Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Descriptive Statistics
Top Medications and Diagnoses
3.2. Multivariable Analysis
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Diabetes Diagnosis | ICD-9-CM: 250.* ICD-10-CM: E10. *; E11. * CDC priority condition status |
Foot-related and non-site-specific infection A | ICD-9-CM: 041.11; 681.1 *; 681.9 *; 682.6 *; 682.7 *; 682.9- 686.9-; 730.06; 730.07; 730.08; 730.09; 730.16; 730.17; 730.18; 730.19; 730.26; 730.27; 730.28; 730.29; 785.4 *; 709.8-; 730.20; 892. *; 893. * ICD-10-CM: A49.9; B95.6; E10.5; E11.5; I96. *; L02.-; L02.6; L02.9; L03.-; L03.0; L03.1; L08.9; L97.-; L97.5; M7.9-; M78.9; M86.1; M86.2; M86.3; M86.4; M86.6; M86.8; M86.9 |
Reasons for visit (RFV) indicating foot involvement/infection A | 1840.3; 1935.0; 2201.0 |
Reasons for visit (RFV) indicating non-site-specific lesion B | 1865.0 |
Reasons for visit (RFV) indicating foot injury (open wound) B | 5030.0; 5545.0 |
Diagnosis codes potentially including diabetic foot ulcer B | E10.6 C; E11.6 C |
Diagnosis code of history of diabetic ulcer B | Z86.3 |
Reasons for visit (RFV) indicating possible infection D | 2035.0; 2800.0; 2910.0 |
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2020–2021 | 2020–2021 (COVID-19 Era) | |||||
---|---|---|---|---|---|---|
DFI A | Diabetes | Overall | DFI A | Diabetes | Overall | |
n = 2,372,132 (estimated) | n = 150,596,278 (estimated) | n = 1,074,254,782 (estimated) | n = 526,948 (estimated) | n = 34,685,239 (estimated) | n = 219,343,677 (estimated) | |
Demographics | ||||||
Age (mean ± SD) | 57.4 ± 12.9 * | 60.2 ± 14.4 | 47.3 ± 17.8 | 61.2 ± 8.6 | 61.4 ± 12.5 | 48.9 ± 15.7 |
Male (%) | 62.1 *** | 45.2 *** | 43.1 | 70.2 * | 46.1 * | 45.0 |
Race (%) | ||||||
White | 80.5 ** | 70.3 ** | 72.7 | 82.1 | 71.9 | 72.8 |
Black | 16.5 ** | 25.6 ** | 23.8 | 12.0 * | 23.6 * | 23.1 |
Other | 3.0 | 4.1 | 3.5 | 5.9 | 4.5 | 4.2 |
Ethnicity (%) | ||||||
Hispanic | 14.1 | 13.2 | 13.3 | 8.9 | 12.2 | 13.2 |
Primary Insurance Coverage (%) | ||||||
Private Insurance | 23.5 | 20.6 | 29.1 | 23.1 | 19.6 | 28.0 |
Medicare | 35.7 | 38.4 | 21.6 | 47.4 | 40.8 | 23.7 |
Medicaid | 19.8 | 21.5 | 27.3 | 15.8 | 23.2 | 30.4 |
Dual-Coverage B | 7.9 | 11.3 | 5.3 | 8.1 | 10.1 | 5.1 |
Other | 13.0 | 8.3 | 16.6 | 5.5 | 6.3 | 12.8 |
Health System Characteristics | ||||||
Rural Physician Practice C (%) | 15.6 | 14.8 | 14.2 | 15.9 | 13.8 | 12.3 |
Geographic Region (%) | ||||||
Northeast | 12.7 | 15.3 | 16.8 | 9.3 | 16.8 | 17.4 |
Midwest | 23.1 | 23.8 | 22.6 | 15.0 | 24.0 | 21.3 |
South | 39.5 | 40.2 | 38.6 | 51.8 | 36.1 | 37.0 |
West | 24.7 | 20.7 | 22.0 | 23.9 | 23.1 | 24.3 |
Clinical Characteristics | ||||||
