Do veterans with spinal cord injury and diabetes have greater risk of macrovascular complications? Ranjana Banerjea, PhD 1, Usha Sambamoorthi, PhD 1,2,3, Frances Weaver, PhD 4, Miriam Maney, MS 1, Leonard Pogach, MD, MBA 1,5,Tom Findley, MD, PhD 1 1 HSR&D Center for Health Care Knowledge and Management Department of Veteran Affairs, East Orange, NJ, 2 Division of Health Systems and Policy, School of Public Health, UMDNJ, NJ, 3 Institute for Health, Health Care Policy, and Aging Research, Rutgers University, NJ, 4 Midwest Center for health services & Policy Research (151H), VA hospital, Hines, IL Chi-square tests and multiple logistic regressions were used to analyze adjusted and unadjusted subgroup differences among diabetes and non-diabetes patients with SCI and their rates of macrovascular conditions Our study highlights the highly significant relationship between diabetes and macrovascular conditions in veterans with SCI. Neurological deficit combined with increased insulin resistance has a greater macrovascular impact on SCI veterans than those who do not have diabetes. Increasing age and physical comorbidites compound the problem. BACKGROUND OBJECTIVES RESULTS CONCLUSION STATISTICAL ANALYSIS The number of people in the United States living with spinal cord injury (SCI) is estimated to range between 222,000 to 285,000 (National SCI Database, 2004). Nearly one in five (44,000) are veterans who are eligible for Department of Veterans Affairs (VHA) medical care. The VHA has the largest single network of SCI care in the nation and provided medical care to 22,800 veterans with SCI and disorders (SCI/D) in 2004 (VA 2005). SCI patients have been reported to have a higher risk for insulin resistance, atherogenic lipid profile, and metabolic syndrome, (precursors of diabetes and macrovascular disease). Compare the rates of macrovascular conditions in veterans with Spinal Cord Injury (SCI) in patients with and without diabetes and examine the variation by patient-level demographic, socioeconomic, access to care and health status factors Overall, 16% (n = 2,531) of SCI veterans were identified with diabetes in FY Among SCI veterans with diabetes 25.6% had at least one macrovascular condition (MVC) while only 13.3% of those without diabetes had it (p <.0001). After controlling for other characteristics, those with diabetes were 1.5 times as likely as those without diabetes to have a MVC during FY In every subgroup (gender, age, race, income, rural and comorbidities), those with diabetes had higher rates of MVC than those without diabetes (p<.01, chi-sq significant). The likelihood of any macrovascular conditions increased with age, with those ages 75 years and older were 5.4 times as likely as those under 50 years old to have any macrovascular conditions. Fig. 2: Rates of Macrovascular Condition By Duration of SCI Adjusted Odds Ratios for Age, Other Comorbidities & Substance Abuse Fig. 2: Rates of Diabetes in SCI Veterans By SCI Status Fig. 1: Age Distribution in Patients By Diabetes who are Alive STUDY DESIGN & SAMPLE MEASURES Retrospective longitudinal analysis of merged Veteran Health Administration (VHA) and Spinal Cord Disorders (SCD) Registry in FY 1999 and 2000 Sample: N=15,703 VHA patients who utilize the VHA health care system: inpatient or face-to face outpatient episodes in FY 1999 with macrovascular outcomes in 2000 (excludes persons who have multiple-sclerosis or are erroneously coded as SCI) SCI Condition: A definite diagnosis of SCI condition was identified using the Registry (before Sept1999 & alive till 2000-end) Diabetes: Identified through the Diabetes Epidemiology Cohort (DepiC) a multi-year, dynamic cohort of individuals with diabetes. Dependant variable: Macrovascular Conditions: Includes: stroke, congestive heart failure, ischemic heart disease, transient ischemic attack, peripheral vascular disease and chronic pulmonary disease (identified by ICD-9 codes in the VHA inpatient and outpatient files in the year 2000). Independent variables: Demographic variables like gender, age, race, marital status, urbanicity and means (income, copay). Physical and mental comorbidities and substance abuse SCI status (tetraplegia, paraplegia) Duration of SCI (recent to >20 yrs) Fig 3: Rates of Macrovascular Condition By Diabetes Table 1: Description of Veteran Clinic Users with Spinal Cord Injury FY Those dead (in FY1999 & 2000) have Those with SCI status='Not applicable' have been removed from analysis. & Means measures the level of benefits indicated by incomes & disability status. # Selim index: based on ICD-9 diagnostic codes