Incidence of hospitalization and mortality in patients with diabetic foot regardless of amputation: a population study
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The aim of our study was to estimate the overall rate of first hospitalizations for diabetic foot (DF) regardless of the outcome in amputations, as well as the mortality rate with their determinants in the period 2012–2016 in Piedmont Region in Italy.
The study included all the subjects registered in the Regional Diabetes Registry and alive as at January 1, 2012. DF cases were identified by record linkage with the regional hospital discharge database. Incident cases of diabetic foot were followed up for mortality.
The 5-year rates were 1762, 324, and 343 × 100,000 patients for first hospitalization without amputations, with major amputations, and with minor amputations, respectively. Patients not undergoing amputations were more than 70% of the cohort. Patients with the more severe stages of diabetes and those with low education were at higher risk of each type of hospitalization. The risk of death during a mean follow-up of 2.5 years was about 16, 18, and 30% among patients without amputations, with major amputations, and with minor amputations, respectively. Males, insulin-treated patients, those affected with severe diabetes complications, particularly on dialysis, and those with lower levels of education were at higher risk.
The heavier burden of DF on hospitalizations is due to cases without amputation, a condition that is seldom considered in the diabetes literature. The severity of diabetes, preexisting complications, and low educational levels are associated with both first hospitalization and subsequent survival at any level of severity of DF.
KeywordsDiabetic foot Diabetes mellitus Amputation Hospitalization Epidemiology Health services research
ML and GR conceived of and guided the analysis and wrote the manuscript. CP and GR conducted the analysis. BF, GC, CP and BG contributed to the data collection and reviewed and edited the manuscript. ML and GR are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with ethical standards
Conflict of interest
No potential conflicts of interest relevant to this article were reported.
This is an observational study and data were collected retrospectively. All data were anonymously linked and no personal identifiers were available to researchers. No ethical approval was required according to Italian law 211/2003, which explains that no ethics committee permission is required for this kind of study.
Data were drawn from anonymous regional database and informed consent was impossible to obtain. According to Italian privacy law, no patient’s or relative’s consent is required for large retrospective population-based studies and if data are published only in aggregated form.
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