The epidemiology of lower-extremity disease in veterans with diabetes.
OBJECTIVE
To describe the epidemiology of lower-extremity complications of diabetes in veterans who are users of the Department of Veterans Affairs (VA).


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.
Mayfield
Jennifer A
JA
Center of Excellence in Amputation, Prosthetics and Limb Loss Prevention, Rehabilitation, Research and Development, Seattle, Washington, USA.
Reiber
Gayle E
GE
Maynard
Charles
C
Czerniecki
Joseph
J
Sangeorzan
Bruce
B
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology*; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D014768:Virginia / Q000453:epidemiology