دورية أكاديمية
أعرض في EDS

Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas.

التفاصيل البيبلوغرافية
العنوان: Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas.
المؤلفون: Fanaroff AC; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA., Yang L; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA., Nathan AS; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA., Khatana SAM; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA., Julien H; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA., Wang TY; Division of Cardiology and Duke Clinical Research Institute Duke University Durham NC., Armstrong EJ; Division of Cardiology University of Colorado Aurora CO., Treat-Jacobson D; School of Nursing University of Minnesota Minneapolis MN., Glaser JD; Division of Vascular Surgery and Endovascular Therapy University of Pennsylvania Philadelphia PA., Wang G; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Vascular Surgery and Endovascular Therapy University of Pennsylvania Philadelphia PA., Damrauer SM; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Vascular Surgery and Endovascular Therapy University of Pennsylvania Philadelphia PA.; Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA., Giri J; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Division of Cardiovascular Medicine University of Pennsylvania Philadelphia PA.; Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA., Groeneveld PW; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center University of Pennsylvania Philadelphia PA.; Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.; Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia PA.; Division of General Internal Medicine University of Pennsylvania Philadelphia PA.
المصدر: Journal of the American Heart Association [J Am Heart Assoc] 2021 Sep 07; Vol. 10 (17), pp. e021456. Date of Electronic Publication: 2021 Aug 25.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.
اللغة: English
بيانات الدورية: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Oxford : Wiley-Blackwell
مواضيع طبية MeSH: Healthcare Disparities* , Medicare* , Peripheral Arterial Disease*/epidemiology , Peripheral Arterial Disease*/surgery , Social Class*, Amputation, Surgical/*statistics & numerical data, Aged ; Humans ; Lower Extremity/surgery ; United States/epidemiology
مستخلص: Background Rates of major lower extremity amputation in patients with peripheral artery disease are higher in rural communities with markers of low socioeconomic status, but most Americans live in metropolitan areas. Whether amputation rates vary within US metropolitan areas is unclear, as are characteristics of high amputation rate urban communities. Methods and Results We estimated rates of major lower extremity amputation per 100 000 Medicare beneficiaries between 2010 and 2018 at the ZIP code level among ZIP codes with ≥100 beneficiaries. We described demographic characteristics of high and low amputation ZIP codes, and the association between major amputation rate and 3 ZIP code-level markers of socioeconomic status-the proportion of patients with dual eligibility for Medicaid, median household income, and Distressed Communities Index score-for metropolitan, micropolitan, and rural ZIP code cohorts. Between 2010 and 2018, 188 995 Medicare fee-for-service patients living in 31 391 ZIP codes with ≥100 beneficiaries had a major lower extremity amputation. The median (interquartile range) ZIP code-level number of amputations per 100 000 beneficiaries was 262 (75-469). Though nonmetropolitan ZIP codes had higher rates of major amputation than metropolitan areas, 78.2% of patients undergoing major amputation lived in metropolitan areas. Compared with ZIP codes with lower amputation rates, top quartile amputation rate ZIP codes had a greater proportion of Black residents (4.4% versus 17.5%, P <0.001). In metropolitan areas, after adjusting for clinical comorbidities and demographics, every $10 000 lower median household income was associated with a 4.4% (95% CI, 3.9-4.8) higher amputation rate, and a 10-point higher Distressed Communities Index score was associated with a 3.8% (95% CI, 3.4%-4.2%) higher amputation rate; there was no association between the proportion of patients eligible for Medicaid and amputation rate. These findings were comparable to the associations identified across all ZIP codes. Conclusions In metropolitan areas, where most individuals undergoing lower extremity amputation live, markers of lower socioeconomic status and Black race were associated with higher rates of major lower extremity amputation. Development of community-based tools for peripheral artery disease diagnosis and management targeted to communities with high amputation rates in urban areas may help reduce inequities in peripheral artery disease outcomes.
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معلومات مُعتمدة: IK2 CX001780 United States CX CSRD VA; K23 HL153772 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: amputation; healthcare disparities; peripheral artery disease
تواريخ الأحداث: Date Created: 20210825 Date Completed: 20220104 Latest Revision: 20240404
رمز التحديث: 20240404
مُعرف محوري في PubMed: PMC8649262
DOI: 10.1161/JAHA.121.021456
PMID: 34431320
قاعدة البيانات: MEDLINE
الوصف
تدمد:2047-9980
DOI:10.1161/JAHA.121.021456