Visual Abstract
Background: Black, rural, and disadvantaged neighborhood populations are at increased risk of major amputations due to diabetic foot ulcers (DFU). We aimed to determine how the intersection of these health disparity factors is tied to outcomes.
Methods: We built a retrospective cohort of 124,487 patients hospitalized with DFU in 2014 with the 100% national Original Medicare population. We used logistic regression and marginal modeling to estimate 30-day composite major amputation/death rates, controlling for other sociodemographics and comorbidities, with interaction terms between the three disparity factors of focus.
Results: The predicted rate of major amputation or death for black patients was 19.6% (95% CI 19.0-20.2), compared to 17.3% (17.1-17.6) for white patients, and 17.6% overall. Those living in a disadvantaged neighborhood had a predicated rate of 18.6% (18.1-19.1), compared to 17.4% (17.1-17.6) for those living in a non-disadvantaged neighborhood. Small town residence predicted a 20.2% (19.2-21.1) rate, compared to 16.9% (16.7-17.2) for urban residence. The predicted rate for black patients living in disadvantaged, small towns was 24.2% (20.6-27.8, Figure), with a significant interaction between black race and small town (OR 1.59, p<0.001).
Conclusion: Black patients in small towns face high risk of major amputation or death. Such disparities call for new intervention strategies.
M. Brennan: None. J. Kramer: None. W. Powell: None. A. J. H. Kind: None. C. M. Bartels: Research Support; Self; Pfizer Foundation.
Agency for Healthcare Research and Quality (K08HS02679); National Institute of Diabetes and Digestive and Kidney Diseases; National Institute on Aging (RF1AG057784); National Institute on Minority Health and Health Disparities (R01MD010243)
