TY - JOUR
T1 - Trends in diabetes-related foot disease hospitalizations and amputations in Australia, 2010 to 2019
AU - Quigley, Matthew
AU - Morton, Jedidiah I.
AU - Lazzarini, Peter A.
AU - Zoungas, Sophia
AU - Shaw, Jonathan E.
AU - Magliano, Dianna J.
N1 - Funding Information:
The diabetes study cohort (NDSS) was linked to the hospital admissions datasets in each state and to the National Death Index (NDI) by the Australian Institute of Health and Welfare, as previously described [16] . Hospital admissions datasets collect information on all admissions to public and private hospitals within each state of Australia. Public hospitals provide free medical care to all Australian citizens, while private hospitals are utilized by people with private health insurance, with more complex care usually undertaken in public hospitals [16] . However, private hospital data was only available in the linked dataset for the states of Victoria in 2010–2017 and Queensland in 2010–2019, and thus, private hospital data was excluded from the primary analysis. However, to assess the effect of excluding private hospital data in the primary analysis, sensitivity analyses were conducted by including and excluding private hospital data from Queensland and Victoria. Analyses in this study were conducted by financial year. Ethics approval for this study was provided by the Alfred Hospital Ethics Committee (Project No: 463/18) and the Australian Institute of Health and Welfare Ethics Committee (EO2018/5/501).
Funding Information:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. MQ is supported by an Australian Government Research Training Program (RTP) Scholarship. J.I.M. is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. P.A.L. is supported by a National Health and Medical Research Council Early Career Fellowship. S.Z. is supported by Monash University as Head, School of Public Health and Preventive Medicine. D.J.M. is supported by an Alice Baker and Eleanor Shaw Gender Equity Fellowship. J.E.S. is supported by a National Health and Medical Research Council Investigator Grant. This work was partly supported by a Diabetes Australia Research Program Grant and the Victorian Government’s Operational Infrastructure Support Program. The funding sources were not involved in the: study design; collection, analysis or interpretation of data; writing of the report; or the decision to submit the article for publication.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/12
Y1 - 2022/12
N2 - Aim: To determine trends in the incidence of hospitalizations and amputations for diabetes-related foot disease (DFD) in Australia. Methods: We included 70,766 people with type 1, and 1,087,706 with type 2 diabetes from the Australian diabetes registry from 2010 to 2019, linked to hospital admissions databases. Trends in age-adjusted incidence were summarized as annual percent changes (APC). Results: In people with type 1 diabetes, total DFD hospitalizations increased from 20.8 to 30.5 per 1,000 person-years between 2010 and 2019 (APC: 5.1% (95% CI: 3.5, 6.8)), including increases for ulceration (13.3% (2.9, 24.7)), osteomyelitis (5.6% (2.7, 8.7)), peripheral arterial disease (7.7% (3.7, 11.9)), and neuropathy (8.7% (5.5, 12.0)). In people with type 2 diabetes, DFD hospitalizations changed from 18.6 to 24.8 per 1,000 person-years between 2010 and 2019 (APC: 4.5% (3.6, 5.4); 2012–2019), including increases for ulceration (8.7% (4.0, 13.7)), cellulitis (5.4% (3.7, 7.0)), osteomyelitis (6.7% (5.7, 7.7)), and neuropathy (6.9% (5.2, 8.5)). Amputations were stable in type 1, whereas in type 2, above knee amputations decreased (-6.0% (-9.1, −2.7). Adjustment for diabetes duration attenuated the magnitude of most increases, but many remained significant. Conclusions: DFD hospitalizations increased markedly in Australia, mainly driven by ulceration and neuropathy, highlighting the importance of managing DFD to prevent hospitalizations.
AB - Aim: To determine trends in the incidence of hospitalizations and amputations for diabetes-related foot disease (DFD) in Australia. Methods: We included 70,766 people with type 1, and 1,087,706 with type 2 diabetes from the Australian diabetes registry from 2010 to 2019, linked to hospital admissions databases. Trends in age-adjusted incidence were summarized as annual percent changes (APC). Results: In people with type 1 diabetes, total DFD hospitalizations increased from 20.8 to 30.5 per 1,000 person-years between 2010 and 2019 (APC: 5.1% (95% CI: 3.5, 6.8)), including increases for ulceration (13.3% (2.9, 24.7)), osteomyelitis (5.6% (2.7, 8.7)), peripheral arterial disease (7.7% (3.7, 11.9)), and neuropathy (8.7% (5.5, 12.0)). In people with type 2 diabetes, DFD hospitalizations changed from 18.6 to 24.8 per 1,000 person-years between 2010 and 2019 (APC: 4.5% (3.6, 5.4); 2012–2019), including increases for ulceration (8.7% (4.0, 13.7)), cellulitis (5.4% (3.7, 7.0)), osteomyelitis (6.7% (5.7, 7.7)), and neuropathy (6.9% (5.2, 8.5)). Amputations were stable in type 1, whereas in type 2, above knee amputations decreased (-6.0% (-9.1, −2.7). Adjustment for diabetes duration attenuated the magnitude of most increases, but many remained significant. Conclusions: DFD hospitalizations increased markedly in Australia, mainly driven by ulceration and neuropathy, highlighting the importance of managing DFD to prevent hospitalizations.
KW - Amputation
KW - Diabetes-related foot disease
KW - Epidemiology
KW - Hospitalization
KW - Trends
KW - Type 1 diabetes mellitus
KW - Type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85143540677&partnerID=8YFLogxK
U2 - 10.1016/j.diabres.2022.110189
DO - 10.1016/j.diabres.2022.110189
M3 - Article
C2 - 36442544
AN - SCOPUS:85143540677
SN - 0168-8227
VL - 194
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 110189
ER -
