Diabetic foot ulcer studies show racial, rural disparities

Black patients living in rural areas face higher rates of death and amputation.
FILE: Medical treatment is often sought too late when it comes to footcare.
FILE: Medical treatment is often sought too late when it comes to footcare.(WIFR)
Published: Apr. 21, 2022 at 2:59 PM CDT
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MADISON, Wis. (WIFR) - Black patients living in rural areas face sharply increased risk of death or leg amputation due to diabetic foot ulcers, according to a new study from the University of Wisconsin School of Medicine and Public Health.

The study was published online in the Journal of the American Medical Association Network. Dr. Meghan Brennan, an assistant professor of medicine who treats people with diabetic foot ulcers, led the study. People with diabetes can suffer foot ulcers, infections and tissue death (known as gangrene), which can place them at risk of limb loss.

“We found yet another instance where a group of people are doing poorly due to disparities,’’ Brennan said. “They are undergoing major amputations at a rate that is much higher than it should be. Disparities happen in medicine and we need to recognize them before we can begin to address them.”

Brennan and her coauthors analyzed Medicare data for 124,487 patients with diabetic foot ulcers who were hospitalized in 2013 and 2014.

Researchers found that while the overall group had a 17.6% rate of major amputation or death, Black patients had a rate of 21.9%, a 4.3% disparity. Those living in rural areas had a 0.7% increase in death or amputation. The amplified effect for Black people living in rural areas was not the sum of the two (5%), but rather an increase of 10.4% in death and amputation.

“When you actually look, they have a more than 10% increased risk, doubling what we would have expected,’’ said Brennan, who said the data show how health disparities can amplify each other, a concept known as intersectionality.

She said the results could indicate weak points in the ambulatory health and triage care systems, as specialists like vascular surgeons and wound salvage teams are sparse in rural health care settings.

Brennan works with the Rural Wisconsin Health Cooperative, which represents 43 different rural health systems in the state, to design better triage tools so that patients who need to be seen by specialists can get referrals to larger hospitals, resulting in quicker access to necessary limb and life-saving care.

Dr. Meghan Brennan is a UW Health infectious disease physician whose research focuses on the management of patients with diabetic foot ulcers. She co-directs the diabetic foot ulcer clinic at the William S. Middleton Veterans Hospital in Madison. Co-authors from the University of Wisconsin School of Medicine and Public Health include Dr. Christie Bartels, Dr. Ryan Powell, Dr. Farah Kaiksow, Joseph Kramer, MA, Dr. Yao Liu, and Dr. Amy Kind.

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