Racial disparities in health care with timing to amputation following diabetic foot ulcer.
Open accessAbstract
OBJECTIVE: To examine variations in timing of lower-limb amputation (LLA) across race/ethnicity and sex among older adults with a diabetic foot ulcer (DFU). It was hypothesized Black/African Americans were more likely to have LLA post-DFU earlier compared with non-Hispanic/Whites, and more men would receive LLA earlier post-DFU compared with women. RESEARCH DESIGN AND METHODS: This was a retrospective cohort analysis of enrolled Medicare fee-for-service (FFS) beneficiaries with a diagnosis of DFU during the study period (2012-2017), allowing up to 5 years post-DFU. Final analytic sample contained 643,287 individuals; the subsample consisted of 68,633 individuals with LLA only. The primary outcome was mutually exclusive groups based on timing of LLA. Multinomial logistic regression was applied to assess likelihood of membership into a group post-DFU based on characteristics such as sex and race/ethnicity. RESULTS: Black/African American beneficiaries had 1.98 (95% CI 1.93-2.03) times the odds of receiving an LLA within 1 year of DFU diagnosis compared with non-Hispanic/White beneficiaries relative to no amputation. Female beneficiaries had increased odds (odds ratio [OR] 1.07, 95% CI 1.02-1.11] between 1 and 3 years and OR 1.08 [95% CI 1.03-1.12] in ≥3 years) of a delayed LLA compared with men among those that underwent LLA. CONCLUSIONS: Notably, these results present novel evidence on timing of LLA between racial groups and sex for Medicare FFS beneficiaries post-DFU. Results may be generalizable to individuals with Medicare FFS and DFU. Clinically more targeted, evidence-based decision making informs care decisions with opportunities to address inequities related to the social determinants of health that may lead to LLA.
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People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.
“People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.[16][17][18]”
From Diabetic Foot Ulcers (2023) · cites this paper as [16]
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Cites
The global burden of diabetic foot disease
Boulton, A. J. M., Vileikytė, L., Tennvall, G. R., & Apelqvist, J. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67698-2 · Cited by 2,578 · see citing works
Social determinants of health and diabetes: A scientific review
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2021) · Diabetes Care · doi:10.2337/dci20-0053 · Cited by 1,732 · see citing works
Health disparities and health equity: Concepts and measurement
Braveman, P. (2006) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.27.021405.102103 · Cited by 1,570 · see citing works
Amputation and Mortality in New-Onset Diabetic Foot Ulcers Stratified by Etiology
Moulik, P. K., Mtonga, R. E., & Gill, G. V. (2003) · Diabetes Care · doi:10.2337/diacare.26.2.491 · Cited by 613 · see citing works
Arya, S., Binney, Z. O., Khakharia, A., Brewster, L. P., Goodney, P. P., Patzer, R. E., Hockenberry, J. M., & Wilson, P. W. F. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.007425 · Cited by 244 · see citing works
Skrepnek, G. H., Mills, J. L., & Armstrong, D. G. (2015) · PLoS ONE · doi:10.1371/journal.pone.0134914 · Cited by 179 · see citing works
Racial disparities in the use of revascularization before leg amputation in Medicare patients
Holman, K. H., Henke, P. K., Dimick, J. B., & Birkmeyer, J. D. (2011) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2011.02.035 · Cited by 177 · see citing works
Li, P., Kim, M. M., & Doshi, J. A. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-245 · Cited by 152 · see citing works
