Abstract：
OBJECTIVE: Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set.
METHODS: We conducted a 12-consecutive-year observational study using Oklahoma\'s hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups.
RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category.
CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.
METHODS: We conducted a 12-consecutive-year observational study using Oklahoma\'s hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups.
RESULTS: Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category.
CONCLUSIONS: Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.
摘要：
背景：在美国，由于终末期慢性疾病引起的下肢截肢的年度趋势正在上升。这些截肢导致患者和医疗系统的巨额费用。在俄克拉荷马州,我们有高风险人群，因为获得护理的机会很少，没有保险的人数很高，心血管健康状况不佳，我们的整体医疗保健表现在全国排名第50位。但是我们对俄克拉荷马人及其肢体丧失的风险知之甚少。是的,因此,必须仔细观察这一人口以发现当代利率，趋势,糖尿病和/或外周动脉疾病（PAD）导致截肢的特定危险因素。我们假设特定状态的人群将被确定为肢体丧失的风险最高，并且截肢的当代趋势正在上升。为了创建可实施的肢体保存解决方案，必须设置基线。
方法：我们使用俄克拉荷马州的出院数据进行了一项连续12年的观察性研究。包括患有糖尿病和/或PAD的主要或次要诊断的20岁或以上的患者的出院。使用ICD-9和ICD-10代码识别诊断和截肢程序。每1000次出院计算截肢率。截肢率的趋势是通过年度百分比变化（APC）来衡量的。患病率比评估了人口统计学组截肢率的差异。
结果：从2008-2019年确定了超过5,000,000个排放。24％的人被诊断为糖尿病和/或PAD。糖尿病和/或PAD患者的总截肢率为12/千次出院。糖尿病和/或PAD相关的截肢率从8.1增加到16.2（APC：6.0，95％CI：4.7-7.3）。大多数截肢是轻微的(59.5%)，尽管未成年人与主要患者相比以更快的速度增加(未成年人截肢APC：8.1，95%CI：6.7-9.6vs.大截肢APC：3.1，95%CI：1.5-4.7），主要截肢的显著增加。截肢率在男性中最高（16.7），美洲印第安人(19.2)无保险(21.2)，未婚患者（12.7），以及年龄在45至49岁（18.8岁）之间的患者，和计算出的患病率比在各自类别内进行比较时,均有显著意义(p=0.001).
结论：俄克拉荷马州的截肢率在12年内几乎翻了一番，主要和次要截肢都显着增加。这项研究描述了一种恶化的趋势，强调由于慢性疾病造成的截肢是一个紧迫的全州医疗保健问题。我们还提出了截肢医疗保健差距的重要例子。通过定义这些特定州的地区和处于危险中的人群，我们已经确定了追求和改善护理的领域。这些独特的风险因素将有助于制定全州范围内的肢体保留干预措施。
方法：我们使用俄克拉荷马州的出院数据进行了一项连续12年的观察性研究。包括患有糖尿病和/或PAD的主要或次要诊断的20岁或以上的患者的出院。使用ICD-9和ICD-10代码识别诊断和截肢程序。每1000次出院计算截肢率。截肢率的趋势是通过年度百分比变化（APC）来衡量的。患病率比评估了人口统计学组截肢率的差异。
结果：从2008-2019年确定了超过5,000,000个排放。24％的人被诊断为糖尿病和/或PAD。糖尿病和/或PAD患者的总截肢率为12/千次出院。糖尿病和/或PAD相关的截肢率从8.1增加到16.2（APC：6.0，95％CI：4.7-7.3）。大多数截肢是轻微的(59.5%)，尽管未成年人与主要患者相比以更快的速度增加(未成年人截肢APC：8.1，95%CI：6.7-9.6vs.大截肢APC：3.1，95%CI：1.5-4.7），主要截肢的显著增加。截肢率在男性中最高（16.7），美洲印第安人(19.2)无保险(21.2)，未婚患者（12.7），以及年龄在45至49岁（18.8岁）之间的患者，和计算出的患病率比在各自类别内进行比较时,均有显著意义(p=0.001).
结论：俄克拉荷马州的截肢率在12年内几乎翻了一番，主要和次要截肢都显着增加。这项研究描述了一种恶化的趋势，强调由于慢性疾病造成的截肢是一个紧迫的全州医疗保健问题。我们还提出了截肢医疗保健差距的重要例子。通过定义这些特定州的地区和处于危险中的人群，我们已经确定了追求和改善护理的领域。这些独特的风险因素将有助于制定全州范围内的肢体保留干预措施。
