Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population

Mark R. Nehler, Sue Duval, Lihong Diao, Brian H. Annex, William R. Hiatt, Kevin Rogers, Armen Zakharyan, Alan T. Hirsch

Research output: Contribution to journalArticle

Abstract

Background: Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD) and is the major cause of ischemic amputation in the United States. Risk factors and the associated incidence and prevalence of CLI have not been well described in the general population. This study describes the risk factors for PAD progression to CLI and estimates the annual incidence and prevalence of CLI in a representative United States patient cohort. Methods: This was a retrospective cohort analysis of adults with commercial, Medicare supplemental, or Medicaid health insurance who had at least one PAD or CLI health care claim from January 1, 2003, through December 31, 2008, and 12 months of continuous coverage. Two subgroups of CLI presentation were identified: primary CLI (patients without any prior PAD or subsequent PAD diagnostic code >30 days after CLI diagnostic code) and secondary CLI (patients with prior PAD or subsequent PAD diagnostic codes ≤30 days of a CLI diagnostic code). Patterns of presentation, annual incidence, and prevalence of CLI were stratified by health care plan. Risk factors for progression to CLI were compared by presentation type. Results: From 2003 to 2008, the mean annual incidence of PAD was 2.35% (95% confidence interval [CI], 2.34%-2.36%) and the incidence of CLI was 0.35% (95% CI, 0.34%-0.35%) of the eligible study population, with primary and secondary presentations occurring at similar rates. The mean annualized prevalence of PAD was 10.69% (95% CI, 10.67%10.70%) and the mean annualized prevalence of CLI was 1.33% (95% CI, 1.32%-1.34%) of the eligible study population, and two-thirds of the cases presented as secondary CLI. CLI developed in 11.08% (95% CI, 11.30%-11.13%) of patients with PAD. A multivariable model demonstrated that diabetes, heart failure, stroke, and renal failure were stronger predictors of primary rather than secondary CLI presentation. Conclusions: These data establish new national estimates of the incidence and prevalence of CLI and define key risk factors that contribute to primary or secondary presentations of CLI within a very large contemporary insured population cohort in the United States.

Original languageEnglish (US)
Pages (from-to)686-695.e2
JournalJournal of Vascular Surgery
Volume60
Issue number3
DOIs
StatePublished - Sep 2014

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Peripheral Arterial Disease
Epidemiology
Ischemia
Extremities
Population
Confidence Intervals
Incidence
Delivery of Health Care
Medicaid

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Nehler, M. R., Duval, S., Diao, L., Annex, B. H., Hiatt, W. R., Rogers, K., ... Hirsch, A. T. (2014). Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. Journal of Vascular Surgery, 60(3), 686-695.e2. https://doi.org/10.1016/j.jvs.2014.03.290

Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. / Nehler, Mark R.; Duval, Sue; Diao, Lihong; Annex, Brian H.; Hiatt, William R.; Rogers, Kevin; Zakharyan, Armen; Hirsch, Alan T.

In: Journal of Vascular Surgery, Vol. 60, No. 3, 09.2014, p. 686-695.e2.

Research output: Contribution to journalArticle

Nehler, MR, Duval, S, Diao, L, Annex, BH, Hiatt, WR, Rogers, K, Zakharyan, A & Hirsch, AT 2014, 'Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population', Journal of Vascular Surgery, vol. 60, no. 3, pp. 686-695.e2. https://doi.org/10.1016/j.jvs.2014.03.290
Nehler, Mark R. ; Duval, Sue ; Diao, Lihong ; Annex, Brian H. ; Hiatt, William R. ; Rogers, Kevin ; Zakharyan, Armen ; Hirsch, Alan T. / Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. In: Journal of Vascular Surgery. 2014 ; Vol. 60, No. 3. pp. 686-695.e2.
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title = "Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population",
abstract = "Background: Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD) and is the major cause of ischemic amputation in the United States. Risk factors and the associated incidence and prevalence of CLI have not been well described in the general population. This study describes the risk factors for PAD progression to CLI and estimates the annual incidence and prevalence of CLI in a representative United States patient cohort. Methods: This was a retrospective cohort analysis of adults with commercial, Medicare supplemental, or Medicaid health insurance who had at least one PAD or CLI health care claim from January 1, 2003, through December 31, 2008, and 12 months of continuous coverage. Two subgroups of CLI presentation were identified: primary CLI (patients without any prior PAD or subsequent PAD diagnostic code >30 days after CLI diagnostic code) and secondary CLI (patients with prior PAD or subsequent PAD diagnostic codes ≤30 days of a CLI diagnostic code). Patterns of presentation, annual incidence, and prevalence of CLI were stratified by health care plan. Risk factors for progression to CLI were compared by presentation type. Results: From 2003 to 2008, the mean annual incidence of PAD was 2.35{\%} (95{\%} confidence interval [CI], 2.34{\%}-2.36{\%}) and the incidence of CLI was 0.35{\%} (95{\%} CI, 0.34{\%}-0.35{\%}) of the eligible study population, with primary and secondary presentations occurring at similar rates. The mean annualized prevalence of PAD was 10.69{\%} (95{\%} CI, 10.67{\%}10.70{\%}) and the mean annualized prevalence of CLI was 1.33{\%} (95{\%} CI, 1.32{\%}-1.34{\%}) of the eligible study population, and two-thirds of the cases presented as secondary CLI. CLI developed in 11.08{\%} (95{\%} CI, 11.30{\%}-11.13{\%}) of patients with PAD. A multivariable model demonstrated that diabetes, heart failure, stroke, and renal failure were stronger predictors of primary rather than secondary CLI presentation. Conclusions: These data establish new national estimates of the incidence and prevalence of CLI and define key risk factors that contribute to primary or secondary presentations of CLI within a very large contemporary insured population cohort in the United States.",
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T1 - Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population

