Hanger Institute for Clinical Research and Education, Austin, TX.
School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA.
Diabetes Care. 2022 Oct 1;45(10):2336-2341. doi: 10.2337/dc21-2693.
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.
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.
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.
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.
研究在患有糖尿病足溃疡（DFU）的老年患者中，下肢截肢（LLA）的时机在种族/民族和性别上的差异。假设黑人/非裔美国人在 DFU 后接受 LLA 的时间比非西班牙裔/白人更早，而且男性在 DFU 后更早接受 LLA 的可能性更大。
这是一项对参加研究期间（2012-2017 年）医疗保险费用分担（FFS）受益人的回顾性队列分析，允许在 DFU 后最多 5 年进行分析。最终分析样本包含 643287 人；亚组由仅接受 LLA 的 68633 人组成。主要结果是基于 LLA 时机的互斥组。应用多项逻辑回归评估基于性别和种族/民族等特征在 DFU 后成为某个组别的可能性。
与未接受截肢的非西班牙裔/白人受益相比，黑人/非裔美国人受益在 DFU 诊断后 1 年内接受 LLA 的可能性高出 1.98 倍（95% CI 1.93-2.03）。与男性相比，女性受益在 1 至 3 年（优势比[OR]1.07，95% CI 1.02-1.11）和≥3 年（OR 1.08，95% CI 1.03-1.12）接受 LLA 的可能性更高。
值得注意的是，这些结果为 Medicare FFS 受益在 DFU 后，根据种族群体和性别之间的 LLA 时机提供了新的证据。结果可能适用于具有 Medicare FFS 和 DFU 的个体。临床上更有针对性、基于证据的决策为护理决策提供信息，并有机会解决与健康的社会决定因素相关的不平等问题，这些问题可能导致 LLA。
