Lower extremity amputation rates in people with diabetes as an indicator of health systems performance. A critical appraisal of the data collection 2000-2011 by the Organization for Economic Cooperation and Development (OECD).

Autor: Carinci F; Professor of Health Systems and Policy, School of Health Sciences, Faculty of Health and Medical Sciences, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7XH, UK. f.carinci@surrey.ac.uk., Massi Benedetti M; Hub for International Health Research, Perugia, Italy., Klazinga NS; Organization for Economic Cooperation and Development (OECD), Paris, France.; Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands., Uccioli L; Università Tor Vergata, Rome, Italy.
Jazyk: angličtina
Zdroj: Acta diabetologica [Acta Diabetol] 2016 Oct; Vol. 53 (5), pp. 825-32. Date of Electronic Publication: 2016 Jul 21.
DOI: 10.1007/s00592-016-0879-4
Abstrakt: Aims: Critical appraisal of secondary data made available by the OECD for the time frame 2000-2011.
Methods: Comparison of trends and variation of amputations in people with diabetes across OECD countries. Generalized estimating equations to test the statistical significance of the annual change adjusting for major potential confounders.
Results: A total of 26 OECD countries contributed to the OECD data collection for at least 1 year in the reference time frame, showing a decline in rates of over 40 %, from a mean of 13.2 (median 9.4, range 5.1-28.1) to 7.8 amputations per 100,000 in the general population (9.9, 1.0-18.4). The multivariate model showed an average decrease equal to -0.27 per 100,000 per year (p = 0.015), adjusted by structural characteristics of health systems, showing lower amputation rates for health systems financed by public taxation (-4.55 per 100,000 compared to insurance based, p = 0.002) and non-ICD coding mechanisms (-7.04 per 100,000 compared to ICD-derived, p = 0.001). Twelve-year decrease was stronger among insurance-based financing systems (tax based: -0.16 per 100,000, p = 0.064; insurance based: -0.36 per 100,000; p = 0.046).
Conclusions: In OECD countries, amputation rates in diabetes continuously decreased over 12 years. Still, in 2011, one amputation every 7 min could be directly attributed to diabetes. Although interesting, these results should be taken with extreme caution, until common definitions are improved and data quality issues, e.g., a different ability in capturing diabetes diagnoses, are fully resolved.
Competing Interests: The authors declare that they have no conflict of interests. Ethical standard The authors declare that no ethical issues apply to the present study. Statement of human and animal rights This article does not contain any studies with human or animal subjects performed by the any of the authors. Informed consent No informed consent is required.
Databáze: MEDLINE
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