Surg. 2010 Feb;51(2):372-8.e1; discussion 378-9. doi: 10.1016/j.jvs.2009.09.006.
Gender-related differences continue to challenge the management of lower extremity (LE) peripheral arterial disease (PAD) in women. We analyzed the time-trends in hospital care of such differences.
Data for patients with PAD from New York, New Jersey, and Florida state hospital inpatient discharge databases (1998-2007) were analyzed using univariate and multivariate regression analyses.
The 2.4 million PAD-related inpatient discharge records analyzed showed a slight decrease of inpatient procedures for both genders. Compared with men, women had 18% to 27% fewer PAD and 33% to 49% fewer vascular procedural hospitalizations (P < .0001). They were persistently more likely than men to be admitted emergently (56% vs 51% in 1998 and 57% vs 53% in 2007) and discharged to a nursing home. During the study period, the amputation rate declined by 36% in women and 21% in men with PAD, and similarly, open procedures decreased by 36% and 30%. Endovascular procedures, however, increased by 150% in women and 144% in men. Procedural mortality was 4.95% vs 4.37% for men (P < .0001). Female mortality rates were persistently higher after amputations (9.89% vs 8.90%, P < .0001), open (5.49% vs 4.00%, P < .0001), and endovascular procedures (2.87% vs 2.10%, P < .0001). Time trends showed improved mortality for men and women, with a stable difference between the two.
The analysis of representative state administrative databases of inpatient care records demonstrated improvements in mortality and amputation rates over time. However, a gender-related disparity in PAD outcomes remains that merits further investigation.
性别相关差异继续挑战女性下肢（LE）外周动脉疾病（PAD）的治疗。我们分析了医院对这些差异的治疗时间趋势。
使用单变量和多变量回归分析，对来自纽约、新泽西和佛罗里达州医院住院患者数据库（1998-2007 年）的 PAD 患者数据进行分析。
分析了 240 万例 PAD 相关住院患者记录，发现男女患者的住院治疗程序均略有减少。与男性相比，女性 PAD 发生率降低 18%至 27%，血管治疗住院率降低 33%至 49%（P<.0001）。她们更有可能被紧急收治入院（1998 年为 56%，2007 年为 57%，而男性为 51%），出院后更有可能进入疗养院。在研究期间，女性 PAD 患者的截肢率下降了 36%，男性下降了 21%，同样，开放性手术减少了 36%和 30%。然而，女性的血管内治疗程序增加了 150%，男性增加了 144%。手术死亡率为男性 4.95%，女性 4.37%（P<.0001）。女性截肢（9.89%比 8.90%，P<.0001）、开放性（5.49%比 4.00%，P<.0001）和血管内手术（2.87%比 2.10%，P<.0001）后的死亡率持续高于男性。时间趋势显示，男女患者的死亡率均有所改善，两者之间的差异保持稳定。
对代表性的州住院患者管理数据库的分析表明，随着时间的推移，死亡率和截肢率有所提高。然而，PAD 结果仍然存在性别相关的差异，需要进一步研究。
