Risk of stroke, heart attack, and diabetes complications among veterans with spinal cord injury.

OBJECTIVES

To compare the rates of diabetes and macrovascular conditions in veterans with spinal cord injury (SCI) and to examine variations by patient-level demographic, socioeconomic, access, and health status factors.

DESIGN

A retrospective analysis. Diabetes status was classified by merging with diabetes epidemiology cohort using a validated algorithm. Chi-square tests and logistic regressions used to compare rates in macro- and microvascular conditions in veterans with and without diabetes.

SETTING

Veteran Health Administration clinic users in fiscal year (FY) 1999 to FY 2001.

PARTICIPANTS

SCI patients (N=8769) with diabetes (n=1333), in FY 2000, identified through the SCI registry.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Macrovascular and microvascular conditions in the next year (February 2001). Derived from International Statistical Classification of Diseases, 9th Revision, Clinical Modification, codes in the patient treatment files.

RESULTS

Overall, 15% of SCI veterans were identified with diabetes but this was an underestimate due to high mortality (8%). Among SCI veterans with diabetes, 49% had at least one macrovascular condition and 54% had microvascular conditions compared with 24% and 25% of those without diabetes (P<.001).

CONCLUSIONS

Our study highlights the highly significant relationship between diabetes and macro- and microvascular conditions in veterans with SCI. Neurologic deficit combined with increased insulin resistance has a greater macrovascular impact on SCI veterans than on those who do not have diabetes. Increasing age and physical comorbidities compound the problem.