Amputations among younger patients with chronic limb threatening ischemia (CLTI) may carry higher personal and societal costs, but younger patients are often not included in CLTI research because of dataset limitations. We aimed to characterize and compare outcomes between younger (<65 years old) and older patients with CLTI. This retrospective cohort study identified patients with CLTI between July 1, 2014 and December 31, 2017 in the MarketScan commercial claims database, a proprietary set of claims for over 50 million patients with private insurance in the United States. The primary outcome was major adverse limb events (MALE); secondary outcomes included amputations, major adverse cardiovascular events, and statin prescription fills. The study cohort included 64,663 people with CLTI, of whom 25,595 (39.6%) were <65 years old. Younger patients were more likely to have diabetes mellitus (54.1% versus 49.9%, <.001) but less likely to have other comorbidities. A higher proportion of younger patients suffered MALE (31.7% versus 30.2%, =.002), specifically amputation (11.5% versus 9.3%, <.001). After adjustment, age <65 years old was associated with a 24% increased risk of amputation (HR 1.24, 95%CI 1.18-1.32, <.001) and a 10% increased risk of MALE (HR 1.10, 95%CI 1.07-1.14, <.001). A significant proportion of commercially insured patients with CLTI are under the age of 65, and younger patients have worse limb-related outcomes. These findings highlight the importance of aggressively treating risk factors for atherosclerosis and intentionally including younger patients with CLTI in future analyses to better understand their disease patterns and outcomes.

中文翻译：

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患有慢性肢体威胁性缺血的年轻患者面临更频繁的截肢

患有慢性肢体威胁性缺血 (CLTI) 的年轻患者的截肢可能会带来更高的个人和社会成本，但由于数据集的限制，年轻患者通常不包括在 CLTI 研究中。我们的目的是描述和比较年轻（<65 岁）和老年 CLTI 患者的结果。这项回顾性队列研究在 MarketScan 商业索赔数据库中确定了 2014 年 7 月 1 日至 2017 年 12 月 31 日期间患有 CLTI 的患者，该数据库是美国超过 5000 万拥有私人保险患者的专有索赔集。主要结局是主要不良肢体事件（MALE）；次要结局包括截肢、主要不良心血管事件和他汀类药物处方。研究队列包括 64,663 名 CLTI 患者，其中 25,595 名 (39.6%) 年龄 <65 岁。年轻患者更有可能患有糖尿病（54.1% vs 49.9%，<.001），但患有其他合并症的可能性较小。年轻患者遭受 MALE 的比例较高（31.7% vs 30.2%，=.002），特别是截肢（11.5% vs 9.3%，<.001）。调整后，年龄<65岁与截肢风险增加24%相关（HR 1.24，95%CI 1.18-1.32，<.001），与MALE风险增加10%相关（HR 1.10，95%CI 1.07- 1.14，<.001）。大部分有商业保险的 CLTI 患者年龄在 65 岁以下，年轻患者的肢体相关结果较差。这些发现强调了积极治疗动脉粥样硬化危险因素的重要性，并有意将年轻的 CLTI 患者纳入未来的分析中，以更好地了解他们的疾病模式和结果。