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Fowler XP, Eid MA, Barnes JA, Gladders B, Austin AM, Goodney EJ, Moore KO, Kearing S, Feinberg MW, Bonaca MP, Creager MA, Goodney PP. Trends of Concomitant Diabetes and Peripheral Artery Disease and Lower Extremity Amputation in US Medicare Patients, 2007 to 2019. Circ Cardiovasc Qual Outcomes 2023; 16:e009531. [PMID: 37339191 DOI: 10.1161/circoutcomes.122.009531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Previous studies demonstrate geographic and racial/ethnic variation in diagnosis and complications of diabetes and peripheral artery disease (PAD). However, recent trends for patients diagnosed with both PAD and diabetes are lacking. We assessed the period prevalence of concurrent diabetes and PAD across the United States from 2007 to 2019 and regional and racial/ethnic variation in amputations among Medicare patients. METHODS Using Medicare claims from 2007 to 2019, we identified patients with both diabetes and PAD. We calculated period prevalence of concomitant diabetes and PAD and incident cases of diabetes and PAD for every year. Patients were followed to identify amputations, and results were stratified by race/ethnicity and hospital referral region. RESULTS 9 410 785 patients with diabetes and PAD were identified (mean age, 72.8 [SD, 10.94] years; 58.6% women, 74.7% White, 13.2% Black, 7.3% Hispanic, 2.8% Asian/API, and 0.6% Native American). Period prevalence of diabetes and PAD was 23 per 1000 beneficiaries. We observed a 33% relative decrease in annual new diagnoses throughout the study. All racial/ethnic groups experienced a similar decline in new diagnoses. Black and Hispanic patients had on average a 50% greater rate of disease compared with White patients. One- and 5-year amputation rates remained stable at ≈1.5% and 3%, respectively. Native American, Black, and Hispanic patients were at greater risk of amputation compared with White patients at 1- and 5-year time points (5-year rate ratio range, 1.22-3.17). Across US regions, we observed differential amputation rates, with an inverse relationship between the prevalence of concomitant diabetes and PAD and overall amputation rates. CONCLUSIONS Significant regional and racial/ethnic variation exists in the incidence of concomitant diabetes and PAD among Medicare patients. Black patients in areas with the lowest rates of PAD and diabetes are at disproportionally higher risk for amputation. Furthermore, areas with higher prevalence of PAD and diabetes have the lowest rates of amputation.
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Affiliation(s)
- Xavier P Fowler
- Department of General Surgery (X.F., M.A.E.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark A Eid
- Department of General Surgery (X.F., M.A.E.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Aaron Barnes
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara Gladders
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andrea M Austin
- The Dartmouth Institute, Dartmouth College, Hanover, NH (A.M.A., P.P.G.)
| | - Eric J Goodney
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla O Moore
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stephen Kearing
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark W Feinberg
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.W.F.)
| | - Marc P Bonaca
- Division of Cardiology, University of Colorado School of Medicine, Denver (M.P.B.)
| | - Mark A Creager
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Heart and Vascular Center (J.A.B., B.G., E.J.G., K.O.M., S.K., M.A.C., P.P.G.), Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute, Dartmouth College, Hanover, NH (A.M.A., P.P.G.)
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