德克萨斯州主要非创伤性截肢手术数量并未减少：当代趋势、风险因素关联及血运重建的影响。
A Lack of Decline in Major Nontraumatic Amputations in Texas: Contemporary Trends, Risk Factor Associations, and Impact of Revascularization.
机构信息
Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX.
Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX.
出版信息
Diabetes Care. 2019 Jun;42(6):1061-1066. doi: 10.2337/dc19-0078. Epub 2019 Apr 9.
OBJECTIVE
Nontraumatic major lower extremity amputations (LEAs) have been reported to be declining nationally; however, trends in Texas have been less well described. We evaluated demographic and clinical risk factors and revascularization associations for LEAs by using inpatient hospital discharge data in Texas from 2005 to 2014.
RESEARCH DESIGN AND METHODS
Inpatient hospital discharge data were obtained from the Texas Center for Health Statistics. Multivariate logistic regression analyses were performed to evaluate clinical, ethnic, and socioeconomic risk factors associated with LEA. The impact of revascularization (surgical and/or endovascular) on LEA was analyzed.
RESULTS
Between 2005 and 2014, of 19,939,716 admissions, 46,627 were for nontraumatic major LEAs. Over time, LEAs were constant, and revascularization rates during index admission declined. The majority of LEAs occurred in males and in individuals aged 60-79 years. Risk factors associated with LEA included diabetes, peripheral arterial disease, chronic kidney disease, and male sex ( < 0.001). Insurance status, hyperlipidemia, coronary artery disease, and stroke/transient ischemic attack were associated with lower odds of amputation ( < 0.001). Hispanic (odds ratio [OR] 1.51 [95% CI 1.48, 1.55], < 0.001) and black (OR 1.97 [95% CI 1.92, 2.02], < 0.001) ethnicities were associated with a higher risk for amputation when compared with non-Hispanic whites. Revascularization, either surgical or endovascular (OR 0.52 [95% CI 0.5, 0.54], < 0.001), was also associated with lower odds for amputation.
CONCLUSIONS
Amputation rates in Texas have remained constant, whereas revascularization rates are declining. A higher risk for LEA was seen in minorities, including Hispanic ethnicity, which is the fastest growing demographic in Texas. Revascularization and having insurance were associated with lower odds for amputation.
目的
据报道，全国范围内非外伤性下肢主要截肢（LEA）的发生率正在下降；然而，德克萨斯州的趋势描述得较少。我们利用 2005 年至 2014 年德克萨斯州住院患者出院数据，评估了 LEA 的人口统计学和临床危险因素以及血运重建的相关性。
研究设计和方法
从德克萨斯州卫生统计中心获得住院患者出院数据。采用多变量逻辑回归分析评估与 LEA 相关的临床、种族和社会经济风险因素。分析了血运重建（手术和/或血管内）对 LEA 的影响。
结果
在 2005 年至 2014 年期间，在 19939716 例住院患者中，有 46627 例为非外伤性下肢主要截肢。随着时间的推移，LEA 保持不变，而索引入院期间的血运重建率下降。大多数 LEA 发生在男性和 60-79 岁的个体中。与 LEA 相关的危险因素包括糖尿病、外周动脉疾病、慢性肾脏病和男性（<0.001）。保险状况、高脂血症、冠心病和中风/短暂性脑缺血发作与较低的截肢几率相关（<0.001）。与非西班牙裔白人相比，西班牙裔（比值比[OR]1.51[95%CI 1.48,1.55]，<0.001）和黑人（OR 1.97[95%CI 1.92,2.02]，<0.001）种族与更高的截肢风险相关。血运重建，无论是手术还是血管内（OR 0.52[95%CI 0.5,0.54]，<0.001），也与较低的截肢几率相关。
结论
德克萨斯州的截肢率保持不变，而血运重建率正在下降。少数族裔，包括西班牙裔，患 LEA 的风险更高，而西班牙裔是德克萨斯州增长最快的人口。血运重建和有保险与较低的截肢几率相关。
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