Deyo–Charlson Comorbidity Index (mean ± SD) | 1.8 ± 1.1 | 2.0 ± 1.2 | 0.6 ± 1.0 | 2.5 ± 1.2 | 2.2 ± 1.1 | 0.7 ± 1.0 |
Diabetic Foot Infection (DFI) | |||
---|---|---|---|
2012–2021 (estimated n = 2,372,132) | % | 2020–2021 (estimated n = 526,948) | % |
1. Vancomycin | 28.1 | 1. Vancomycin | 25.6 |
2. Cephalexin | 17.2 | 2. Piperacillin-Tazobactam | 18.0 |
3. Piperacillin-Tazobactam | 15.6 | 3. Cephalexin | 17.1 |
4. Sulfamethoxazole-Trimethoprim | 13.9 | 4. Acetaminophen | 15.4 |
5. Clindamycin | 13.5 | 5. Clindamycin | 15.3 |
6. Ondansetron | 12.0 | 6. Insulin | 14.5 |
7. Acetaminophen | 11.5 | 7. Ceftriaxone | 13.4 |
8. Hydrocodone-Acetaminophen | 11.0 | 8. Morphine | 11.5 |
9. Insulin | 10.9 | 9. Iopamodil | 11.3 |
10. Morphine | 9.2 | 10. Labetalol | 11.3 |
Diabetes without Foot Complications | |||
2012–2021 (estimated n = 150,596,278) | % | 2020–2021 (estimated n = 34,685,239) | % |
1. Ondansetron | 18.2 | 1. Ondansetron | 18.9 |
2. Acetaminophen | 10.4 | 2. Acetaminophen | 15.5 |
3. Aspirin | 8.5 | 3. Ketorolac | 8.3 |
4. Hydrocodone-Acetaminophen | 8.1 | 4. Aspirin | 7.9 |
5. Morphine | 7.9 | 5. Morphine | 7.3 |
6. Ketorolac | 7.5 | 6. Ceftriaxone | 7.2 |
7. Albuterol | 5.4 | 7. Albuterol | 6.2 |
8. Ceftriaxone | 5.4 | 8. Lidocaine | 6.0 |
9. Insulin | 5.2 | 9. Hydrocodone-Acetaminophen | 5.6 |
10. Hydromorphone | 5.1 | 10. Ibuprofen | 5.3 |
Diabetic Foot Infection (DFI) | |||
---|---|---|---|
2012–2021 (estimated n = 2,372,132) | % | 2020–2021 (estimated n = 526,948) | % |
1. Cellulitis and acute lymphangitis of other parts of limb | 37.3 | 1. Non-pressure chronic ulcer of other part of foot | 30.0 |
2. Type 2 diabetes mellitus with other specified complications | 19.3 | 2. Type 2 diabetes mellitus with circulatory complications | 28.4 |
3. Non-pressure chronic ulcer of other part of foot | 13.4 | 3. Type 2 diabetes mellitus with other specified complications | 28.2 |
4. Cellulitis and acute lymphangitis of finger and toe | 11.1 | 4. Osteomyelitis, unspecified | 13.6 |
5. Type 2 diabetes mellitus without mention of complications | 9.6 | 5. Cellulitis and acute lymphangitis of other parts of limb | 13.0 |
6. Essential (primary) hypertension | 8.7 | 6. Hyperlipidemia, unspecified | 11.9 |
7. Cellulitis and acute lymphangitis | 8.6 | 7. Atherosclerotic heart disease of native coronary artery | 9.6 |
8. Local infection of the skin and subcutaneous tissue, unspecified | 7.7 | 8. End stage renal disease | 9.3 |
9. Osteomyelitis, unspecified | 7.5 | 9. Cellulitis and acute lymphangitis of finger and toe | 8.3 |
10. Type 2 diabetes mellitus with circulatory complications | 7.1 | 10. Type 2 diabetes mellitus without complications | 7.4 |