Gender Differences in Diabetes-related Lower Extremity Amputations
Peek, M. E. (2010) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-010-1735-4 · Cited by 97 · see citing works
Curran, T., Zhang, J. Q., Lo, R. C., Fokkema, M. T. M., McCallum, J. C., Buck, D. B., Darling, J. D., & Schermerhorn, M. L. (2014) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2014.05.050 · Cited by 94 · see citing works
Tan, T., Armstrong, D. G., Concha-Moore, K. C., Marrero, D. G., Zhou, W., Calhoun, E. A., Chang, C., & Lo-Ciganic, W.-H. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001328 · Cited by 72 · see citing works
Lefebvre, K. M., & Chevan, J. (2015) · Vascular Medicine · doi:10.1177/1358863x14565373 · Cited by 69 · see citing works
Kamrad, I., Söderberg, B., Örneholm, H., & Hagberg, K. (2020) · Acta Orthopaedica · doi:10.1080/17453674.2020.1756101 · Cited by 69 · see citing works
Sutherland, B. L., Pecanac, K. E., Bartels, C. M., & Brennan, M. B. (2020) · Journal of Foot and Ankle Research · doi:10.1186/s13047-020-00395-y · Cited by 44 · see citing works
Crawford, F., Chappell, F. M., Lewsey, J., Riley, R. D., Hawkins, N., Nicolson, D., Heggie, R., Smith, M. C., Horne, M., Amanna, A. E., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24620 · Cited by 39 · see citing works
Blumberg, S. N., & Warren, S. M. (2013) · Journal of Diabetes · doi:10.1111/1753-0407.12050 · Cited by 28 · see citing works
Escarce, J. J., & McGuire, T. G. (2003) · Health Services Research · doi:10.1111/1475-6773.00178 · Cited by 28 · see citing works
The burden of health conditions across race and ethnicity for aging Americans
McGrath, R., Snih, S. A., Markides, K. S., Faul, J. D., Vincent, B. M., Hall, O. T., & Peterson, M. D. (2019) · Medicine · doi:10.1097/md.0000000000017964 · Cited by 28 · see citing works
RACIAL AND GEOGRAPHIC VARIATION IN LEG AMPUTATIONS AMONG TEXANS.
Barshes, N. R., Sharath, S., Zamani, N., Smith, K., Serag, H., & Rogers, S. O. (2018) · PubMed · Cited by 23 · see citing works
Racial Disparities in Above-knee Amputations After TKA: A National Database Study
George, J., Navale, S. M., Schiltz, N. K., Siccha, M., Klika, A. K., & Higuera, C. A. (2016) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-016-5195-3 · Cited by 17 · see citing works
Racial/ethnic Disparities in Lower Extremity Amputation Vs Revascularization: A Brief Review
Hughes, K., & Sehgal, N. J. (2018) · Journal of the National Medical Association · doi:10.1016/j.jnma.2018.02.003 · Cited by 13 · see citing works
Wittbrodt, E. T., Kong, A. M., Moore-Schiltz, L. C., & Juneau, P. L. (2017) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13145 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,658 · see citing works
Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers
McDermott, K. M., Fang, M., Boulton, A. J. M., Selvin, E., & Hicks, C. W. (2022) · Diabetes Care · doi:10.2337/dci22-0043 · Cited by 1,295 · see citing works
Wang, R., Li, B., Dong, M., Zhu, H., Jin, P., & Zou, Y. (2025) · Burns & Trauma · doi:10.1093/burnst/tkaf020 · Cited by 40 · see citing works
Gavette, H., McDonald, C. L., Kostick, K. M., Mullen, A., Najafi, B., & Finco, M. G. (2024) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1335966 · Cited by 23 · see citing works
Wang, X., Xu, M., Meng, L., Song, M., Jia, Z., Zhao, L., Han, X., Wang, S., Zong, J., & Lu, M. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102433 · Cited by 20 · see citing works
Brennan, M. B., Tan, T., Schechter, M. C., & Fayfman, M. (2023) · Seminars in Vascular Surgery · doi:10.1053/j.semvascsurg.2023.01.002 · Cited by 15 · see citing works
