Department of Surgery, Broomfield Hospital, Chelmsford, UK.
Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
Eur J Vasc Endovasc Surg. 2020 Oct;60(4):602-612. doi: 10.1016/j.ejvs.2020.05.037. Epub 2020 Jul 21.
Lower extremity amputation (LEA) carries significant mortality, morbidity, and health economic burden. In the Western world, it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. The incidence of PAOD has declined in Europe, the United States, and parts of Australasia. The present study aimed to assess trends in LEA incidence in European Union (EU15+) countries for the years 1990-2017.
This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15+ countries for each of the years 1990-2017. Trends were analysed using Joinpoint regression analysis.
Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15+ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients -22.93%, male patients -29.76%; toe amputation: female patients -29.93%, male patients -32.67%). The greatest overall increase in incidence was observed in Australia.
Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.
下肢截肢（LEA）具有显著的死亡率、发病率和健康经济负担。在西方世界，它最常见于外周动脉阻塞性疾病（PAOD）或糖尿病足病的并发症。欧洲、美国和澳大拉西亚部分地区的 PAOD 发病率已经下降。本研究旨在评估 1990-2017 年欧盟（EU15+）国家 LEA 发病率的趋势。
这是一项观察性研究，使用了 2017 年全球疾病负担（GBD）研究的数据。从 GBD 结果工具（http://ghdx.healthdata.org/gbd-results-tool）中提取了 1990-2017 年 EU15+国家 toe 截肢和 LEA 近端至 toe 截肢的 LEA 年龄标准化发病率（ASIR）数据。使用 Joinpoint 回归分析对趋势进行了分析。
在 1990 年至 2017 年间，欧盟 15 国的 LEA 发病率呈不同趋势。对于 LEA 近端至 toe，19 个国家中有 6 个国家呈上升趋势，9 个国家呈下降趋势，4 个国家男女之间呈不同趋势。对于 toe 截肢，19 个国家中有 8 个国家呈上升趋势，19 个国家中有 8 个国家呈下降趋势，3 个国家男女之间呈不同趋势。在所有时间点，澳大利亚的男女 LEA 发病率均最高，且呈稳步上升趋势。美国在分析期间观察到所有 LEA 在男女患者中的发病率均有最大降幅（LEA 近端至 toe：女性患者-22.93%，男性患者-29.76%；toe 截肢：女性患者-29.93%，男性患者-32.67%）。发病率总体增幅最大的是澳大利亚。
欧盟 15 国的 LEA 发病率呈不同趋势。这些趋势与同期 PAOD 发病率的下降不符。