Diabetes without Foot Complications | |||
2012–2021 (estimated n = 150,596,278) | % | 2020–2021 (estimated n = 34,685,239) | % |
1. Type 2 diabetes mellitus without complications | 15.1 | 1. Type 2 diabetes mellitus without complications | 12.4 |
2. Essential (primary) hypertension | 11.5 | 2. Essential (primary) hypertension | 10.7 |
3. Chest pain, unspecified | 7.3 | 3. Chest pain, unspecified | 7.1 |
4. Urinary tract infection, site not specified | 4.7 | 4. Acute kidney failure, unspecified | 5.1 |
5. Unspecified abdominal pain | 4.3 | 5. Urinary tract infection, site not specified | 4.5 |
6. Heart failure, unspecified | 3.0 | 6. Dyspnea | 4.1 |
7. Pneumonia, unspecified organism | 2.6 | 7. COVID-19 | 3.7 |
8. Acute kidney failure, unspecified | 2.4 | 8. Unspecified abdominal pain | 3.6 |
9. Dyspnea | 2.4 | 9. Hyperglycemia, unspecified | 3.4 |
10. Hyperglycemia, unspecified | 2.3 | 10. Pain in limb, hand, foot, fingers and toes | 3.0 |
2012–2021 | 2012–2021 (COVID-19 Era) | |||||
---|---|---|---|---|---|---|
Seen in ED in Last 72 h A | Hospitalization A | Length of Stay B | Seen in ED in Last 72 h A | Hospitalization A | Length of Stay B | |
[Odds Ratio (95% CI)] | [Odds Ratio (95% CI)] | [Incidence Ratio (95% CI)] | [Odds Ratio (95% CI)] | [Odds Ratio (95% CI)] | [Incidence Ratio (95% CI)] | |
Disease State | ||||||
DFI C | 0.813 (0.404,1.634) | 3.002 *** (2.145,4.203) | 1.550 *** (1.241,1.936) | 0.811 (0.404,1.631) | 3.016 *** (2.155,4.221) | 1.557 *** (1.249,1.940) |
Demographics | ||||||
Age | 0.995 (0.987,1.002) | 1.020 *** (1.017,1.024) | 1.001 (0.998,1.005) | 0.995 (0.987,1.002) | 1.020 *** (1.017,1.024) | 1.001 (0.998,1.004) |
Male | 1.129 (0.945,1.349) | 1.275 *** (1.161,1.401) | 1.072 (0.996,1.154) | 1.131 (0.947,1.351) | 1.271 *** (1.159,1.395) | 1.065 (0.986,1.150) |
Race (ref. White) | ||||||
Black | 0.962 (0.726,1.273) | 0.780 *** (0.680,0.894) | 1.080 (0.946,1.232) | 0.964 (0.728,1.277) | 0.776 *** (0.676,0.891) | 1.074 (0.942,1.224) |
Other | 0.997 (0.610,1.628) | 1.342 * (1.062,1.695) | 1.020 (0.825,1.262) | 0.993 (0.608,1.622) | 1.354 * (1.072,1.710) | 1.031 (0.834,1.273) |
Ethnicity | ||||||
Hispanic | 1.187 (0.684,2.060) | 0.870 (0.746,1.015) | 0.959 (0.846,1.087) | 1.190 (0.686,2.064) | 0.865 (0.740,1.012) | 0.938 (0.827,1.064) |
Primary Insurance Coverage (ref. Private Insurance) | ||||||
Medicare | 1.300 (0.894,1.890) | 1.127 (0.958,1.325) | 1.134 * (1.014,1.269) | 1.296 (0.892,1.884) | 1.133 (0.962,1.334) | 1.143 * (1.026,1.273) |
Medicaid | 1.632 * (1.119,2.379) | 0.960 (0.829,1.112) | 1.144 (0.980,1.335) | 1.628 * (1.116,2.375) | 0.965 (0.832,1.119) | 1.155 (0.996,1.339) |
