Editor's Choice - Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data

Eur J Vasc Endovasc Surg. 2020 Jan;59(1):59-66. doi: 10.1016/j.ejvs.2019.08.006. Epub 2019 Nov 16.

Abstract

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.

Keywords: Chronic limb threatening ischaemia; Comorbidity; Elixhauser coding; Health insurance claims data; Peripheral arterial disease; van Walraven score.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administrative Claims, Healthcare / statistics & numerical data
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation / statistics & numerical data
  • Amputation / trends*
  • Comorbidity / trends*
  • Diabetes Mellitus
  • Female
  • Germany / epidemiology
  • Health Care Costs / statistics & numerical data
  • Health Care Costs / trends
  • Heart Failure / epidemiology
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends*
  • Humans
  • Hypertension / epidemiology
  • Hypothyroidism / epidemiology
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / economics
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / surgery*
  • Prevalence
  • Renal Insufficiency / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / economics
  • Vascular Surgical Procedures / statistics & numerical data
  • Vascular Surgical Procedures / trends*