Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Diabetes Care. 2012 Feb;35(2):273-7. doi: 10.2337/dc11-1360.
To assess trends in rates of hospitalization for nontraumatic lower-extremity amputation (NLEA) in U.S. diabetic and nondiabetic populations and disparities in NLEA rates within the diabetic population.
We calculated NLEA hospitalization rates, by diabetes status, among persons aged ≥40 years on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence. We used joinpoint regression to calculate the annual percentage change (APC) and to assess trends in rates from 1988 to 2008.
The age-adjusted NLEA discharge rate per 1,000 persons among those diagnosed with diabetes and aged ≥40 years decreased from 11.2 in 1996 to 3.9 in 2008 (APC -8.6%; P < 0.01), while rates among persons without diagnosed diabetes changed little. NLEA rates in the diabetic population decreased significantly from 1996 to 2008 in all demographic groups examined (all P < 0.05). Throughout the entire study period, rates of diabetes-related NLEA were higher among persons aged ≥75 years than among those who were younger, higher among men than women, and higher among blacks than whites.
From 1996 to 2008, NLEA discharge rates declined significantly in the U.S. diabetic population. Nevertheless, NLEA continues to be substantially higher in the diabetic population than in the nondiabetic population and disproportionately affects people aged ≥75 years, blacks, and men. Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the U.S. diabetic population that are at higher risk.
评估美国糖尿病和非糖尿病人群中非创伤性下肢截肢(NLEA)住院率的趋势,以及糖尿病人群中 NLEA 率的差异。
我们根据国家住院调查数据中关于 NLEA 手术的资料和国家健康访谈调查数据中关于糖尿病流行率的资料,计算了≥40 岁人群中按糖尿病状态分类的 NLEA 住院率。我们使用联合点回归来计算每年的百分比变化(APC),并评估 1988 年至 2008 年期间的趋势。
在被诊断患有糖尿病且年龄≥40 岁的人群中,每 1000 人调整年龄后的 NLEA 出院率从 1996 年的 11.2 下降到 2008 年的 3.9(APC-8.6%;P<0.01),而未被诊断患有糖尿病的人群的比率变化不大。在所有检查的人群中,糖尿病患者的 NLEA 率从 1996 年到 2008 年显著下降(所有 P<0.05)。在整个研究期间,≥75 岁人群的糖尿病相关 NLEA 率高于年龄较小的人群,男性高于女性,黑种人高于白种人。
从 1996 年到 2008 年,美国糖尿病患者的 NLEA 出院率显著下降。尽管如此,NLEA 在糖尿病患者中的发生率仍然明显高于非糖尿病患者,并且不成比例地影响≥75 岁的人群、黑种人和男性。需要继续努力降低 NLEA 风险因素的流行率,并改善美国糖尿病患者中某些风险较高的亚组的足部护理。