2006年至2019年与糖尿病或外周动脉疾病相关的原发性下肢截肢趋势的演变

Evolution in Trends of Primary Lower-Extremity Amputations Associated With Diabetes or Peripheral Artery Disease From 2006 to 2019.

作者信息

O'Connor Sarah, Blais Claudia, Leclerc Jacinthe, Sylvain-Morneau Jérémie, Laouan Sidi Elhadji Anassour, Hamel Denis, Drudi Laura, Gilbert Nathalie, Poirier Paul

机构信息

Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada; Research centre, Institut universitaire de cardiologie et pneumologie de Québec, Québec City, Québec, Canada.

出版信息

Can J Cardiol. 2023 Mar;39(3):321-330. doi: 10.1016/j.cjca.2022.11.010. Epub 2022 Nov 26.

DOI:10.1016/j.cjca.2022.11.010

PMID:36574522

Abstract

BACKGROUND

Given the importance in prevention of lower extremity amputations (LEAs) associated with diabetes or peripheral artery disease (PAD), we sought to document the trends of primary LEA in Québec, Canada, from years 2006 to 2019.

METHODS

Using the Québec Integrated Chronic Disease Surveillance System, we calculated crude and age-standardized annual incidence rates of primary LEA associated with diabetes and PAD among adults ≥ 40 years (99% confidence intervals [CI]), and all-cause 1-year mortality proportion trends following a primary LEA (95% CI), stratified by minor or major as the highest level of LEA during the same hospital stay and age groups. Trends were assessed using multivariate regression models.

RESULTS

In 2019, the crude rate of primary LEA was 116.0 per 100,000 (n = 825) with 93.7 and 21.9 per 100,000 of minor (n = 665) and major (n = 160) LEA, respectively. A tendency of decrease by 8% (-15.0 to 0.4%) of age-standardized incidence of primary LEA was observed between 2006 and 2019, while the absolute number of primary LEA increased from 610 to 825 cases. Minor LEA increased by 14.2% (3.7 to 25.9%) and major LEA decreased by 49.5% (-57.1 to -40.5%). Incidence trends remained stable among the 40 to 64 years, and declined by 14.6% and 20.1% for the 65 to 79 and ≥ 80 years of age groups, respectively. Major LEA decreased in all age groups, whereas minor LEA increased by 26.2% among the patients 40 to 64 years of age only. Age-standardized 1-year mortality decreased by 35.1% (95% CI, -43.4 to -25.7%) between 2006 and 2019, with a crude 1-year mortality of 11.3% in 2019.

CONCLUSIONS

The reduction of major LEA and 1-year mortality are encouraging, although increased minor LEA, especially in younger age groups, emphasizes the importance to improve preventive care further.

摘要

背景

鉴于预防与糖尿病或外周动脉疾病（PAD）相关的下肢截肢（LEA）的重要性，我们试图记录2006年至2019年加拿大魁北克原发性LEA的趋势。

方法

利用魁北克综合慢性病监测系统，我们计算了40岁及以上成年人中与糖尿病和PAD相关的原发性LEA的粗发病率和年龄标准化年发病率（99%置信区间[CI]），以及原发性LEA后全因1年死亡率比例趋势（95%CI），按同一住院期间LEA的最高级别为轻度或重度以及年龄组进行分层。使用多变量回归模型评估趋势。

结果

2019年，原发性LEA的粗发病率为每10万人116.0例（n = 825），轻度LEA（n = 665）和重度LEA（n = 160）的发病率分别为每10万人93.7例和21.9例。2006年至2019年期间，观察到原发性LEA的年龄标准化发病率有下降8%（-15.0%至0.4%）的趋势，而原发性LEA的绝对数量从610例增加到825例。轻度LEA增加了14.2%（3.7%至25.9%），重度LEA减少了49.5%（-57.1%至-40.5%）。40至64岁年龄组的发病率趋势保持稳定，65至79岁和80岁及以上年龄组分别下降了14.6%和20.1%。所有年龄组的重度LEA均下降，而仅40至64岁患者中的轻度LEA增加了26.2%。2006年至2019年期间，年龄标准化1年死亡率下降了35.1%（95%CI，-43.4%至-25.7%），2019年的粗1年死亡率为11.3%。