Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan:30:292-8.e1.
doi: 10.1016/j.avsg.2015.07.040. Epub 2015 Nov 5.

Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region

Karina Newhall  1 , Emily Spangler  2 , Nino Dzebisashvili  3 , David C Goodman  4 , Philip Goodney  5
Affiliations

Amputation Rates for Patients with Diabetes and Peripheral Arterial Disease: The Effects of Race and Region

Karina Newhall et al. Ann Vasc Surg. 2016 Jan.

Abstract

Background: It remains unknown whether care of high-risk vascular patients with both diabetes and peripheral arterial disease (PAD) is improving. We examined national trends in care of patients with both PAD and diabetes.

Methods: A cohort of patients diagnosed with PAD and diabetes between 2007 and 2011 undergoing open or endovascular diagnostic or revascularization procedures was analyzed using Medicare claims data. Main outcome measure was amputation-free survival measured from time of initial revascularization procedure to 24 months, stratified by race and hospital referral region (HRR).

Results: From 2007 to 2011, 2.3 per 1,000 patients underwent a major amputation with the higher rate among black patients (5.5 per 1,000 vs. 1.9 per 1,000; P < 0.001) compared with nonblack. The rate varied widely by HRR (1.2 per 1,000-6.2 per 1,000), with higher variation in amputation rates in black patients (2.1-16.1 per 1,000). Overall, amputation-free survival was approximately 74.6% at 2 years, 68.4% among black patients, and 75.4% among nonblack patients, with the disparity between the 2 groups increasing over time.

Conclusions: Prevalence of concurrent PAD and diabetes is increasing, but amputation rates and amputation-free survival vary significantly by both race and HRR. Prevention and care coordination effort should aim to limit racial disparities in the treatment and outcomes of these high-risk patients.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1. Regional variation in amputation rate among patients with diabetes and peripheral artery disease
Leg amputation by Medicare beneficiaries with Diabetes and Peripheral Arterial Disease (per 1,000 beneficiaries), by Hospital Referral Region
FIGURE 2
FIGURE 2
Amputation and re-intervention-free survival after vascular procedure, by race
FIGURE 3
FIGURE 3
Amputation and re-intervention-free survival after vascular procedure, by procedure type and race
See this image and copyright information in PMC

References

    1. Gregg EW, Li YF, Wang J, et al. Changes in Diabetes-Related Complications in the United States, 1990–2010. New England Journal of Medicine. 2014;370:1514–23. - PubMed
    1. Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. Journal of the American College of Cardiology. 2006;47:921–9. - PubMed
    1. Brownrigg JR, Apelqvist J, Bakker K, Schaper NC, Hinchliffe RJ. Evidence-based management of PAD & the diabetic foot. Eur J Vasc Endovasc Surg. 2013;45:673–81. - PubMed
    1. Kono Y, Muder RR. Identifying the incidence of and risk factors for reamputation among patients who underwent foot amputation. Ann Vasc Surg. 2012;26:1120–6. - PubMed
    1. Mueller T, Hinterreiter F, Luft C, Poelz W, Haltmayer M, Dieplinger B. Mortality rates and mortality predictors in patients with symptomatic peripheral artery disease stratified according to age and diabetes. J Vasc Surg. 2014;59:1291–9. - PubMed

Publication types

MeSH terms