Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Finnish Institute for Health and Welfare, Helsinki, Finland.
St. George's Vascular Institute, St. George's Healthcare NHS Trust, London, United Kingdom.
Atherosclerosis. 2020 Aug;306:11-14. doi: 10.1016/j.atherosclerosis.2020.06.017. Epub 2020 Jul 6.
Individual-level socioeconomic deprivation is associated with an increased risk of adverse patient outcomes following cardiovascular disease interventions, but the role of area-level socioeconomic circumstances as a predictor for treatment outcomes is unclear. We have examined the association of neighbourhood socioeconomic deprivation with risks of major lower limb amputation and death following surgical and endovascular lower limb revascularisation due to peripheral artery disease (PAD).
Patients aged 50+ years who underwent surgical or endovascular lower limb revascularisation for PAD were identified from Hospital Episode Statistics, a nationwide hospital data warehouse in England. Major amputations and deaths within a year of revascularisation were ascertained from HES and national mortality register, respectively. Index of Multiple Deprivation (IMD) was used to measure neighbourhood deprivation. Flexible parametric competing risks models were used to estimate sub-distribution hazard ratios (SHRs) for amputation and death.
In all, 65,806 patients underwent endovascular and 20,072 underwent surgical revascularisation. The covariate-adjusted 1-year risk of major amputation was higher among patients from the most deprived compared to least deprived neighbourhoods following endovascular revascularisation (SHR: 1.24, 95% confidence interval, CI:1.10 to 1.38) and surgical revascularisation (SHR:1.28, 95% CI: 1.09 to 1.51). The risk of death was higher in most deprived compared to the least deprived neighbourhoods following both procedures.
We found a consistent association between neighbourhood deprivation and amputation and death outcomes following lower limb revascularisation for PAD. These findings suggest there may be opportunities for targeted interventions to improve care of PAD patients in deprived neighbourhoods.
个体层面的社会经济剥夺与心血管疾病干预后不良患者结局风险增加相关，但区域层面的社会经济环境作为治疗结局的预测因素尚不清楚。我们研究了社区社会经济剥夺与下肢动脉疾病（PAD）患者接受手术和血管内下肢血运重建后发生主要下肢截肢和死亡风险的相关性。
从英国全国性医院数据仓库医院病例统计数据中确定了年龄在 50 岁及以上、因 PAD 接受手术或血管内下肢血运重建的患者。通过 HES 和国家死亡率登记处分别确定血运重建后一年内的主要截肢和死亡情况。使用多因素剥夺指数（IMD）来衡量社区剥夺程度。使用灵活参数竞争风险模型估计截肢和死亡的亚分布风险比（SHR）。
共有 65806 例患者接受了血管内治疗，20072 例患者接受了手术治疗。血管内血运重建后，来自最贫困社区的患者与来自最不贫困社区的患者相比，1 年主要截肢风险较高（SHR：1.24，95%置信区间，CI：1.10 至 1.38）和手术血运重建（SHR：1.28，95% CI：1.09 至 1.51）。与最贫困的社区相比，在两种治疗方法中，来自最贫困社区的患者死亡风险更高。
我们发现，下肢动脉疾病患者接受下肢血运重建后，社区贫困程度与截肢和死亡结局之间存在一致的相关性。这些发现表明，在贫困社区可能有机会采取有针对性的干预措施来改善 PAD 患者的护理。
