Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors Among Patients Using Veterans Health Administration Services From 2008 to 2018

Abstract Context There is evidence that diabetes-related complications are declining but most data sources have limitations. Objective To characterize temporal changes in incidence rates (IRs) of chronic complications and mortality in well-characterized, community-based Australians. Design Longitudinal observational study. Setting Urban population. Participants Participants with type 2 diabetes from the Fremantle Diabetes Study phases I (FDS1; n = 1291 recruited 1993-1996) and II (FDS2; n = 1509 recruited 2008-2011) age-, sex,- and ZIP code-matched 1:4 to people without diabetes. Main outcome measures First hospitalizations for/with myocardial infarction (MI), stroke, heart failure (HF), lower extremity amputation, and cardiovascular disease (CVD) and all-cause mortality. Five-year IRs, IR ratios for those with versus without diabetes in FDS1 and FDS2, and IR differences (IRDs), were calculated. Results The 13,995 participants had a mean age of 64.8 years and 50.4% were males. There were lower IR ratios for MI, stroke, HF, and CVD death in FDS2 versus FDS1. IRDs for people with versus without type 2 diabetes had reduced by >50% between phases for MI, stroke, HF, lower extremity amputation, and CVD death, with no change in IRD for all-cause mortality. Within the pooled type 2 diabetes cohort, FDS2 versus FDS1 participation was an independent inverse predictor of stroke, HF, CVD death, and all-cause mortality after adjustment in Cox proportional hazards models. Conclusions Cardiovascular outcomes in Australians have improved since the 1990s, especially in type 2 diabetes. The difference in all-cause mortality between those with and without type 2 diabetes has persisted despite longer survival.

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Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: A 6.5-year follow-up study in Taiwan

Atherosclerosis ◽

10.1016/j.atherosclerosis.2007.02.011 ◽

2008 ◽

Vol 197 (1) ◽

pp. 111-117 ◽

Cited By ~ 21

Author(s):

Chin-Hsiao Tseng ◽

Choon-Khim Chong ◽

Ching-Ping Tseng ◽

Ju-Chien Cheng ◽

May-Kuen Wong ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Causes Of Death ◽

Lower Extremity Amputation ◽

Diabetic Patients ◽

Follow Up Study ◽

Mortality Causes ◽

Associated Risk Factors ◽

Extremity Amputation

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Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study

Diabetes ◽

10.2337/diabetes.42.6.876 ◽

1993 ◽

Vol 42 (6) ◽

pp. 876-882 ◽

Cited By ~ 31

Author(s):

J. S. Lee ◽

M. Lu ◽

V. S. Lee ◽

D. Russell ◽

C. Bahr ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Lower Extremity Amputation ◽

Incidence Risk ◽

Extremity Amputation

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Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

Military Medicine ◽

10.1093/milmed/usaa469 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 651-658

Author(s):

Kath M Bogie ◽

Steven K Roggenkamp ◽

Ningzhou Zeng ◽

Jacinta M Seton ◽

Katelyn R Schwartz ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

User Interface ◽

Veterans Health Administration ◽

Study Cohort ◽

Veterans Health ◽

Health Administration ◽

Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

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Lower Extremity Amputation Risk Factors Associated With Elevated Ankle Brachial Indices and Radiographic Arterial Calcification

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2014.12.022 ◽

2015 ◽

Vol 54 (3) ◽

pp. 473-477 ◽

Cited By ~ 17

Author(s):

Eric Lew ◽

Nicole Nicolosi ◽

Georgeanne Botek

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Lower Extremity Amputation ◽

Arterial Calcification ◽

Factors Associated ◽

Extremity Amputation

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Testing practices and incidence of chlamydial and gonococcal infection in the Veterans Health Administration, 2009-2019

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1454 ◽

2020 ◽

Author(s):

Lauren A Beste ◽

Marissa M Maier ◽

Joleen Borgerding ◽

Elliott Lowy ◽

Ronald G Hauser ◽

...

