Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations
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Aims The purpose of this study was to identify the presence or absence of geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers (DFU) and lower extremity amputations (LEA).Methods Diabetic beneficiaries with foot ulcers (n=682,887) and lower extremity amputations (n=151,752) were enrolled in Medicare Parts A and B during the calendar year 2007. We used ordinary least squares (OLS) regression to explain geographic variation in per capita Medicare spending and one-year mortality rates.Results Health care spending and mortality rates varied considerably across the nation for our two patient cohorts. However, higher spending was not associated with a statistically significant reduction in one-year patient mortality (P=.12 for DFU, P=.20 for LEA). Macrovascular complications for amputees were more common in parts of the country with higher mortality rates (P<.001), but this association was not observed for our foot ulcer cohort (P=.12). In contrast, macrovascular complications were associated with increased per capita spending for beneficiaries with foot ulcers (P=.01). Rates of hospital admission were also associated with higher per capita spending and increased mortality rates for individuals with foot ulcers (P<.001 for health spending and mortality) and lower extremity amputations (P<.001 for health spending, P=.01 for mortality).Conclusions Geographic variation in Medicare spending and mortality rates for diabetic patients with foot ulcers and amputations is associated with regional differences in the utilization of inpatient services and the prevalence of macrovascular complications.
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The 5-year mortality rate for patients with diabetic-related amputations is about 50%.
“In addition, the 5-year mortality rate for patients with diabetic-related amputations is about 50% (13).”
From Wound repair and regeneration: Mechanisms, signaling, and translation (2014) · cites this paper as [13]
The 5-year mortality rate for patients with diabetic foot ulcers or ischemic ulcers is much higher than that of prostate or breast cancer.
“Although not an immediately obvious concept, the 5-year mortality rate for patients suffering from DFU or ischemic ulcers is much higher than that of prostate or breast cancer (11-13).”
From Wound repair and regeneration: Mechanisms, signaling, and translation (2014) · cites this paper as [13]
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- Authors
- Sargen, M. R., Hoffstad, O., & Margolis, D. J.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Sargen, Michael R.
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 27
- Issue
- 2
- Pages
- 128-133
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- PMC
- PMC3673572
- OpenAlex
- W2021527262
- Cited by
- 93
- References
- 34
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 19 · 2020: 9 · 2019: 10 · 2018: 11 · 2017: 5 · 2016: 8 · 2015: 2 · 2014: 5 · 2013: 1 · 2012: 1
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR02212, K24AR002212)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- diabetic foot ulcer, lower limb amputation, regional variation, Medicare spending, mortality, macrovascular complications, hospitalization, health care utilization, diabetes mellitus
- MeSH terms
- Aged, Aged, 80 and over, Amputation, Surgical, Costs and Cost Analysis, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Hospitalization, Humans, Male, United States, Cohort Studies, Prevalence, Least-Squares Analysis, Medicare Part A, Medicare Part B, Health Care Costs, Diabetic Foot, Microvessels
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