A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease
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A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease. / Heidemann, Franziska; Kuchenbecker, Jenny; Peters, Frederik; Kotov, Artur; Marschall, Ursula; L'Hoest, Helmut; Acar, Laura; Ramkumar, Niveditta; Goodney, Philip; Debus, Eike Sebastian; Rother, Ulrich; Behrendt, Christian-Alexander.
in: J VASC SURG, Jahrgang 74, Nr. 3, 09.2021, S. 780-787.e7.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease
AU - Heidemann, Franziska
AU - Kuchenbecker, Jenny
AU - Peters, Frederik
AU - Kotov, Artur
AU - Marschall, Ursula
AU - L'Hoest, Helmut
AU - Acar, Laura
AU - Ramkumar, Niveditta
AU - Goodney, Philip
AU - Debus, Eike Sebastian
AU - Rother, Ulrich
AU - Behrendt, Christian-Alexander
N1 - Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - OBJECTIVE: Several reports have addressed sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. In the present study, we aimed to determine the disparities between sexes after percutaneous endovascular revascularization (ER) for symptomatic PAOD.METHODS: Health insurance claims data from the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients who had undergone index percutaneous ER of symptomatic PAOD from January 1, 2010 to December 31, 2018 were included in the present study. The study cohort was stratified by the presence of intermittent claudication, ischemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences in age, treated vessel region, comorbidities, and pharmacologic treatment. Sex-related differences regarding cardiovascular event-free survival, amputation-free survival, and overall survival within 5 years of surgery were determined using Kaplan-Meier time-to-event curves, log-rank test, and Cox regression analysis.RESULTS: In the present study, 50,051 patients (47.2% women) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited lower mortality (hazard ratio [HR], 0.69-0.90), fewer amputations or death (HR, 0.70-0.89), and fewer cardiovascular events or death (HR, 0.78-0.91). The association between female sex and improved long-term outcomes was most pronounced for the patients with intermittent claudication.CONCLUSIONS: In the present propensity score-matched analysis of health insurance claims, we observed superior cardiovascular event-free survival, amputation-free survival, and overall survival during 5 years of follow-up after percutaneous ER in women with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate whether the conflicting data from previous reports might have resulted from insufficient stratification of the studies.
AB - OBJECTIVE: Several reports have addressed sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. In the present study, we aimed to determine the disparities between sexes after percutaneous endovascular revascularization (ER) for symptomatic PAOD.METHODS: Health insurance claims data from the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients who had undergone index percutaneous ER of symptomatic PAOD from January 1, 2010 to December 31, 2018 were included in the present study. The study cohort was stratified by the presence of intermittent claudication, ischemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences in age, treated vessel region, comorbidities, and pharmacologic treatment. Sex-related differences regarding cardiovascular event-free survival, amputation-free survival, and overall survival within 5 years of surgery were determined using Kaplan-Meier time-to-event curves, log-rank test, and Cox regression analysis.RESULTS: In the present study, 50,051 patients (47.2% women) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited lower mortality (hazard ratio [HR], 0.69-0.90), fewer amputations or death (HR, 0.70-0.89), and fewer cardiovascular events or death (HR, 0.78-0.91). The association between female sex and improved long-term outcomes was most pronounced for the patients with intermittent claudication.CONCLUSIONS: In the present propensity score-matched analysis of health insurance claims, we observed superior cardiovascular event-free survival, amputation-free survival, and overall survival during 5 years of follow-up after percutaneous ER in women with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate whether the conflicting data from previous reports might have resulted from insufficient stratification of the studies.
KW - Administrative Claims, Healthcare
KW - Aged
KW - Aged, 80 and over
KW - Amputation
KW - Databases, Factual
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Germany
KW - Health Services Research
KW - Health Status Disparities
KW - Healthcare Disparities
KW - Humans
KW - Intermittent Claudication/diagnosis
KW - Ischemia/diagnosis
KW - Limb Salvage
KW - Male
KW - Middle Aged
KW - Peripheral Arterial Disease/diagnosis
KW - Progression-Free Survival
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Sex Factors
KW - Stents
KW - Time Factors
U2 - 10.1016/j.jvs.2021.01.066
DO - 10.1016/j.jvs.2021.01.066
M3 - SCORING: Journal article
C2 - 33647437
VL - 74
SP - 780-787.e7
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 3
ER -