Cardiovascular Center, Tufts Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Mass.
Cardiovascular Center, Tufts Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Mass.
J Vasc Surg Venous Lymphat Disord. 2019 Sep;7(5):724-730. doi: 10.1016/j.jvsv.2019.02.015. Epub 2019 Jun 24.
Lymphedema (LE) has been called the forgotten vascular disease, given such scant knowledge about LE-associated comorbidities or causes. Such knowledge of the comorbidities and treatment of LE may assist in diagnostic decisions and health care planning.
To determine the proportion of LE patients with various LE-associated comorbidities as well as the rate of associated treatment, deidentified Health Insurance Portability and Accountability Act-compliant commercial administrative claims from the Blue Health Intelligence (BHI) research database (165 million Blue Cross Blue Shield members) were queried. We analyzed a BHI study sample of 26,902 patients with LE who had been enrolled with continuous medical benefits for 12 months before and after the index date for the complete years 2012 through 2016. Patients were first identified by comorbidity and then grouped into those receiving no treatment for LE and those receiving any treatment for LE. Any treatment was defined as receiving manual lymphatic drainage, physical therapy, compression garments, or a pneumatic compression device. The purpose of this study was to determine the proportion of LE patients comorbid with various known LE-associated conditions and the treatment rates of LE patients with each comorbidity.
Among the 84,579,269 BHI patients enrolled during the study window, 81,366 patients were identified with LE. From this LE group, our study focused on the 26,902 patients who were enrolled with continuous medical and pharmacy benefits for 12 months before and after the index date. Among these 26,902 LE patients, breast cancer was the most frequent comorbidity with LE (32.1%), and these patients almost universally received any treatment (94.2%); other cancer types, such as melanoma (2.1%) and prostate cancer (0.7%), were less frequent and received any treatment less often, 75% and 82% of the time, respectively. Venous leg ulcer was the most common non-cancer-linked comorbidity for LE (9.6%), but only 81.7% of venous leg ulcer patients received any treatment for LE.
To our knowledge, this is the largest study to date detailing the comorbidities associated with LE and LE treatment rates within each. Our findings suggest that a sizable proportion of cancer-related LE patients do not receive appropriate treatment. Furthermore, this study highlights the role of advanced venous disease as an LE comorbidity that is frequently untreated and its associated gap in treatment.
淋巴水肿（LE）被称为被遗忘的血管疾病，因为人们对 LE 相关的合并症或病因知之甚少。了解 LE 的合并症和治疗方法可能有助于做出诊断决策和制定医疗保健计划。
为了确定具有各种 LE 相关合并症的 LE 患者的比例以及相关治疗的比率，我们查询了 Blue Health Intelligence（BHI）研究数据库（1.65 亿蓝十字蓝盾会员）中的符合健康保险流通与责任法案（HIPAA）规定的去识别商业行政索赔。我们分析了 BHI 研究样本中的 26902 名 LE 患者，他们在 2012 年至 2016 年期间的索引日期前和后连续 12 个月都参加了医疗福利。患者首先根据合并症进行识别，然后分为未接受 LE 治疗的患者和接受任何 LE 治疗的患者。任何治疗都被定义为接受手动淋巴引流、物理治疗、压缩服装或气动压缩设备。本研究的目的是确定 LE 患者与各种已知的 LE 相关疾病合并的比例以及患有每种合并症的 LE 患者的治疗率。
在研究期间，在 84579269 名 BHI 患者中，有 81366 名患者被诊断为 LE。在这个 LE 组中，我们的研究重点是在索引日期前后连续 12 个月参加医疗和药房福利的 26902 名患者。在这 26902 名 LE 患者中，乳腺癌是最常见的 LE 合并症（32.1%），这些患者几乎普遍接受任何治疗（94.2%）；其他癌症类型，如黑色素瘤（2.1%）和前列腺癌（0.7%）则不太常见，接受任何治疗的比例分别为 75%和 82%。静脉性腿部溃疡是 LE 最常见的非癌症相关合并症（9.6%），但只有 81.7%的静脉性腿部溃疡患者接受了 LE 的任何治疗。
据我们所知，这是迄今为止最大的研究，详细描述了与 LE 相关的合并症以及每种合并症的 LE 治疗率。我们的研究结果表明，相当一部分与癌症相关的 LE 患者未接受适当的治疗。此外，这项研究强调了高级静脉疾病作为 LE 合并症的作用，这种合并症经常未得到治疗，且存在治疗缺口。