AU - Nehler, Mark R.

AU - Duval, Sue

AU - Diao, Lihong

AU - Annex, Brian H.

AU - Hiatt, William R.

AU - Rogers, Kevin

AU - Zakharyan, Armen

AU - Hirsch, Alan T.

PY - 2014/9

Y1 - 2014/9

N2 - Background: Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD) and is the major cause of ischemic amputation in the United States. Risk factors and the associated incidence and prevalence of CLI have not been well described in the general population. This study describes the risk factors for PAD progression to CLI and estimates the annual incidence and prevalence of CLI in a representative United States patient cohort. Methods: This was a retrospective cohort analysis of adults with commercial, Medicare supplemental, or Medicaid health insurance who had at least one PAD or CLI health care claim from January 1, 2003, through December 31, 2008, and 12 months of continuous coverage. Two subgroups of CLI presentation were identified: primary CLI (patients without any prior PAD or subsequent PAD diagnostic code >30 days after CLI diagnostic code) and secondary CLI (patients with prior PAD or subsequent PAD diagnostic codes ≤30 days of a CLI diagnostic code). Patterns of presentation, annual incidence, and prevalence of CLI were stratified by health care plan. Risk factors for progression to CLI were compared by presentation type. Results: From 2003 to 2008, the mean annual incidence of PAD was 2.35% (95% confidence interval [CI], 2.34%-2.36%) and the incidence of CLI was 0.35% (95% CI, 0.34%-0.35%) of the eligible study population, with primary and secondary presentations occurring at similar rates. The mean annualized prevalence of PAD was 10.69% (95% CI, 10.67%10.70%) and the mean annualized prevalence of CLI was 1.33% (95% CI, 1.32%-1.34%) of the eligible study population, and two-thirds of the cases presented as secondary CLI. CLI developed in 11.08% (95% CI, 11.30%-11.13%) of patients with PAD. A multivariable model demonstrated that diabetes, heart failure, stroke, and renal failure were stronger predictors of primary rather than secondary CLI presentation. Conclusions: These data establish new national estimates of the incidence and prevalence of CLI and define key risk factors that contribute to primary or secondary presentations of CLI within a very large contemporary insured population cohort in the United States.

AB - Background: Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD) and is the major cause of ischemic amputation in the United States. Risk factors and the associated incidence and prevalence of CLI have not been well described in the general population. This study describes the risk factors for PAD progression to CLI and estimates the annual incidence and prevalence of CLI in a representative United States patient cohort. Methods: This was a retrospective cohort analysis of adults with commercial, Medicare supplemental, or Medicaid health insurance who had at least one PAD or CLI health care claim from January 1, 2003, through December 31, 2008, and 12 months of continuous coverage. Two subgroups of CLI presentation were identified: primary CLI (patients without any prior PAD or subsequent PAD diagnostic code >30 days after CLI diagnostic code) and secondary CLI (patients with prior PAD or subsequent PAD diagnostic codes ≤30 days of a CLI diagnostic code). Patterns of presentation, annual incidence, and prevalence of CLI were stratified by health care plan. Risk factors for progression to CLI were compared by presentation type. Results: From 2003 to 2008, the mean annual incidence of PAD was 2.35% (95% confidence interval [CI], 2.34%-2.36%) and the incidence of CLI was 0.35% (95% CI, 0.34%-0.35%) of the eligible study population, with primary and secondary presentations occurring at similar rates. The mean annualized prevalence of PAD was 10.69% (95% CI, 10.67%10.70%) and the mean annualized prevalence of CLI was 1.33% (95% CI, 1.32%-1.34%) of the eligible study population, and two-thirds of the cases presented as secondary CLI. CLI developed in 11.08% (95% CI, 11.30%-11.13%) of patients with PAD. A multivariable model demonstrated that diabetes, heart failure, stroke, and renal failure were stronger predictors of primary rather than secondary CLI presentation. Conclusions: These data establish new national estimates of the incidence and prevalence of CLI and define key risk factors that contribute to primary or secondary presentations of CLI within a very large contemporary insured population cohort in the United States.

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