September 2015

Annual emergency care for DFUs tops $8B, complications plague rural poor

In the moment: Diabetes

By Emily Delzell

Diabetic foot ulcers (DFUs) cost $8.78 billion per year in emergency department (ED) care and subsequent inpatient admissions, with the rural poor at particularly high risk for serious complications, according to research from the Southern Arizona Limb Salvage Alliance at the University of Arizona in Tucson.

The investigators used Agen­cy for Healthcare Research and Quality data on healthcare costs from 2006-2010 ED discharge records of 1,019,861 patients (mean age 62.5 years, 40.6% women) with any DFU diagnosis. They conducted multivariable analyses for clinical outcomes of patient dispositions from the ED (81.2% were admitted), demographic and socioeconomic characteristics, and comorbidities.

Rural residence was associated with higher adjusted odds of major amputation (+51.3%), minor amputation (+14.9%), and inpatient death (+41.4%). Investigators also observed independently increased odds of major amputation among Medicaid recipi- ents (+21.1% versus Medicare) and the lowest income quartile regions (+38.5% versus highest quartile regions). PLOS One epublished the results on August 6.

The authors suggested improved systems for screening, prevention, and coordinated care of diabetic foot problems could lower ED related costs.


Skrepnek GH, Mills JL, Armstrong DG. A diabetic emergency one million feet long: disparities and burdens of illness among diabetic foot ulcer cases within emergency departments in the United States, 2006–2010. PLOS One 2015;10(8):e0134914.

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