Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea.
College of Nursing and Brain Korea 21 FOUR Project, Yonsei University College of Nursing, Seoul, Republic of Korea.
PLoS One. 2022 May 10;17(5):e0268201. doi: 10.1371/journal.pone.0268201. eCollection 2022.
Older adults with peripheral arterial disease (PAD) have increased risks of major cardiovascular events and hospitalization. Metabolic comorbidities, such as hypertension, diabetes mellitus, and dyslipidemia, are common risk factors for these unfavorable health events. This study aimed to determine how multiple metabolic comorbidities affect the risk of adverse health outcomes in older adults with PAD. A retrospective cohort study was adopted using administrative claim data from the Health Insurance Review and Assessment Service Agency. The study sample included 3,122 older adults (≥ 65 years old) with at least one PAD diagnosis in an inpatient setting from 2011 to 2013 and who had at least one follow-up visit after hospitalization by 2018. The three metabolic comorbidities were defined as having at least two diagnostic claims or one prescription per year of anti-hypertensive, anti-diabetic, or anti-dyslipidemic medications for the corresponding diagnosis. The outcome variables included major adverse cardiovascular events (MACEs) and major adverse limb events (MALE). Kaplan-Meier survival curves demonstrated that PAD patients with more metabolic comorbidities had shorter MACE-free and MALE-free periods. Adjusted Cox proportional hazards analyses suggested significant additive effects of multiple metabolic comorbidities on increased risks of MACE and MALE among older adults with PAD. Lower socioeconomic status and non-metabolic comorbidities also increased the risk of MACE. Male sex, being young-old (65-74 years), and a higher proportion of inpatient claims increased the risk of MALE. The findings of this study suggest the need for a comprehensive care program for older adults with PAD and metabolic comorbidities. In addition, the healthcare utilization pattern should be considered when designing preventive care for older patients with comorbidities to manage PAD at an earlier stage.
患有外周动脉疾病（PAD）的老年人发生主要心血管事件和住院的风险增加。代谢合并症，如高血压、糖尿病和血脂异常，是这些不良健康事件的常见危险因素。本研究旨在确定多种代谢合并症如何影响患有 PAD 的老年人不良健康结局的风险。采用回顾性队列研究，使用健康保险审查和评估服务机构的行政索赔数据。研究样本包括 3122 名老年人（≥65 岁），他们在 2011 年至 2013 年期间至少有一次住院 PAD 诊断，并且在 2018 年之前至少有一次住院后随访。三种代谢合并症的定义为每年至少有两次诊断性索赔或一次抗高血压、抗糖尿病或抗血脂药物的处方，用于相应的诊断。结局变量包括主要不良心血管事件（MACE）和主要不良肢体事件（MALE）。Kaplan-Meier 生存曲线表明，代谢合并症较多的 PAD 患者 MACE 无事件期和 MALE 无事件期较短。调整后的 Cox 比例风险分析表明，多种代谢合并症对 PAD 老年患者 MACE 和 MALE 风险的增加具有显著的附加效应。较低的社会经济地位和非代谢合并症也增加了 MACE 的风险。男性、年轻老年人（65-74 岁）和更高比例的住院索赔增加了 MALE 的风险。本研究的结果表明，需要为患有 PAD 和代谢合并症的老年人制定综合护理计划。此外，在为患有合并症的老年患者设计预防性护理时，应考虑医疗保健利用模式，以便更早地管理 PAD。
