School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada.
PLoS One. 2022 Sep 2;17(9):e0274037. doi: 10.1371/journal.pone.0274037. eCollection 2022.
Changing demographics in a population may have an inevitable influence on disease incidence including limb amputation. However, the extent to which these changes affect limb amputation (LA) is unknown. Understanding the impact of changing demographics on LA would provide the best opportunity to plan for the future. We assessed the impact of changes in age and sex on limb amputation in Saskatchewan between 2006 and 2019.
Retrospective linked Saskatchewan's LA cases, and demographic characteristics and residents population from 2006-2019 was used. The amputation rate was calculated by dividing the total number of LA cases recorded each year by the annual Saskatchewan resident population and the results expressed per 100,000 populations. Furthermore, decomposition analysis was used to assess the impact of changes in age and sex on LA in a decade (2008-2017) and the Generalized Additive Model (GAM) was employed to examine the linear and non-linear effect of age.
We found that in the ten years (2008-2017), the absolute LA rate difference was 9.0 per 100,000 population. Changes in age structure alone contributed 7.7% to the LA rate increase and 92.3% to changes in age-specific LA rates. The decade witnessed a marginal population difference between males and females, but the LA rate was 2.1-2.2 times higher in males than in females. The GAM revealed a non-linear relationship between LA and age, and further indicates that the risk of LA significantly increased as age increases.
In a decade, we found that changes in age distribution and age-specific rate substantially impacted the increase in the LA rate observed in the province. This highlights the urgent need for strategized programs to respond to these changes as both the population and diabetes, which is age-dependent and a leading cause of LA, are expected to increase in the province by 2030. As changes in population and demographic factors are inevitable, this study provides data for policy makers on the need for continuous incorporation of the shift in population in the design of future health services.
人口结构的变化可能对包括截肢在内的疾病发病率产生不可避免的影响。然而，这些变化对截肢的影响程度尚不清楚。了解人口结构变化对截肢的影响将为未来规划提供最佳机会。我们评估了 2006 年至 2019 年期间萨斯喀彻温省人口年龄和性别变化对截肢的影响。
使用 2006-2019 年期间萨省截肢病例以及人口统计学特征和居民人口的回顾性链接数据。通过将每年记录的截肢病例总数除以萨省年度居民人口来计算截肢率，并以每 10 万人为单位表示结果。此外，还进行了分解分析，以评估 10 年内（2008-2017 年）年龄和性别变化对截肢的影响，同时使用广义加性模型（GAM）来检验年龄的线性和非线性影响。
我们发现，在这十年中（2008-2017 年），绝对截肢率差异为每 10 万人 9.0 例。仅年龄结构的变化就导致截肢率增加了 7.7%，并导致特定年龄组的截肢率变化了 92.3%。这十年见证了男性和女性之间的人口差异略有缩小，但男性的截肢率是女性的 2.1-2.2 倍。GAM 显示了截肢与年龄之间的非线性关系，并进一步表明随着年龄的增加，截肢的风险显著增加。
在十年内，我们发现年龄分布和特定年龄组的变化显著影响了该省观察到的截肢率的增加。这突显出迫切需要制定战略计划来应对这些变化，因为人口和糖尿病（这两者都与年龄有关，是导致截肢的主要原因）预计到 2030 年在该省将增加。由于人口和人口统计因素的变化是不可避免的，因此本研究为政策制定者提供了有关在未来卫生服务设计中不断纳入人口变化的必要性的数据。
