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Disparities in outcomes of patients admitted with diabetic foot infections.
Open accessAbstract
OBJECTIVE: The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs). RESEARCH DESIGN AND METHODS: The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS). Incidence for amputation and open or endovascular revascularization were evaluated over the study period. Multivariable regression analyses were performed to assess the association between race/ethnicity and outcomes. RESULTS: There were 150,701 admissions for DFI, including 98,361 Whites, 24,583 AAs, 24,472 Hispanics, and 1,654 Native Americans (NAs) in the study cohort. Overall, 45,278 (30%) underwent a minor amputation, 9,039 (6%) underwent a major amputation, 3,151 underwent an open bypass, and 8,689 had an endovascular procedure. There was a decreasing incidence in major amputations and an increasing incidence of minor amputations over the study period (P < .05). The risks for major amputation were significantly higher (all p<0.05) for AA (OR 1.4, 95%CI 1.4,1.5), Hispanic (OR 1.3, 95%CI 1.3,1.4), and NA (OR 1.5, 95%CI 1.2,1.8) patients with DFIs compared to White patients. Hispanics (OR 1.3, 95%CI 1.2,1.5) and AAs (OR 1.2, 95%CI 1.1,1.4) were more likely to receive endovascular intervention or open bypass than Whites (all p<0.05). NA patients with DFI were less likely to receive a revascularization procedure (OR 0.6, 95%CI 0.3, 0.9, p = 0.03) than Whites. The mean hospital length of stay (LOS) was significantly longer for AAs (9.2 days) and Hispanics (8.6 days) with DFIs compared to Whites (8.1 days, p<0.001). CONCLUSION: Despite a consistent incidence reduction of amputation over the past decade, racial and ethnic minorities including African American, Hispanic, and Native American patients admitted to hospitals with DFIs have a consistently significantly higher risk of major amputation and longer hospital length of stay than their White counterparts. Native Americans were less likely to receive revascularization procedures compared to other minorities despite exhibiting an elevated risk of an amputation. Further study is required to address and limit racial and ethnic disparities and to further promote equity in the treatment and outcomes of these at-risk patients.
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“The diagnosis of diabetic foot infection is primarily based on clinical assessment and is suggested by presence of more than 2 signs of inflammation, such as erythema, swelling and possibly purulence, fluctuance, or lymphangiitis.7,13”
From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [13]
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“Randomized clinical trial data are not available to support obtaining wound cultures from all patients with diabetic foot ulcers.7,13”
From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [13]
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“For diagnosing osteomyelitis, bone biopsy and culture remain the gold standard.7,13”
From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [13]
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Metadata
- Authors
- Tan, T.-W., Shih, C.-D., Concha-Moore, K. C., Diri, M. M., Hu, B., Marrero, D., Zhou, W., & Armstrong, D. G.
- Affiliations
- University of Arizona (US)
- University of Southern California (US)
- Cleveland Clinic (US)
- Corresponding author
- Tan, Tze-Woei
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-02-04
- Volume
- 14
- Issue
- 2
- Pages
- e0211481
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6361439
- OpenAlex
- W2913555931
- Cited by
- 111
- References
- 37
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 27 · 2023: 22 · 2022: 14 · 2021: 11 · 2020: 18 · 2019: 2
- FWCI
- 9.13
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-04-11)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UA Campus Repository (The University of Arizona) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111022)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Infectious Diseases › Streptococcal Infections and Treatments
- Keywords
- diabetic foot infection, racial disparities, ethnic disparities, amputation, major amputation, minor amputation, revascularization, endovascular intervention, length of hospital stay, African American patients, Hispanic patients, Native American patients, hospital admission outcomes, health care access disparities, health care quality disparities
- MeSH terms
- Amputation, Surgical, Ethnicity, Female, Hospitalization, Humans, Male, Middle Aged, Prognosis, Cohort Studies, Treatment Outcome, Diabetic Foot, Racial Groups, Healthcare Disparities, Endovascular Procedures
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