Keyword(s):

Risk Groups ◽

Veterans Health Administration ◽

The United States ◽

Incidence Rates ◽

Veterans Health ◽

Health Administration ◽

Hiv Status ◽

Demographic Group ◽

Immunodeficiency Virus ◽

Testing Practices

Abstract Background Chlamydia trachomatis and Neisseria gonorrhoeae cases reached a record high in the United States in 2018. Although active duty military servicemembers have high rates of chlamydia and gonorrhea infection, trends in chlamydia and gonorrhea in the Veterans Health Administration (VHA) system have not been previously described, including among patients with human immunodeficiency virus (HIV) and young women. Methods We identified all Veterans in VHA care from 2009-2019. Tests and cases of chlamydia and gonorrhea were defined based on lab results in the electronic health record. Chlamydia and gonorrhea incidence rates were calculated each year by demographic group and HIV status. Results In 2019, testing for chlamydia and gonorrhea occurred in 2.3% of patients, 22.6% of women ages 18-24, and 34.1% of persons with HIV. 2019 incidence of chlamydia and gonorrhea was 100.8 and 56.3 cases per 100,000 VHA users, an increase of 267% and 294%, respectively, since 2009. Veterans aged <34 years accounted for 9.5% of the VHA population but 66.9% of chlamydia and 42.9% of gonorrhea cases. Chlamydia and gonorrhea incidence rates in persons with HIV were 1,432 and 1,687 per 100,000, respectively. Conclusions The incidence of chlamydia and gonorrhea rose dramatically from 2009-2019. Among tested persons, those with HIV had a 15.2-fold higher unadjusted incidence of chlamydia and 34.9-fold higher unadjusted incidence of gonorrhea compared to those without HIV. VHA-wide adherence to chlamydia and gonorrhea testing in high-risk groups merits improvement.

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1164. County-Level Geographic Distribution of Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae Across Outpatient Settings of the Veterans Health Administration, 2000–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.997 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S350-S351

Author(s):

Michihiko Goto ◽

Rajeshwari Nair ◽

Daniel Livorsi ◽

Marin Schweizer ◽

Michael Ohl ◽

...

Keyword(s):

United States ◽

Veterans Health Administration ◽

The United States ◽

Incidence Rates ◽

County Level ◽

Veterans Health ◽

Health Administration ◽

Geographic Variability ◽

Extended Spectrum ◽

Outpatient Settings

Abstract Background Extended-spectrum cephalosporin resistance (ESCR) among Enterobacteriaceae has emerged globally over the last two decades, with increased prevalence in the community. Data from European countries and healthcare-associated isolates in the United States have demonstrated substantial geographic variability in the prevalence of ESCR, but community-onset isolates in the United States have been less studied. We aimed to describe geographic distribution and spread of ESCR among outpatient settings across the Veterans Health Administration (VHA) over 18 years. Methods We analyzed a retrospective cohort of all patients who had any positive clinical culture specimen for ESCR Enterobacteriaceae collected in an outpatient setting; ESCR was defined by phenotypic nonsusceptibility to at least one extended-spectrum cephalosporin agent or detection of an extended-spectrum β-lactamase. Patient-level data were grouped by county of residence, and the total number of unique patients who received care within VHA for each county was used as a denominator. We aggregated data by time terciles (2000–2005, 2006–2011, and 2012–2017), and overall and county-level incidence rates were calculated as the number of unique patients in each year with ESCR Enterobacteriaceae per person-year. Results During the study period, there were 1,980,095 positive cultures for Enterobacteriaceae from 870,797 unique patients across outpatient settings of VHA, from a total of 107,404,504 person-years. Among those, 136,185 cultures (6.9%) from 75,500 unique patients (8.7%) were ESCR. The overall incidence rate was 9.0 cases per 10,000 person-years, which increased from 6.3 per 10,000 person-years in 2000 to 14.6 per 10,000 person-years in 2017. County-level incidence rates ranged widely but increased overall (interquartile range [IQR] in 2000–2005: 0–6.7; 2006–2011: 0–9.1; 2012–2017: 3.1–14.3 per 10,000 person-years), with some geographic clustering (figure). Conclusion This study demonstrates that there has been geographic variation both in incidence rates and trends of ESCR Enterobacteriaceae in outpatient settings of VHA, which suggests the importance of tailoring local antibiotic-prescribing guidelines incorporating geographic variability in epidemiology. Disclosures M. Ohl, Gilead Sciences, Inc.: Grant Investigator, Research grant.

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