The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65069

Chin-Lin Tseng, DrPH¹, Mangala Rajan, MBA², and Leonard Pogach, MD, MBA². (1) Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey, 385 Tremont Avenue, VAMC #129, East Orange, NJ 07018, (973)6761000 ext 2028, tseng@njneuromed.org, (2) Diabetes Research Group, New Jersey East Orange VA Hospital, 385 Tremont, VAMC #129, East Orange, NJ 07018

The aim of this study was to evaluate the roles of marital status (a proxy for third party assistance with foot care) and mental health (a proxy for having difficulty adhering to recommended foot care practices) on lower extremity amputation (LEA) risk, using patient level administrative data, in users of Veterans Administration (VA) healthcare. Individuals were diagnosed as having diabetes based upon one inpatient or two outpatient diabetes claims in a merged Fiscal Year (FY) 1997/1998 VA-Medicare dataset. To assure data completeness, we restricted our analyses to Medicare eligible veterans without HMO coverage. The outcomes were amputations in FY99 for patients alive as of 9/30/98. Minor (toe or transmetarsal) or major (transtibial or transfemoral) amputations were determined from hospital discharges using the highest-level amputation. The impacts of marital status (married versus others) and mental health disorders (any versus none) were evaluated after adjusting for selected known risk factors: age, gender, and race; skin infection (minor foot lesions, cellulitis, ulcer); amputation in FY97-98, peripheral vascular disease and procedures. We identified 215,654 cohort members, of whom 3,048 (1,902) incurred (major) amputations in FY99. We found that for the outcome of major (versus none) amputation, being married reduced the odds of having major amputation (OR=0.83, CI=(0.75, 0.91)), while having any mental health disorder increased the odds (OR=1.22, CI=(1.11, 1.35)). We conclude that unmarried status and mental health disorders were associated with a higher risk of amputation. Our results suggested that amputation prevention programs should emphasize care coordination in these high-risk groups.

Learning Objectives:

• 1. Recognize the impact of marital status on the risk of major amputation
• 2. Recognize the negative impact of being mentally ill on the risk of major amputation.
• 3. Apply the finding of this study in development of prevention program for high-risk groups.

Keywords: Diabetes, Risk Factors

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: grants/employment