Editor's Choice - Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data.
OBJECTIVE
Patients suffering from peripheral arterial occlusive disease (PAOD) are a central target population for multidisciplinary vascular medicine. This study aimed to highlight trends in treatment patterns and comorbidities using up to date longitudinal patient related data from Germany.


METHODS
This study is a retrospective health insurance claims data analysis of patients insured by the second largest health insurance provider in Germany, BARMER. All PAOD patient hospitalisations between 2008 and 2016 were included. The comorbidities were categorised with Elixhauser groups using WHO ICD-10 codes and summarised as the linear van Walraven score (vWS). A trend analysis of the comorbidities was performed after standardisation by age and sex.


RESULTS
A total of 156 217 patients underwent 202 961 hospitalisations (49.4% for chronic limb threatening ischaemia in 2016) with PAOD during the study period. Although the estimated annual incidence of PAOD among the BARMER cohort decreased slightly (- 4.4%), an increase was observed in the prevalence of PAOD (+ 23.1%), number of hospitalisations (+ 25.1%), peripheral vascular interventions (PVI, + 61.1%), and disease related reimbursement costs (+ 31%) from 2008 to 2016. Meanwhile, the number of major amputations decreased (- 15.1%). The proportion of patients aged 71-80 years increased about +10% among PAOD patients and the mean vWS also increased by two points during the study period. Considerable increases were found in the rates of hypertension, renal failure, and hypothyroidism, whereas the rates of diabetes and congestive heart failure decreased over time.


CONCLUSION
Increasing numbers of PVI performed on these ageing and sicker patients lead to rising costs but correlate with decreasing major amputation rates.
['Kreutzburg|Thea|T|', 'Peters|Frederik|F|', 'Rieß|Henrik C|HC|', 'Hischke|Sandra|S|', 'Marschall|Ursula|U|', 'Kriston|Levente|L|', "L'Hoest|Helmut|H|", 'Sedrakyan|Art|A|', 'Debus|Eike S|ES|', 'Behrendt|Christian-Alexander|CA|']
D000067575:Administrative Claims, Healthcare D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000671:Amputation D015897:Comorbidity D003920:Diabetes Mellitus D005260:Female D005858:Germany D017048:Health Care Costs D006333:Heart Failure D006760:Hospitalization D006801:Humans D006973:Hypertension D007037:Hypothyroidism D015994:Incidence D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D058729:Peripheral Arterial Disease D015995:Prevalence D051437:Renal Insufficiency D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome D014656:Vascular Surgical Procedures
Comorbidity Health insurance claims data van Walraven score Chronic limb threatening ischaemia Elixhauser coding Peripheral arterial disease