Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA.
Vascular. 2024 Feb;32(1):118-125. doi: 10.1177/17085381221124994. Epub 2022 Sep 19.
Whether socioeconomic status (SES) is associated with health outcomes in patients with acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI.
We performed a retrospective medical record review of patients who presented with ALI between April 2016 and October 2020 at a single tertiary care center. SES was quantified using individual variables (median household income, level of education, and employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data (higher number indicates lower SES status). The NDI summarizes 8 domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The association between SES and the severity of ALI at presentation and between SES and other health outcomes were analyzed using bivariate analysis of variance, independent t test, and multivariate logistic regression.
During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. The mean age was 64 years, 55% were men, and 57% were White. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8% of patients, respectively. Patients with a low SES status per the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation. The ALI etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation ( = 0.96) or the treatment modality ( = 0.80). No associations between SES and 30-day or 1-year mortality were observed (mean NDI, 0.15 vs 0.26, = 0.58, and 0.20 vs 0.26, = 0.71, respectively) or between SES and 30-day or 1-year limb loss (mean NDI, 0.06 vs 0.30, = 0.18, and 0.1 vs 0.32, = 0.17, respectively). Lower SES (higher NDI) was associated with increased 30-day readmission (mean NDI, 0.49 vs 0.15, = 0.021). However, this association was not significant on multivariate analysis (odds ratio 1.4, 95% CI 0.9-2.1, = 0.06).
SES was not associated with the severity of ALI at patient presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation, SES was not a predictor of short-term or 1-year limb loss and mortality. Overall, ALI presentation and treatment outcomes were independent of SES.
急性肢体缺血（ALI）患者的社会经济地位（SES）与健康结局之间的关系尚不清楚。本研究旨在确定 SES 是否与 ALI 患者的不良表现和结局相关。
我们对 2016 年 4 月至 2020 年 10 月在一家三级医疗中心就诊的 ALI 患者进行了回顾性病历审查。SES 采用个体变量（家庭收入中位数、教育程度和就业状况）和复合终点（邻里剥夺指数（NDI））进行量化。NDI 是一个标准化和可重复的指数，使用人口普查区数据（数字越高表示 SES 越低）。NDI 总结了 8 个社会经济剥夺领域。ALI 严重程度采用 Rutherford 分类法进行分类。使用方差分析、独立 t 检验和多变量逻辑回归分析 SES 与 ALI 发病时严重程度之间的关系以及 SES 与其他健康结局之间的关系。
在研究期间，278 名患者因 ALI 接受治疗，其中 211 名患者 SES 数据完整。平均年龄为 64 岁，55%为男性，57%为白人。疾病严重程度的 Rutherford 分类为 1 级、2a 级、2b 级和 3 级的患者分别占 6%、54%、32%和 8%。根据 NDI 评估的 SES 较低的患者在就诊时更可能患有外周动脉疾病和慢性肾脏病。ALI 的病因（血栓形成与栓塞）与 SES 无关。SES 与 ALI 发病时的严重程度（ = 0.96）或治疗方式（ = 0.80）之间无显著差异。SES 与 30 天或 1 年死亡率之间无相关性（平均 NDI 分别为 0.15 和 0.26， = 0.58 和 0.20 和 0.26， = 0.71），也与 30 天或 1 年肢体丧失之间无相关性（平均 NDI 分别为 0.06 和 0.30， = 0.18 和 0.1 和 0.32， = 0.17）。SES 较低（NDI 较高）与 30 天内再入院率增加相关（平均 NDI 分别为 0.49 和 0.15， = 0.021）。然而，多变量分析结果表明，这种相关性无统计学意义（比值比 1.4，95%CI 0.9-2.1， = 0.06）。
SES 与 ALI 发病时的严重程度无关。尽管 SES 与就诊时存在外周动脉疾病和慢性肾脏病有关，但 SES 并不是短期或 1 年肢体丧失和死亡率的预测因素。总体而言，ALI 的发病和治疗结局与 SES 无关。
