title: Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls.
abstract: OBJECTIVE
  To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.
  
  
  METHODS
  The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients ≥65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.
  
  
  RESULTS
  We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.
  
  
  CONCLUSIONS
  In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI. bcallagh@med.umich.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Callaghan
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kerber
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Ann
authors.initials: A
authors.lastname: Rodgers
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Ryan
authors.initials: R
authors.lastname: McCammon
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: James
authors.initials: J
authors.lastname: Burke
authors.affiliation: From the University of Michigan (B.C., K.K., K.M.L., M.B., A.R., R.M., J.B., E.F.); and the VA Center for Clinical Management Research (K.M.L., J.B.), Ann Arbor, MI.
authors.forename: Eva
authors.initials: E
authors.lastname: Feldman
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D038801:International Classification of Diseases / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000639:trends*; D018802:Patient-Centered Care / Q000379:methods / Q000639:trends*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology