Department of General Surgery (X.F., M.A.E.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Circ Cardiovasc Qual Outcomes. 2023 Jun;16(6):e009531. doi: 10.1161/CIRCOUTCOMES.122.009531. Epub 2023 Jun 20.
Previous studies demonstrate geographic and racial/ethnic variation in diagnosis and complications of diabetes and peripheral artery disease (PAD). However, recent trends for patients diagnosed with both PAD and diabetes are lacking. We assessed the period prevalence of concurrent diabetes and PAD across the United States from 2007 to 2019 and regional and racial/ethnic variation in amputations among Medicare patients.
Using Medicare claims from 2007 to 2019, we identified patients with both diabetes and PAD. We calculated period prevalence of concomitant diabetes and PAD and incident cases of diabetes and PAD for every year. Patients were followed to identify amputations, and results were stratified by race/ethnicity and hospital referral region.
9 410 785 patients with diabetes and PAD were identified (mean age, 72.8 [SD, 10.94] years; 58.6% women, 74.7% White, 13.2% Black, 7.3% Hispanic, 2.8% Asian/API, and 0.6% Native American). Period prevalence of diabetes and PAD was 23 per 1000 beneficiaries. We observed a 33% relative decrease in annual new diagnoses throughout the study. All racial/ethnic groups experienced a similar decline in new diagnoses. Black and Hispanic patients had on average a 50% greater rate of disease compared with White patients. One- and 5-year amputation rates remained stable at ≈1.5% and 3%, respectively. Native American, Black, and Hispanic patients were at greater risk of amputation compared with White patients at 1- and 5-year time points (5-year rate ratio range, 1.22-3.17). Across US regions, we observed differential amputation rates, with an inverse relationship between the prevalence of concomitant diabetes and PAD and overall amputation rates.
Significant regional and racial/ethnic variation exists in the incidence of concomitant diabetes and PAD among Medicare patients. Black patients in areas with the lowest rates of PAD and diabetes are at disproportionally higher risk for amputation. Furthermore, areas with higher prevalence of PAD and diabetes have the lowest rates of amputation.
先前的研究表明，糖尿病和外周动脉疾病（PAD）的诊断和并发症存在地域和种族/民族差异。然而，目前缺乏关于同时患有 PAD 和糖尿病的患者的最新趋势。我们评估了 2007 年至 2019 年期间美国同时患有糖尿病和 PAD 的患者的时期患病率，以及医疗保险患者中截肢术的区域和种族/民族差异。
使用 2007 年至 2019 年的医疗保险索赔数据，我们确定了同时患有糖尿病和 PAD 的患者。我们计算了每年并发糖尿病和 PAD 的时期患病率和新发病例。对患者进行随访以确定截肢术，结果按种族/民族和医院转诊区域进行分层。
共确定了 9410785 名患有糖尿病和 PAD 的患者（平均年龄 72.8 [标准差 10.94] 岁；女性占 58.6%，白人占 74.7%，黑人占 13.2%，西班牙裔占 7.3%，亚裔/太平洋岛民占 2.8%，美洲原住民占 0.6%）。每 1000 名受益人中有 23 人患有糖尿病和 PAD，其时期患病率为 23/1000。在整个研究期间，我们观察到每年新诊断的相对减少了 33%。所有种族/民族群体的新诊断病例均呈下降趋势。与白人患者相比，黑人患者和西班牙裔患者的疾病发生率平均高出 50%。一和五年的截肢率分别稳定在 1.5%和 3%左右。在 1 年和 5 年的时间点，与白人患者相比，美洲原住民、黑人以及西班牙裔患者的截肢风险更高（5 年风险比范围为 1.22-3.17）。在美国各地区，我们观察到了不同的截肢率，同时伴有糖尿病和 PAD 的合并患病率与总体截肢率呈反比关系。
医疗保险患者中同时患有糖尿病和 PAD 的发病率存在显著的地域和种族/民族差异。PAD 和糖尿病发病率最低地区的黑人患者的截肢风险不成比例地更高。此外，PAD 和糖尿病的患病率较高的地区的截肢率最低。
