title: A simple diabetes vascular severity staging instrument and its application to a Torres Strait Islander and Aboriginal adult cohort of north Australia.
abstract: BACKGROUND
  To develop an instrument that predicts diabetes-related vascular disease severity using routinely collected data on Australian Aboriginal and Torres Strait Islander adults with type 2 diabetes, in the absence of diabetes duration.
  
  
  METHODS
  A complex diabetes severity classification system was simplified and adapted for use with an Australian Aboriginal and Torres Strait Islander adult population with type 2 diabetes in north Queensland. Detailed vascular health risks and morbidities were mapped to routinely collected measures. Individual-level health screening, hospital separation and mortality data were linked and used to plot mean monthly in-patient hospital cost and percent mortality by disease severity as defined by the newly developed instrument, to test construct validity.
  
  
  RESULTS
  The revised instrument consists of four combined diabetes-related microvascular and macrovascular stages that range from least severe (stage 1) to severe irreversible vascular impairment (stage 4). When applied to data of an Aboriginal and Torres Strait Islander Australian population the instrument showed good construct validity, predicting higher hospital cost and mortality as vascular disease severity increased.
  
  
  CONCLUSIONS
  This instrument discriminates between levels of diabetes-related vascular disease severity, displays good construct validity by predicting increased hospital cost and mortality with worsening severity and can be populated with routinely collected data. It may assist with future health service research and its use could be extended to practice settings for health care planning for diabetes management programs and monitoring vascular disease progression.
authors: Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, 5001, Australia. odette.gibson@unisa.edu.au
authors: Odette R
authors: OR
authors: Gibson
authors: Leonie
authors: L
authors: Segal
authors: Robyn A
authors: RA
authors: McDermott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology*; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology*; D003953:Diagnosis-Related Groups / Q000191:economics; D005215:Fasting / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011793:Queensland / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology*; D055105:Waist Circumference; D000095283:Australian Aboriginal and Torres Strait Islander Peoples