农村环境对初次截肢风险的影响因种族而异而加剧。
The effect of rurality on the risk of primary amputation is amplified by race.
机构信息
Division of Vascular and Endovascular Surgery, West Virginia University School of Medicine, Morgantown, WV.
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
出版信息
J Vasc Surg. 2020 Sep;72(3):1011-1017. doi: 10.1016/j.jvs.2019.10.090. Epub 2020 Jan 19.
OBJECTIVE
Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship.
METHODS
The national Vascular Quality Initiative amputation data set was used for analyses (N = 6795). The outcome of interest was primary amputation. Independent variables were race/ethnicity (non-Latinx whites vs nonwhites) and rural residence. Multivariable logistic regression examined impact of rurality and race/ethnicity on primary amputation after adjustment for relevant covariates and included an interaction for race/ethnicity by rural status.
RESULTS
Primary amputation occurred in 49% of patients overall (n = 3332), in 47% of rural vs 49% of urban patients (P = .322), and in 46% of whites vs 53% of nonwhites (P < .001). On multivariable analysis, nonwhites had a 21% higher odds of undergoing primary amputation overall (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.05-1.39). On subgroup analysis, rural nonwhites had two times higher odds of undergoing primary amputation than rural whites (AOR, 2.06; 95% CI, 1.53-2.78) and a 52% higher odds of undergoing primary amputation than urban nonwhites (AOR, 1.52; 95% CI, 1.19-1.94). In the urban setting, nonwhites had a 21% higher odds of undergoing primary amputation than urban whites (AOR, 1.21; 95% CI, 1.05-1.39).
CONCLUSIONS
In these analyses, rurality was associated with greater odds for primary amputation in nonwhite patients but not in white patients. The effect of race on primary amputation was significant in both urban and rural settings; however, the effect was significantly stronger in rural settings. These findings suggest that race/ethnicity has a compounding effect on rural health disparities and that strategies to improve health of rural communities need to consider the particular needs of nonwhite residents to reduce disparities.
目的
外周动脉疾病的灾难性并发症之一是原发性截肢（即未尝试血运重建）。 已经描述了原发性截肢的种族差异； 但是，农村地区的差异尚未得到很好的研究。 本研究的目的是检查农村地区对原发性截肢风险的影响，并探讨种族对这种关系的影响。
方法
使用国家血管质量倡议截肢数据集进行分析（N = 6795）。 感兴趣的结果是原发性截肢。 自变量是种族/民族（非拉丁裔白人与非白人）和农村居住地。 多变量逻辑回归检查了农村状况对原发性截肢的影响，并在调整了相关协变量后，包括了种族/民族与农村状况之间的交互作用。
结果
总体而言，49%的患者（n = 3332）发生了原发性截肢，农村患者的截肢率为 47%，城市患者的截肢率为 49%（P =.322），白人患者的截肢率为 46%，非白人患者的截肢率为 53%（P <.001）。 多变量分析显示，非白人患者总体上进行原发性截肢的可能性高 21%（校正优势比 [AOR]，1.21；95%置信区间 [CI]，1.05-1.39）。 在亚组分析中，农村非白人患者进行原发性截肢的可能性是农村白人患者的两倍（AOR，2.06；95%CI，1.53-2.78），比城市非白人患者高 52%（AOR，1.52；95%CI，1.19-1.94）。 在城市环境中，非白人患者进行原发性截肢的可能性比城市白人患者高 21%（AOR，1.21；95%CI，1.05-1.39）。
结论
在这些分析中，农村地区与非白人患者进行原发性截肢的可能性更高相关，但与白人患者无关。 种族对外科截肢的影响在城市和农村环境中均显著； 但是，在农村环境中的影响要强得多。 这些发现表明，种族/民族对外乡卫生差异具有叠加效应，为改善农村社区的健康状况而制定的策略需要考虑到非白人居民的特殊需求，以减少差异。
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