Division of General Surgery, Memorial Healthcare System, Pembroke Pines, FL.
University of Arizona, Tucson, AZ.
Semin Vasc Surg. 2023 Mar;36(1):84-89. doi: 10.1053/j.semvascsurg.2023.01.001. Epub 2023 Jan 6.
The objective of this study was to assess the overall differences in the standard of preventive foot care for patients at risk of diabetic foot ulceration and to identify specific demographic factors affecting these health care practices, including race and ethnicity. The National Health and Nutrition Examination Survey data for 2011 to 2018 were analyzed. Participants (20 years and older) with diabetes were categorized as White, Black, Hispanic, Asian, and others (including multiracial participants) based on self-reported race and ethnicity. The primary outcome was foot examination over the past year administered by a medical professional. Logistic regression was performed to examine the effects of race and ethnicity on the annual diabetic foot examination, controlling for age (65 years and older), gender, and health insurance status. Among the 2,836 participants included in the study (weighted percentage: 61.1% were White, 13.9% were Black, 15.1% were Hispanic, 5.4% were Asian, and 4.5% were other), 2,018 (weighted percentage: 71.6%) received annual diabetic foot examination over the past year. Hispanic participants (adjusted odds ratio [aOR] = 0.685; 95% CI, 0.52-0.90) were significantly less likely than White participants to receive an annual foot examination (Black participants: aOR = 1.11; 95% CI, 0.83-1.49; Asian participants: aOR = 0.80; 95% CI, 0.60-1.07; other participants: aOR = 0.66; 95% CI, 0.40-1.10). Factors associated with receipt of foot examination were age 65 years or older (aOR = 1.42; 95% CI, 1.05-1.92) and having health insurance (aOR = 3.02; 95% CI, 2.27-4.03). Our findings suggest that Hispanic adults with diabetes are receiving disproportionately lower rates of preventive foot care compared with their White counterparts. This significant variation in the standard of care for individuals with diabetes reflects the need to further identify factors driving the disparities in preventive foot care services among racial and ethnic minority groups.
本研究旨在评估有发生糖尿病足溃疡风险的患者在预防足部护理方面的总体标准差异，并确定影响这些医疗保健实践的具体人口统计学因素，包括种族和民族。对 2011 年至 2018 年的国家健康和营养检查调查数据进行了分析。根据自我报告的种族和民族，将 20 岁及以上患有糖尿病的参与者分为白人、黑人、西班牙裔、亚洲人和其他（包括多种族参与者）。主要结果是过去一年中由医疗专业人员进行的足部检查。使用逻辑回归检查种族和民族对每年糖尿病足检查的影响，同时控制年龄（65 岁及以上）、性别和医疗保险状况。在研究纳入的 2836 名参与者中（加权百分比：61.1%为白人，13.9%为黑人，15.1%为西班牙裔，5.4%为亚洲人，4.5%为其他），2018 名（加权百分比：71.6%）参与者在过去一年中接受了年度糖尿病足检查。与白人参与者相比，西班牙裔参与者（调整后的优势比[aOR] = 0.685；95%CI，0.52-0.90）接受年度足部检查的可能性明显较低（黑人参与者：aOR = 1.11；95%CI，0.83-1.49；亚洲参与者：aOR = 0.80；95%CI，0.60-1.07；其他参与者：aOR = 0.66；95%CI，0.40-1.10）。与接受足部检查相关的因素包括 65 岁或以上年龄（aOR = 1.42；95%CI，1.05-1.92）和拥有医疗保险（aOR = 3.02；95%CI，2.27-4.03）。我们的研究结果表明，与白人相比，患有糖尿病的西班牙裔成年人接受的预防足部护理比例明显较低。这种对糖尿病患者护理标准的显著差异反映了需要进一步确定导致少数族裔群体在预防足部护理服务方面存在差异的因素。