Racial and Ethnic Disparities in the Management of Diabetic Feet
Clayton, E. O., Njoku-Austin, C. O., Scott, D., Cain, J. D., & Hogan, M. V. (2023) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-023-09867-7 · Cited by 14 · see citing works
Clemens, S. M., Kershaw, K. N., Bursac, Z., & Lee, S. (2023) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2023.10.003 · Cited by 13 · see citing works
Huang, C., Zheng, E., Zheng, W., Zhang, H., Cheng, Y., Zhang, X., Shijo, V., Bing, R. W., Komornicki, I., Harris, L. M., et al. (2025) · Photoacoustics · doi:10.1016/j.pacs.2025.100690 · Cited by 8 · see citing works
Suzuki, H., Vaughan‐Sarrazin, M., Ohl, M., Mecham, B., McCoy, K. D., Brennan, M. B., Robbins, J. M., & Livorsi, D. J. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.6781 · Cited by 8 · see citing works
Bandeira, M. A., Macedo, R. N., Lázaro‐Martínez, J. L., García‐Álvarez, Y., Rocha, M. N. B., & Santos, V. L. C. D. G. (2024) · The International Journal of Lower Extremity Wounds · doi:10.1177/15347346241292377 · Cited by 6 · see citing works
Lv, J., Li, M., Wang, X., Zhang, L., Han, D., Hao, X., Xu, X., Xu, Y., Tang, Y., Shang, Z., et al. (2025) · Materials Today Bio · doi:10.1016/j.mtbio.2025.102366 · Cited by 6 · see citing works
Luu, I. Y.-K., Hong, A. T., Lin, F., Shin, L., Shih, C.-D., Han, S. M., Armstrong, D. G., & Tan, T. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112331 · Cited by 5 · see citing works
Prevalence of secondary prosthesis use in lower limb prosthesis users
McDonald, C. L., Kahn, A., Hafner, B. J., & Morgan, S. J. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2182919 · Cited by 5 · see citing works
Metrics of Gender Differences in Mortality Risk after Diabetic Foot Disease
Seghieri, G., Gualdani, E., Francia, P., Campesi, I., Franconi, F., Cianni, G. D., & Francesconi, P. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093288 · Cited by 5 · see citing works
Bhasin, A., Krueger, K., Williams, J. L., Gulati, R. K., Sisler, N., & Galvin, S. (2022) · Internal and Emergency Medicine · doi:10.1007/s11739-022-03166-8 · Cited by 4 · see citing works
Hashmi, M., Shiraliyeva, N., Herrera, A., Tabassum, H., Schechter, C. B., Daily, J. P., & Myers, A. K. (2025) · The Journal of Foot & Ankle Surgery · doi:10.1053/j.jfas.2025.01.017 · Cited by 4 · see citing works
Yu, C., Feng, Q., Liao, Y., Tan, M., Zhao, Y., Chen, L., Zhang, W., Lin, C., Zeng, R., Al-Smadi, F., et al. (2026) · Bioactive Materials · doi:10.1016/j.bioactmat.2026.04.009 · Cited by 3 · see citing works
Khaleel, M., Garlapaty, A. R., Hawkins, S., Cook, J. L., Schweser, K. M., & Rucinski, K. J. (2024) · Foot & Ankle Orthopaedics · doi:10.1177/24730114241281335 · Cited by 2 · see citing works
Health Disparities Across the Spectrum of Amputation Care
Gallagher, M., & Bonilla, C. (2024) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2024.06.006 · Cited by 2 · see citing works
Bramante, C. N., Rizzato, J. S., Nakamura, I. B., Galvão, T. F., & Silva, M. T. (2024) · Ethnicity & Disease · doi:10.18865/ethndis-2023-50 · Cited by 2 · see citing works
Sales, J. P., & Tablante, E. B. (2025) · Philippine journal of orthopaedics. · doi:10.69472/poai.2025.06 · Cited by 2 · see citing works
Mondríguez‐González, A., Xie, R., Esparza, R., Sheth, M., & Huang, M. E. (2025) · PM&R · doi:10.1002/pmrj.13400 · Cited by 1 · see citing works
Wang, X., Xu, M., Meng, L., Song, M., Jia, Z., Zhao, L., Han, X., Lu, M., Zong, J., & Wang, S. (2023) · Research Square · doi:10.21203/rs.3.rs-3094391/v1 · Cited by 1 · see citing works
Cardiovasculary surgical diseases
