Impact of Social Determinants of Health on Charcot Neuroarthropathy: A Retrospective Chart Review

Abstract

Background: Charcot neuroarthropathy (CN) is a destructive condition, commonly affecting the foot, and manifests secondary to diabetes mellitus. We compare basic demographics and investigate trends among patients with CN treated at a large, quaternary academic medical center according to surgical procedure, attendance at physical therapy (PT), and all-cause mortality.Methods: Following IRB approval, a database was created using CPT and ICD-10 codes to encapsulate patients with CN of the lower extremity who underwent amputation, exostectomy, and/or arthrodesis at a single institution over a 22-year period. Demographics, number of PT appointments, and all-cause mortality were recorded. Descriptive statistics, chi-square tests of independence and logistic regression were conducted.Results: A total of 1671 patients were identified -248 of whom had documented PT appointments with 735 (44%) female patients, 1,499 (90%) identified as white, 131 (7%) had Medicaid insurance, and patients attending PT resided in 20 different counties. The relationships between PT attendance versus county of residence (p = 0.035), insurance status versus mortality (p = 0.039), and type of procedure versus PT (p = 0.032), demonstrated statistically significant differences. Lastly, a logistic regression model predicted that as the number of PT appointments increased, mortality decreased with 84% accuracy. Conclusion:CN is a progressive, degenerative disease that impairs quality of life. Disease progression harbors a complication profile that may be influenced by socioeconomic factors. Access to a hospital equipped with PT infrastructure is essential and affects outcomes associated with CN through facilitation of gait restoration, foot off-loading education, and wound care -which can lead to an increase in survivorship.