Dual | 1.790 ** (1.185,2.702) | 1.199 * (1.013,1.420) | 1.271 *** (1.113,1.450) | 1.787 ** (1.184,2.699) | 1.203 * (1.014,1.426) | 1.268 *** (1.114,1.443) |
Other | 1.516 * (1.011,2.272) | 0.826 (0.673,1.015) | 1.255 (0.922,1.709) | 1.513 * (1.009,2.269) | 0.826 (0.673,1.016) | 1.264 (0.925,1.728) |
Health System Characteristics | ||||||
Rural Physician Practice D | 1.092 (0.809,1.474) | 0.736 * (0.562,0.965) | 0.802 ** (0.683,0.943) | 1.090 (0.808,1.470) | 0.738 * (0.561,0.969) | 0.804 ** (0.690,0.937) |
Geographic Region (ref. Northeast) | ||||||
Midwest | 0.830 (0.587,1.174) | 0.844 (0.699,1.019) | 0.878 * (0.794,0.970) | 0.831 (0.588,1.174) | 0.842 (0.698,1.016) | 0.869 ** (0.788,0.958) |
South | 1.062 (0.688,1.640) | 0.847 (0.687,1.043) | 0.948 (0.842,1.068) | 1.064 (0.690,1.641) | 0.844 (0.686,1.039) | 0.942 (0.838,1.059) |
West | 1.162 (0.800,1.688) | 0.759 * (0.607,0.949) | 0.972 (0.852,1.109) | 1.162 (0.801,1.686) | 0.760 * (0.609,0.948) | 0.970 (0.849,1.107) |
Clinical Characteristics | ||||||
Deyo–Charlson Comorbidity Index | 0.993 (0.931,1.059) | 1.305 *** (1.254,1.359) | 1.031 * (1.003,1.061) | 0.992 (0.930,1.057) | 1.309 *** (1.258,1.362) | 1.035 * (1.006,1.065) |
Emergency Severity Index | ||||||
Level-5 (Best) | 0.921 (0.700,1.211) | 1.033 (0.909,1.173) | 0.948 (0.832,1.081) | 0.923 (0.702,1.213) | 1.029 (0.907,1.168) | 0.947 (0.831,1.078) |
Level-4 | 1.27 (0.847,1.905) | 0.146 *** (0.0930,0.231) | 0.932 (0.589,1.473) | 1.271 (0.847,1.906) | 0.146 *** (0.093,0.231) | 0.940 (0.594,1.487) |
Level-3 ‘Urgent’ (referent) | ||||||
Level-2 | 0.942 (0.733,1.210) | 2.326 *** (2.071,2.613) | 1.057 (0.925,1.209) | 0.952 (0.741,1.223) | 2.288 *** (2.037,2.569) | 1.045 (0.915,1.192) |
Level-1 (Worst) | 1.071 (0.702,1.634) | 2.006 *** (1.648,2.441) | 1.242 * (1.033,1.492) | 1.077 (0.705,1.645) | 1.997 *** (1.640,2.432) | 1.239 * (1.033,1.487) |
COVID-19 | -- | -- | -- | 0.335 * (0.124,0.903) | 3.298 *** (1.910,5.692) | 1.493 * (1.080,2.064) |
Year | 0.993 (0.941,1.049) | 1.009 (0.983,1.036) | 1.010 (0.996,1.025) | 0.996 (0.943,1.052) | 1.003 (0.977,1.030) | 1.006 (0.992,1.021) |
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Dickson, M.C.; Skrepnek, G.H. Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis. J. Clin. Med. 2024, 13, 5361. https://doi.org/10.3390/jcm13185361
Dickson MC, Skrepnek GH. Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis. Journal of Clinical Medicine. 2024; 13(18):5361. https://doi.org/10.3390/jcm13185361
Chicago/Turabian StyleDickson, Matthew C., and Grant H. Skrepnek. 2024. "Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis" Journal of Clinical Medicine 13, no. 18: 5361. https://doi.org/10.3390/jcm13185361