Bayramov, N., Ibrahimova, A., Teymurov, E., Suleymanova, N., Mahmudov, M., Huseynova, M., Isazade, E., Gahramanova, F. A., Mammadova, S., Imanov, G., et al. (2023) · doi:10.25045/k.nurubay.kvc
Disrupting the Racial and Ethnic Disparity in Diabetes: New Treatments and Solutions
Cole, W., Davis, I., Bae, S.-H. S., Norwood, C., & Hurwitz, P. (2024) · Journal of Diabetes and Treatment · doi:10.29011/2574-7568.010126
Robling, K., McPherson, K., Nolan, D., Greiner, B. H., & Hartwell, M. L. (2025) · Primary Health Care Research & Development · doi:10.1017/s1463423624000392 · Cited by 1 · see citing works
Ratliff, C. R., & Rovnyak, V. G. (2025) · Journal of Vascular Nursing · doi:10.1016/j.jvn.2025.08.005
Health literacy, patient adherence and digital health technology in diabetic foot ulcer management
Xie, M. H., Jain, S., Cluck, M., Panchamukhi, A. V., Cauthen, L. A., Ruiz, I. P. T., Poythress, E. L., & Fukuta, Y. (2025) · Journal of Lower Limb Wound Care · doi:10.12968/llwc.2025.0006
Racial and microvascular determinants of progression to treatment-warranted diabetic eye disease
Hong, A. T., Luu, I. Y.-K., Tan, T., & Toy, B. C. (2026) · Eye · doi:10.1038/s41433-026-04417-0
Welsh, A. M., Smith, J., Lehrer, H. M., Montero‐Zamora, P., Dubois, S. K., Harrison, L., Tanaka, H., & Steinhardt, M. A. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108366
Racial/ethnic inequities in diabetes mellitus: a narrative review
Mazhude, T., Fanas, R. L., & Myers, A. K. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag277
Dong, Q., Xiong, S., Shu, B., Cai, Z., Wang, S. N., Yang, M. R., Dong, X., Chen, P., & Zhang, Z. (2026) · Regenerative Biomaterials · doi:10.1093/rb/rbag153
Rodio, L. A., Good, L., Rodgers, N. J., Hirpara, A., Florentino, S. A., Berk, A. N., Farrell, N. D., Jonard, B. W., & Napora, J. K. (2026) · Journal of Surgical Research · doi:10.1016/j.jss.2026.09.007
Non-Biomedical Factors in Diabetic Foot Prevention in Ulcer-Free Patients: A Delphi Consensus Study
Fernández-Torres, R., Martinez-Barrios, F.-J., Rodríguez-Pérez, L. I., Amores-Ternero, Á., & Ruiz‐Muñoz, M. (2026) · Diabetology · doi:10.3390/diabetology7100196
Association of Referring Specialty With Limb Loss in Chronic Limb-Threatening Ischemia
Khan, N., Pelit, W., Kelly, B., Blecha, M. J., & Soult, M. C. (2026) · Vascular and Endovascular Surgery · doi:10.1177/15385744261494483
时瀛洲, Xue, T., Ma, L., Zou, L., 李可心, Wu, Y., Zhou, Q., Yu, Y., Jiang, X., Li, L., et al. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1983798
- Authors
- Miller, T. A., Campbell, J. H., Bloom, N., & Wurdeman, S. R.
- Affiliations
- University of Pittsburgh (US)
- 1Hanger Institute for Clinical Research and Education, Austin, TX
- 3CareJourney, Arlington, VA
- Corresponding author
- Wurdeman, Shane R.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-09-19
- Volume
- 45
- Issue
- 10
- Pages
- 2336-2341
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC9862414
- OpenAlex
- W4295014114
- Cited by
- 37
- References
- 22
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 6 · 2023: 9 · 2022: 2
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Orthotic and Prosthetic Association
- 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 › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- diabetic foot ulcer, lower limb amputation, racial disparities, sex differences, Black patients, Medicare beneficiaries, older adults, social determinants of health, health care inequities
- MeSH terms
- Aged, Amputation, Surgical, Diabetes Mellitus, Female, Medicare, Humans, Male, Retrospective Studies, United States, Diabetic Foot, Healthcare Disparities
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