The Epidemiology of Lower-Extremity Disease in Veterans With Diabetes

Author:

Mayfield Jennifer A.1,Reiber Gayle E.1234,Maynard Charles23,Czerniecki Joseph15,Sangeorzan Bruce16

Affiliation:

1. Center of Excellence in Amputation, Prosthetics and Limb Loss Prevention, Rehabilitation, Research and Development, Seattle, Washington

2. Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington

3. Department of Health Services, University of Washington, Seattle, Washington

4. Department of Epidemiology, University of Washington, Seattle, Washington

5. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

6. Department of Orthopedic Surgery, University of Washington, Seattle, Washington

Abstract

OBJECTIVE—To describe the epidemiology of lower-extremity complications of diabetes in veterans who are users of the Department of Veterans Affairs (VA). RESEARCH DESIGN AND METHODS—Hospital discharge records for care provided in all VA hospitals in 1998 were obtained. All hospitalizations for lower-extremity ulceration, peripheral vascular procedures, and amputation were analyzed using frequency tables. A diabetes denominator was defined as a veteran with at least three ambulatory care visits with at least one diabetes diagnosis code. Age-specific and total age-adjusted rates of discharge with ulceration, vascular procedures, and amputation were calculated. RESULTS—Veterans with diabetes comprised over half of all hospitalizations for lower-extremity ulceration, one-third of all hospitalizations for peripheral vascular procedures, and two-thirds of all hospitalizations for amputation. The age-specific discharge rate per 1,000 diabetic persons for age 0–64 years, 65–74 years, and 75 years and older for ulceration were 28.4, 31.0, and 37.9; for vascular procedures, the rates were 3.5, 4.4, and 4.4; and for amputation, the rates were 7.3, 9.0, and 10.0, respectively. CONCLUSIONS—Veterans with diabetes comprise a significant proportion of hospitalizations for lower-extremity ulceration, peripheral vascular bypass, and amputation. Age-specific rates of diabetic amputation in veterans are lower than U.S. rates.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference9 articles.

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2. Data & trends, Diabetes Surveillance System [report online], 2003. Available from http://www.cdc.gov/diabetes/statistics/lealevel/methodology.htm. Accessed 18 February 2004

3. Kashner MT: Agreement between administrative files and written medical records. Med Care 36: 1324–1336, 1998

4. International Classification of Diabetes, 9th Revision. Los Angeles, CA, Practice Management Corporation, 1993

5. Holzer S, Camerota A, Martens L, Cuerdon T, Crustal-Peters J, Zagari M: Costs and duration of care for lower extremity ulcers in patients with diabetes. Clin Ther 20:169–181, 1998

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