Yale School of Medicine, New Haven, CT.
Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
J Vasc Surg. 2023 Jul;78(1):166-174.e3. doi: 10.1016/j.jvs.2023.03.027. Epub 2023 Mar 20.
Community distress is associated with adverse outcomes in patients with cardiovascular disease; however, its impact on clinical outcomes after peripheral vascular intervention (PVI) is uncertain. The Distressed Communities Index (DCI) is a composite measure of community distress measured at the zip code level. We evaluated the association between community distress, as measured by the DCI, and 24-month mortality and major amputation after PVI.
We used the Vascular Quality Initiative database, linked with Medicare claims data, to identify patients who underwent initial femoropopliteal PVI between 2017 and 2018. DCI scores were assigned using patient-level zip code data. The primary outcomes were 24-month mortality and major amputation. We used time-dependent receiver operating characteristic curve analysis to determine an optimal DCI value to stratify patients into risk categories for 24-month mortality and major amputation. Mixed Cox regression models were constructed to estimate the association of DCI with 24-month mortality and major amputation.
The final cohort consisted of 16,864 patients, of whom 4734 (28.1%) were classified as having high community distress (DCI ≥70). At 24 months, mortality was elevated in patients with high community distress (30.7% vs 29.5%, P = .02), as was major amputation (17.2% vs 13.1%, P <.001). After adjusting for demographic and clinical characteristics, a 10-point higher DCI score was associated with increased risk of mortality (hazard ratio: 1.01; 95% confidence interval: 1.00-1.03) and major amputation (hazard ratio: 1.02; 95% confidence interval: 1.00-1.04).
High community distress is associated with increased risk of mortality and major amputation after PVI.
社区困境与心血管疾病患者的不良结局相关；然而，其对外周血管介入（PVI）后临床结局的影响尚不确定。Distressed Communities Index（DCI）是一种通过邮政编码水平衡量社区困境的综合指标。我们评估了 DCI 衡量的社区困境与 PVI 后 24 个月死亡率和主要截肢之间的关系。
我们使用 Vascular Quality Initiative 数据库，结合 Medicare 理赔数据，确定了 2017 年至 2018 年间首次接受股腘 PVI 的患者。使用患者邮政编码数据分配 DCI 评分。主要结局是 24 个月死亡率和主要截肢。我们使用时间依赖的接收者操作特征曲线分析来确定最佳 DCI 值，以将患者分层为 24 个月死亡率和主要截肢的风险类别。构建混合 Cox 回归模型来估计 DCI 与 24 个月死亡率和主要截肢的关系。
最终队列包括 16864 名患者，其中 4734 名（28.1%）被归类为具有高社区困境（DCI≥70）。在 24 个月时，高社区困境患者的死亡率升高（30.7%比 29.5%，P=0.02），主要截肢率也升高（17.2%比 13.1%，P<.001）。在调整人口统计学和临床特征后，DCI 评分每增加 10 分，死亡风险增加（风险比：1.01；95%置信区间：1.00-1.03），主要截肢风险增加（风险比：1.02；95%置信区间：1.00-1.04）。
高社区困境与 PVI 后死亡率和主要截肢风险增加相关。
