Disease Severity and Disability in Persons with Peripheral Arterial Disease

摘要

Peripheral arterial disease (PAD) is a serious condition that can lead to long-term disability. Recently the National Heart, Lung and Blood Institute began a campaign to educate the public and increase awareness of PAD. The diagnosis of PAD frequently occurs late in the process. The purpose of this study was to understand the relationship between mild or severe PAD and disability (health-related quality of life) and determine which factors affect that relationship. This study explored pain, mobility and activity alterations in response to PAD. Sociodemographic, chronic diseases and biological risk factors were also examined. A cross-sectional design was used to examine 4559 adults age 40 and over from the NHANES 2001-2004 data. An ankle-brachial index (ABI) measured PAD severity and the Center for Disease Control and Prevention Health-Related Quality of Life 4 question set measured physical, mental and activity disability.;Comparisons of PAD levels: severe (ABI less than 0.7), mild (ABI 0.7-0.9) and no disease showed that differences in pain, activity, mobility and risk factors become apparent when PAD is considered asymptomatic. Logistic regression showed physical disability was 1.7 times (95% CI 1.3, 2.2) more likely with mild PAD than no disease. No effect was found between PAD and mental or activity disability. Education, poverty income ratio and hypertension were confounding factors. Mobility difficulty and calf pain with walking were mediators between PAD and physical disability. Age, ability to do vigorous activity, total cholesterol and obesity were effect moderators. Compared with no disease, odds ratio of physical disability were 4.4 times higher (95% CI 1.5, 13.2) at age 48 with severe PAD, 2.9 times higher (95% CI 1.39, 5.97) with elevated total cholesterol and mild PAD and 4.14 times higher (95% CI 1.23, 13.98) for obesity with severe PAD. Mobility, vigorous activity and calf pain made the most difference in the relationship between PAD and physical disability. Low prevalence of PAD in the general population (6.1%, 95% CI 4.9, 7.1) makes monitoring for disability impractical. Mean number of physically unhealthy days was higher for mild PAD, so surveillance with the CDC HRQOL-4 may be helpful in monitoring PAD impact.