Miyamori Daisuke, Yoshida Shuhei, Ito Masanori
Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan.
J Diabetes Investig. 2025 Aug;16(8):1551-1560. doi: 10.1111/jdi.70078. Epub 2025 May 23.
COVID-19 has been linked to increased vascular complications, but its long-term impact on amputation rates is unclear. This study evaluated amputation risk post-COVID-19 using a nationwide insurance claims database in Japan.
We conducted a retrospective cohort study using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. COVID-19 cases were identified via insurance payment waivers, and amputations were defined by procedure codes. Propensity score matching created balanced cohorts of COVID-19 exposed and unexposed individuals. Matched cohorts were compared for amputation incidence, calculating incidence rate ratios (IRRs), and differences (IRDs). Sensitivity analyses examined outcomes at different time points, and subgroup analyses stratified results by key characteristics.
This study included 3,098,948 matched pairs. Over a median follow-up of 7 months, 286 amputations occurred in the COVID-19 group vs 123 in controls (IRR 2.33, 95% CI 1.88-2.90; IRD 5.57 per 1,000,000 person-months, 95% CI 4.22-6.92). The elevated risk persisted beyond 2 years post infection (IRR 2.03, 95% CI 1.31-3.20). Subgroup analyses showed higher risks in individuals with higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥2; IRR 2.45 95% CI 1.92, 2.79) vs lower comorbidity burden (CCI 0-1; IRR 0.71 95%CI 0.29, 1.71) with significant interaction (P = 0.04).
Amputation rates increased among COVID-19 survivors, persisting for over 2 years post infection. The interaction between COVID-19 and comorbidity burden highlights the need for vigilant long-term monitoring and management of vascular complications in COVID-19 survivors, particularly those with multiple comorbidities.
新型冠状病毒肺炎（COVID-19）与血管并发症增加有关，但其对截肢率的长期影响尚不清楚。本研究利用日本全国性保险理赔数据库评估了COVID-19感染后的截肢风险。
我们使用来自日本国民健康保险理赔和特定健康检查国家数据库的数据进行了一项回顾性队列研究。通过保险费用豁免来确定COVID-19病例，并根据手术编码定义截肢情况。倾向评分匹配创建了COVID-19暴露组和未暴露组的均衡队列。比较匹配队列的截肢发生率，计算发病率比（IRR）和差异（IRD）。敏感性分析在不同时间点检查结果，亚组分析按关键特征对结果进行分层。
本研究纳入了3098948对匹配对象。在中位随访7个月期间，COVID-19组发生286例截肢，而对照组为123例（IRR 2.33，95%CI 1.88-2.90；IRD为每100万人月5.57例，95%CI 4.22-6.92）。感染后2年以上，风险仍持续升高（IRR 2.03，95%CI 1.31-3.20）。亚组分析显示，合并症负担较高（Charlson合并症指数[CCI]≥2；IRR 2.45，95%CI 1.92，2.79）的个体与合并症负担较低（CCI 0-1；IRR 0.71，95%CI 0.29，1.71）的个体相比，风险更高，且存在显著交互作用（P=0.04）。
COVID-19幸存者的截肢率增加，感染后持续超过2年。COVID-19与合并症负担之间的相互作用凸显了对COVID-19幸存者，尤其是那些有多种合并症的幸存者进行长期血管并发症监测和管理的必要性。
