Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Diabet Med. 2023 Jun;40(6):e15056. doi: 10.1111/dme.15056. Epub 2023 Feb 10.
AIM/HYPOTHESIS: To describe the influence of diabetes on temporal changes in rates of lower extremity revascularisation and amputation for peripheral artery disease (PAD) in Ontario, Canada.
In this population-based repeated cross-sectional study, we calculated annual rates of lower extremity revascularisation (open or endovascular) and amputation (toe, foot or leg) related to PAD among Ontario residents aged ≥40 years between 2002 and 2019. Annual rate ratios (relative to 2002) adjusted for changes in diabetes prevalence alone, as well as fully adjusted for changes in demographics, diabetes and other comorbidities, were estimated using generalized estimating equation models to model population-level effects while accounting for correlation within units of observation.
Compared with 2002, the Ontario population in 2019 exhibited a significantly higher prevalence of diabetes (18% vs. 10%). Between 2002 and 2019, the crude rate of revascularisation increased from 75.1 to 90.7/100,000 person-years (unadjusted RR = 1.10, 95% CI = 1.07-1.13). However, after adjustment, there was no longer an increase in the rate of revascularisation (diabetes-adjusted RR = 0.98, 95% CI = 0.96-1.01, fully-adjusted RR = 0.94, 95% CI = 0.91-0.96). The crude rate of amputation decreased from 2002 to 2019 from 49.5 to 45.4/100,000 person-years (unadjusted RR = 0.78, 95% CI = 0.75-0.81), but was more pronounced after adjustment (diabetes-adjusted RR = 0.62, 95% CI = 0.60-0.64; fully-adjusted RR = 0.58, 95% CI = 0.56-0.60).
CONCLUSIONS/INTERPRETATION: Diabetes prevalence rates strongly influenced rates of revascularisation and amputation related to PAD. A decrease in amputations related to PAD over time was attenuated by rising diabetes prevalence rates.
目的/假设：描述糖尿病对加拿大安大略省外周动脉疾病（PAD）下肢血运重建和截肢率随时间变化的影响。
在这项基于人群的重复横断面研究中，我们计算了 2002 年至 2019 年间安大略省 40 岁及以上居民与 PAD 相关的下肢血运重建（开放或血管内）和截肢（脚趾、足部或腿部）的年发生率。使用广义估计方程模型，仅根据糖尿病流行率的变化，以及根据人口统计学、糖尿病和其他合并症的变化进行完全调整，估计了与 2002 年相比的年比率（相对比率），以在考虑观察单位相关性的同时模拟人群水平的效果。
与 2002 年相比，2019 年安大略省人口的糖尿病患病率明显更高（18%比 10%）。2002 年至 2019 年间，血运重建的粗率从 75.1 增至 90.7/100,000 人年（未调整 RR=1.10，95%CI=1.07-1.13）。然而，调整后，血运重建率不再增加（糖尿病调整 RR=0.98，95%CI=0.96-1.01，完全调整 RR=0.94，95%CI=0.91-0.96）。2002 年至 2019 年间，截肢的粗率从 49.5 降至 45.4/100,000 人年（未调整 RR=0.78，95%CI=0.75-0.81），但调整后更为明显（糖尿病调整 RR=0.62，95%CI=0.60-0.64；完全调整 RR=0.58，95%CI=0.56-0.60）。
结论/解释：糖尿病患病率强烈影响与 PAD 相关的血运重建和截肢率。随着时间的推移，与 PAD 相关的截肢率下降，但由于糖尿病患病率上升，这种下降趋势有所减弱。
