Affiliation:
1. Department of Surgery University of Toronto Toronto Ontario Canada
2. Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
3. Department of Surgery King Faisal Specialist Hospital and Research Center Riyadh Kingdom of Saudi Arabia
4. ICES Toronto Ontario Canada
5. Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
6. Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada
7. Peter Munk Cardiac Centre and the Joint Department of Medical Imaging at the University Health Network Toronto Ontario Canada
8. Sunnybrook Health Sciences Centre Toronto Ontario Canada
Abstract
AbstractAim/HypothesisTo describe the influence of diabetes on temporal changes in rates of lower extremity revascularisation and amputation for peripheral artery disease (PAD) in Ontario, Canada.MethodsIn this population‐based repeated cross‐sectional study, we calculated annual rates of lower extremity revascularisation (open or endovascular) and amputation (toe, foot or leg) related to PAD among Ontario residents aged ≥40 years between 2002 and 2019. Annual rate ratios (relative to 2002) adjusted for changes in diabetes prevalence alone, as well as fully adjusted for changes in demographics, diabetes and other comorbidities, were estimated using generalized estimating equation models to model population‐level effects while accounting for correlation within units of observation.ResultsCompared with 2002, the Ontario population in 2019 exhibited a significantly higher prevalence of diabetes (18% vs. 10%). Between 2002 and 2019, the crude rate of revascularisation increased from 75.1 to 90.7/100,000 person‐years (unadjusted RR = 1.10, 95% CI = 1.07–1.13). However, after adjustment, there was no longer an increase in the rate of revascularisation (diabetes‐adjusted RR = 0.98, 95% CI = 0.96–1.01, fully‐adjusted RR = 0.94, 95% CI = 0.91–0.96). The crude rate of amputation decreased from 2002 to 2019 from 49.5 to 45.4/100,000 person‐years (unadjusted RR = 0.78, 95% CI = 0.75–0.81), but was more pronounced after adjustment (diabetes‐adjusted RR = 0.62, 95% CI = 0.60–0.64; fully‐adjusted RR = 0.58, 95% CI = 0.56–0.60).Conclusions/InterpretationDiabetes prevalence rates strongly influenced rates of revascularisation and amputation related to PAD. A decrease in amputations related to PAD over time was attenuated by rising diabetes prevalence rates.
Funder
Physicians' Services Incorporated Foundation
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine