A recent nationwide study highlights significant regional differences in the incidence, treatment approaches, and in-hospital outcomes for patients with critical limb ischemia (CLI) across Japan. These disparities suggest a need for more uniform healthcare strategies to ensure consistent patient care nationwide.
Variations in Incidence and Patient Demographics
Researchers analyzed data from the Diagnosis Procedure Combination database, encompassing patients aged 18 and older discharged from acute-care hospitals between April 2018 and March 2020. The Kyushu region reported the highest CLI admissions per million population at 112.1, while the Kanto region had the lowest at 59.9. Body mass index (BMI) varied significantly across regions, with Kansai showing the highest percentage of patients with a BMI between 18.5 and 30.0 kg/m², and Okinawa having the highest rate of patients with a BMI over 30.0 kg/m². Additionally, the need for dialysis ranged from 33.8% in Chugoku-Shikoku to 38.2% in Okinawa, indicating varying levels of patient comorbidities.
Differing Treatment Approaches and Outcomes
The study found considerable differences in treatment methods, with endovascular therapy (EVT) rates ranging from 67.6% in Hokkaido-Tohoku to 84.8% in Kansai. Amputation rates also varied, being lowest in Kansai at 22.2% and highest in Chugoku-Shikoku at 33.4%. In-hospital mortality rates differed significantly, from 5.7% in Chugoku-Shikoku to 10.9% in Okinawa. Medication prescriptions showed that 82.1% of CLI patients received anti-platelet agents, while only 36.1% were prescribed statins.
- Higher CLI admission rates in Kyushu may indicate better detection or higher prevalence.
- Variation in EVT and amputation rates suggests differing regional treatment protocols.
- Lower in-hospital mortality in Chugoku-Shikoku could reflect more effective management strategies.
- Disparities in BMI distributions may influence treatment outcomes and complication rates.
The findings underscore the necessity for standardized, evidence-based care practices to mitigate regional disparities and enhance patient outcomes for those suffering from CLI across Japan.
Establishing unified guidelines and ensuring equitable access to advanced treatments like EVT can bridge the gaps observed. Addressing regional variations in patient demographics, such as BMI and comorbidities, will further tailor effective interventions. Continuous monitoring and data-driven strategies are essential to optimize CLI management and reduce mortality rates uniformly across all regions.
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