Abstract：
OBJECTIVE: To identify disparities in sociodemographic factors that are associated with major lower limb amputation in patients with peripheral arterial disease (PAD).
METHODS: A systematic review of the literature was performed to identify studies that reported major lower limb amputation rates in patients with PAD among different sociodemographic groups. Data that compared amputation rates on the basis of sex, race, ethnicity, income, insurance, geography, and hospital type were collected and described. Outcomes were then aggregated and standardized, and a meta-analysis was performed to synthesis data into single odds ratios (ORs).
RESULTS: Forty-one studies were included in the review. There was no association found between males and females (OR, 0.95; 95% confidence interval [CI], 0.90-1.00). Compared with Whites, higher rates of amputation were seen among Blacks/African Americans (OR, 2.02; 95% CI, 1.81-2.26) and Native Americans (OR, 1.22; 95% CI, 1.04-1.45). No significant association was found between Whites and Asians, Native Hawaiians, or Pacific Islanders (OR, 1.15; 95% CI, 1.00-1.33). Hispanics had higher rates of amputation compared with non-Hispanics (OR, 1.36; 95% CI, 1.22-1.52). Compared with private insurance, higher rates of amputation were seen among Medicare patients (OR, 1.38; 95% CI, 1.27-1.50), Medicaid patients (OR, 1.59; 95% CI, 1.44-1.76), and noninsured patients (OR, 1.41; 95% CI, 1.02-1.95). Compared with the richest income quartile, higher rates of amputation were seen among the second income quartile (OR, 1.10; 95% CI, 1.05-1.15), third income quartile (OR, 1.20; 95% CI, 1.07-1.35), and bottom income quartile (OR, 1.36; 95% CI, 1.24-1.49). There was no association found between rural and urban populations (OR, 1.35; 95% CI, 0.92-1.97) or between teaching and nonteaching hospitals (OR, 1.01; 95% CI, 0.91-1.12).
CONCLUSIONS: Our study has identified a number of disparities and quantified the influence of sociodemographic factors on major lower limb amputation rates owing to PAD between groups. We believe these findings can be used to better target interventions aimed at decreasing amputation rates, although further research is needed to better understand the mechanisms behind our findings.
METHODS: A systematic review of the literature was performed to identify studies that reported major lower limb amputation rates in patients with PAD among different sociodemographic groups. Data that compared amputation rates on the basis of sex, race, ethnicity, income, insurance, geography, and hospital type were collected and described. Outcomes were then aggregated and standardized, and a meta-analysis was performed to synthesis data into single odds ratios (ORs).
RESULTS: Forty-one studies were included in the review. There was no association found between males and females (OR, 0.95; 95% confidence interval [CI], 0.90-1.00). Compared with Whites, higher rates of amputation were seen among Blacks/African Americans (OR, 2.02; 95% CI, 1.81-2.26) and Native Americans (OR, 1.22; 95% CI, 1.04-1.45). No significant association was found between Whites and Asians, Native Hawaiians, or Pacific Islanders (OR, 1.15; 95% CI, 1.00-1.33). Hispanics had higher rates of amputation compared with non-Hispanics (OR, 1.36; 95% CI, 1.22-1.52). Compared with private insurance, higher rates of amputation were seen among Medicare patients (OR, 1.38; 95% CI, 1.27-1.50), Medicaid patients (OR, 1.59; 95% CI, 1.44-1.76), and noninsured patients (OR, 1.41; 95% CI, 1.02-1.95). Compared with the richest income quartile, higher rates of amputation were seen among the second income quartile (OR, 1.10; 95% CI, 1.05-1.15), third income quartile (OR, 1.20; 95% CI, 1.07-1.35), and bottom income quartile (OR, 1.36; 95% CI, 1.24-1.49). There was no association found between rural and urban populations (OR, 1.35; 95% CI, 0.92-1.97) or between teaching and nonteaching hospitals (OR, 1.01; 95% CI, 0.91-1.12).
