MORTALITY RISK OF CHARCOT ARTHROPATHY COMPARED TO DIABETIC FOOT ULCER AND DIABETES ALONE

Abstract

Objective: To compare mortality risks of patients with Charcot arthropathy to those with diabetic foot ulcer and those with diabetes alone (no ulcer or Charcot arthropathy).

Research design and methods: A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large healthcare system was compared to patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up period. Charcot arthropathy patients were matched to individuals in the other two groups using propensity score matching based on patient age, sex, race, marital status, diabetes duration, and diabetes control.

Results: During follow-up 28.07% of the sample died; 18.8% with diabetes only and 37.0% with foot ulcer died compared to 28.3% with Charcot arthropathy. Multivariable Cox regression shows that, compared with Charcot arthropathy, foot ulcer was associated with 35% higher mortality risk (HR =; 1.35; 95% CI, 1.18 – 1.54) and diabetes alone with 23% lower risk (HR = 0.77; 95% CI, 0.66 – 0.90). Of the Charcot arthropathy patients, 63% experienced foot ulceration before or after the Charcot onset. Stratified analyses suggest that Charcot arthropathy is associated with significantly increased mortality risk independent of foot ulcer and other co-morbidities.

Conclusions: Charcot arthropathy was significantly associated with higher mortality risk than diabetes alone and with lower risk than foot ulcer. Foot ulcer patients tended to have higher prevalence of peripheral vascular disease and macrovascular diseases than Charcot arthropathy patients. This may explain the difference in mortality risks between the two groups.