Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA.
Diabetes Care. 2020 May;43(5):956-963. doi: 10.2337/dc19-1486. Epub 2020 Mar 4.
Daily foot self-inspection may permit earlier detection and treatment of a foot lesion, reducing the risk of infection and lower-limb amputation (LLA). Though race and ethnicity are strongly associated with LLA risk, with higher risk seen in African Americans (AA), American Indians/Alaska Natives (AI/AN), and Native Hawaiians/Pacific Islanders (NH/PI), associations between foot self-inspection and racial and ethnic groups are inconsistent. We aimed to assess differences in foot self-inspection among people with diabetes by race/ethnicity.
Using national, cross-sectional data from the 2015-2017 Behavioral Risk Factor Surveillance System surveys and including 88,424 individuals with diabetes, we estimated prevalence ratios (PRs) and associated 95% CIs of daily foot checking for sores or irritation by racial and ethnic groups using log-binomial linear regression models, after accounting for survey weights.
Compared with whites (who had a weighted prevalence [P] of daily foot self-inspection of 57%), AA (P 67%, PR 1.18 [95% CI 1.14, 1.23]), AI/AN (P 66%, PR 1.15 [95% CI 1.07, 1.25]), and NH/PI (P 71%, PR 1.25 [95% CI 1.03, 1.52]) had higher prevalences of daily foot self-inspection. The prevalence of daily foot inspection was significantly lower among Asians (P 35%, PR 0.62 [95% CI 0.48, 0.81]) and Hispanics (P 53%, PR 0.93 [95% CI 0.88, 0.99]) compared with whites. Associations did not vary importantly by insulin use, years since diabetes diagnosis, or having received diabetes self-management education.
The higher frequency of foot self-inspection in racial and ethnic groups at elevated risk of diabetes-related LLA is not sufficient to eliminate LLA disparities; additional interventions are needed to achieve this aim.
每天进行足部自我检查可能会更早地发现和治疗足部病变，从而降低感染和下肢截肢（LLA）的风险。尽管种族和民族与 LLA 风险密切相关，非裔美国人（AA）、美洲印第安人/阿拉斯加原住民（AI/AN）和夏威夷原住民/太平洋岛民（NH/PI）的风险更高，但足部自我检查与种族和民族群体之间的关联并不一致。我们旨在评估糖尿病患者的足部自我检查在种族/民族方面的差异。
使用来自 2015-2017 年行为风险因素监测系统调查的全国性、横断面数据，包括 88424 名糖尿病患者，我们使用对数二项式线性回归模型，在考虑到调查权重后，估计了不同种族和民族群体每天检查足部是否有疮或刺激的患病率比率（PR）及其相关的 95%置信区间（CI）。
与白人（足部自我检查的加权患病率[P]为 57%）相比，AA（P67%，PR1.18[95%CI1.14,1.23]）、AI/AN（P66%，PR1.15[95%CI1.07,1.25]）和 NH/PI（P71%，PR1.25[95%CI1.03,1.52]）的足部自我检查频率更高。亚洲人（P35%，PR0.62[95%CI0.48,0.81]）和西班牙裔（P53%，PR0.93[95%CI0.88,0.99]）的足部自我检查频率明显低于白人。这些关联在胰岛素使用、糖尿病诊断年限或接受糖尿病自我管理教育方面没有显著差异。
在糖尿病相关 LLA 风险较高的种族和民族群体中，更高的足部自我检查频率不足以消除 LLA 差异；需要采取额外的干预措施来实现这一目标。
