A. R. ALDHAHERI1, M. F. Osman1, J. Ortiz1, F. C. Brunicardi1, W. Qu1, K. Bauer1, M. Shanidze1, M. Nazzal1 1University Of Toledo Medical Center,Vascular Surgery/ Department Of Surgery/ College Of Medicine,Toledo, OH, USA
Introduction:
Complications of diabetes (DM), such as diabetic foot ulcers (DFU), are common in hospital settings and are expected to increase in the future. Our goal is to analyze the prevalence, demographics, revascularization, and amputation associated with DFU.
Methods:
All diagnoses and procedures were identified with ICD-9-CM code from the National Inpatient Sample (NIS) database (2008-2014). All statistical analyses were done with IBM SPSS statistical software ver.24. Type I error level was set at 0.05.
Results:
The total number of DM and DFU in this study was (9567169 & 309496) respectively. Prevalence of DM was higher in the patients 65yr or older than younger patients, males (28.7% vs. 22.5%), Native Americans (NAA) and African Americans (AA) compared to Caucasians (CA, 31.1% and 30.6% vs. 23.3%), and patients in the 0-25thpercentile of the income scale (IT1) than those at 76th-100thpercentile (IT4, 28% vs 20.9%,all p<.001). DFU was most prevalent in those 45-64yr (IT3, 4.3%), males (4.4% vs. 2.2%), in NAA (4.1%) than AA (3.4%) and CA (3.2%) and higher in IT1 compared to the IT4 (3.4% vs 3.1%,all p<.001). Annual rates of minor amputation (MIA) increased from 13.7% to 16.4% over the study period (coeff=0.55%, P=.002) while major amputations (MAA) was relatively unchanged. The MAA rate in age group 18-24yr was 1.5% compared to 6.3% in age group >=65yr (p<.001). MIA was more common in age groups of 25-44yr (17.4%) and 45-64yr (17.3%). Both MIA and MAA were higher in males (6.1% and 16.9% vs 5.3% and 11.5%,both p<.001). MAA was higher in AA than CA (7.8% vs 5.2%, p<.001). Medicare patients had a higher rate of MAA than private insurance patients (6.3% vs 4.7%, p<.001). MAA and MIA were higher in IT1 group than the IT4 group (6.6% and 15.2% vs 4.8% and 14.2%, both p<.001).
Annual rate of revascularization (RV) decreased over time (11.2 to 10.5%, coeff = -0.16%, p=.011). RV for the DFU was higher in patients >=65yr (14.7%), females (11.3% vs 10.4%), Medicare patients than private insurance (12.8% vs 8.8%) and in IT4 than IT1 (11.5% vs 10.3%, all p<.001). Both open RV and endovascular interventions were higher in the IT4 group (8.3% and 3.7% respectively) compared to the IT1 group (7.8% and 3.1%, respectively, all p <.001).
Post-hospital discharge to nursing home was higher in females (33.4% vs 28.1%), higher in IT4 than IT1 (32.5% vs 28.5%, both p<.001), with no differences seen between AA and CA (31.5% vs 31.1%, P>.05).
Conclusion:
The prevalence of DM is higher in patients >=65yr, males, NAA, AA and low-income patients. DFU has a higher incidence in the IT3 group 45-64yr, males, NAA, AA and the low-income group. Amputation rate was high in the older age group, males, AA, and the low-income group. This study demonstrates variations in DM and DFU as well as amputations based on (ethnicity, income, age and gender), and also suggests that there are disparities of health in the prevalence and management of DFU.