CONCLUSIONS: Our study has identified a number of disparities and quantified the influence of sociodemographic factors on major lower limb amputation rates owing to PAD between groups. We believe these findings can be used to better target interventions aimed at decreasing amputation rates, although further research is needed to better understand the mechanisms behind our findings.
摘要：
目的：确定与PAD患者下肢严重截肢相关的社会人口统计学因素的差异。
方法：对文献进行系统综述，以确定报告不同社会人口统计学群体中PAD患者下肢严重截肢率的研究。根据性别比较截肢率的数据，种族,种族,收入,保险,地理,收集并描述医院类型。然后对结果进行汇总和标准化，进行荟萃分析,将数据合成为单一比值比.
结果：41项研究纳入综述。在男性和女性之间没有发现相关性（OR：0.95，95％CI：0.90-1.00）。与白人相比,在黑人/非裔美国人(OR:2.02,95%CI:1.81-2.26)和美洲原住民(OR:1.22,95%CI:1.04-1.45)中截肢率较高.在白人和亚洲人之间没有发现显著的关联，夏威夷原住民,或太平洋岛民（OR：1.15，95%CI：1.00-1.33）。西班牙裔患者截肢率高于非西班牙裔患者(OR:1.36,95%CI:1.22-1.52)。与私人保险相比，在医疗保险中截肢率较高(OR：1.38，95%CI：1.27-1.50)，医疗补助（OR：1.59，95%CI：1.44-1.76），和未投保者(OR：1.41，95%CI：1.02-1.95)。与收入最高的四分位数相比，第二收入四分位数的截肢率较高(OR：1.10，95%CI：1.05-1.15)，第三收入四分位数(OR：1.20，95%CI：1.07-1.35)，和最低收入四分位数（OR：1.36，95%CI：1.24-1.49）。在农村和城市人口之间（OR：1.35，95％CI：0.92-1.97）或教学医院与非教学医院之间（OR：1.01，95％CI：0.91-1.12）没有发现关联。
结论：我们的研究发现了一些差异，并量化了社会人口统计学因素对由于PAD引起的主要下肢截肢率的影响。我们相信这些发现可用于更好地针对旨在降低截肢率的干预措施；尽管，需要进一步的研究来更好地理解我们发现背后的机制.
方法：对文献进行系统综述，以确定报告不同社会人口统计学群体中PAD患者下肢严重截肢率的研究。根据性别比较截肢率的数据，种族,种族,收入,保险,地理,收集并描述医院类型。然后对结果进行汇总和标准化，进行荟萃分析,将数据合成为单一比值比.
结果：41项研究纳入综述。在男性和女性之间没有发现相关性（OR：0.95，95％CI：0.90-1.00）。与白人相比,在黑人/非裔美国人(OR:2.02,95%CI:1.81-2.26)和美洲原住民(OR:1.22,95%CI:1.04-1.45)中截肢率较高.在白人和亚洲人之间没有发现显著的关联，夏威夷原住民,或太平洋岛民（OR：1.15，95%CI：1.00-1.33）。西班牙裔患者截肢率高于非西班牙裔患者(OR:1.36,95%CI:1.22-1.52)。与私人保险相比，在医疗保险中截肢率较高(OR：1.38，95%CI：1.27-1.50)，医疗补助（OR：1.59，95%CI：1.44-1.76），和未投保者(OR：1.41，95%CI：1.02-1.95)。与收入最高的四分位数相比，第二收入四分位数的截肢率较高(OR：1.10，95%CI：1.05-1.15)，第三收入四分位数(OR：1.20，95%CI：1.07-1.35)，和最低收入四分位数（OR：1.36，95%CI：1.24-1.49）。在农村和城市人口之间（OR：1.35，95％CI：0.92-1.97）或教学医院与非教学医院之间（OR：1.01，95％CI：0.91-1.12）没有发现关联。
结论：我们的研究发现了一些差异，并量化了社会人口统计学因素对由于PAD引起的主要下肢截肢率的影响。我们相信这些发现可用于更好地针对旨在降低截肢率的干预措施；尽管，需要进一步的研究来更好地理解我们发现背后的机制.
