THE EPIDEMIOLOGY AND COST OF INPATIENT CARE FOR PERIPHERAL VASCULAR-DISEASE, INFECTION, NEUROPATHY, AND ULCERATION IN DIABETES

OBJECTIVE To describe the epidemiology and costs of the acute care of peripheral vascular disease, infection, neuropathy, and ulceration in a U.K. population with special consideration of those patients with di abetes. RESEARCH DESIGN AND METHODS - Routine data describing inpatien t care for a 4-year period were analyzed (financial years 1991/1992 to 1991/1995). These data had undergone record-linkage to draw together records from the same patients, and records of patients with diabetes were flagged. Cost estimates were determined by attributing a diagnosi s-related group cost-weight to each record. RESULTS - A total of 4,245 admissions (1.2% of all admissions) had a primary diagnosis of periph eral vascular disease, infection, neuropathy, or ulceration, and 7,379 (2.1%) admissions had these categories recorded in any one of six dia gnostic fields. These figures were generated by 3,159 and 4,751 patien ts, respectively. This represented a range of crude annual incidence o f admission of between 1.9 and 2.9 per 1,000 people. Patients with dia betes accounted for 625 (15.4%) of primary admissions, a crude annual incidence of admission of 18.8 per 1,000. The age-standardized relativ e risk of admission for patients with diabetes to the nondiabetic popu lation was 7.61 for men and 6.85 for women. The length of stay for pat ients with diabetes was almost twice that of the nondiabetic populatio n (15.5 vs. 8.7 days). The relative risk of hospital mortality (diabet es vs. non-diabetes) was 2.83. Surgical procedures were carried out on 857 patients, 272 (31.2%) with diabetes. This represented an age-stan dardized relative risk of 31.19. The estimated cost of admissions for primary diagnoses in these categories over 4 years was pound 6,128,211 ($9,743,855). Patients with diabetes accounted for pound 1,236,623 ($ 1,966,230), an excess of 87% attibutable to the diabetic state. CONCLU SIONS - Diabetes is confirmed as a significant risk factor for periphe ral vascular disease, infection, neuropathy, and ulceration. The sever ity of these disorders in terms of increased risk of hospital mortalit y, length of stay and risk of surgical procedure is also demonstrated for those patients with diabetes.