Age and Sex May Significantly Interact With Diabetes on the Risks of Lower-Extremity Amputation and Peripheral Revascularization Procedures

Abstract

OBJECTIVE -Using the National Health Insurance claim data, we prospectively investigated the age-and sex-specific incidence density and relative hazards of nontraumatic lowerextremity amputation (LEA) and peripheral revascularization procedure (PRP) of the diabetic population in Taiwan.RESEARCH DESIGN AND METHODS -A total of 500,868 diabetic patients and 500,248 age-and sex-matched control subjects, selected from the ambulatory care claim (1997) and the registry for beneficiaries, respectively, were linked to inpatient claims (1997)(1998)(1999)(2000)(2001)(2002) to identify hospitalizations due to nontraumatic LEA and PRP. Incidence density was calculated under the Poisson assumption, and the Kaplan-Meier analysis was used to assess the cumulative event rates over a 6-year follow-up period. We also evaluated the age-and sex-specific relative hazards of nontraumatic LEA and PRP in relation to diabetes with Cox proportional hazard regression model adjusted for demographics and regional areas.RESULTS -The estimated incidence density of nontraumatic LEA and PRP for diabetic men was 410.3 and 317.0 per 100,000 patient-years, respectively. The corresponding data for diabetic women were relatively low at 115.2 and 86.0 per 100,000 patient-years. Compared with control subjects with the same age and sex, diabetic patients consistently suffered from significantly elevated relative hazards of nontraumatic LEA. Young and female patients were especially vulnerable to experience increased risks of nontraumatic LEA, but such effect modification by age and sex was less apparent for PRP.CONCLUSIONS -Multidisciplinary diabetes foot care systems, including the provision of revascularization procedures, should be further enforced to reduce subsequent risks of nontraumatic LEA, especially in young and female diabetic patients. Diabetes Care

Diabetes-related kidney, eye, and foot disease in Taiwan: An analysis of the nationwide data for 2000–2009

“…10 A previous study showed that the risk of nontraumatic lower extremity amputation due to diabetic complications was 9.22 and 11.67 times higher than that in the nondiabetic population for men and women, respectively. 11 Foot problems were present in 2.9% of the patients with diabetes, and ulcers represented 86.7% of all the initiating events. 12 Nevertheless, no nationwide epidemiologic survey of diabetic foot problems in Taiwan has been carried out and data on the treatment outcomes for diabetic foot ulcers are still not available.…”

Risk of Alzheimer’s Disease in Relation to Diabetes: A Population-Based Cohort Study

“…An individual was classified as being a diabetic patient if he or she had an initial diabetes-related diagnosis at any time in 2000 and was then diagnosed one or more times within the following 12 months. The first and last outpatient visits within 1 year were required to be >30 days apart to avoid accidental inclusion of miscoded patients [14]. To detect newly diagnosed AD, we excluded patients who sought treatment in hospitals or ambulatory care visits for AD (ICD-9 code 331.0) from 1997 to the first ambulatory care appearance in 2000 from our diabetic group.…”

Risk of malignant neoplasms of liver and biliary tract in diabetic patients with different age and sex stratifications

“…26 To detect newly diagnosed malignant neoplasm cases, we excluded those patients admitted to the hospitals for any kinds of malignant neoplasm (ICD-9: 140-208) during 1997-1999 from our diabetic group. In Taiwan, BNHI issues major illness/injury certificates to all patients who suffer from malignant neoplasm, and these patients are exempt from copayment to the NHI if they are admitted for the illness associated with the related malignancy.…”