Disparities in Preventative Diabetic Foot Examination

Elsevier

Available online 6 January 2023

Seminars in Vascular SurgeryAuthor links open overlay panelAbstractObjective

The objective of this study is 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 healthcare practices including race and ethnicity.

Methods

The National Health and Nutrition Examination Survey (NHANES) data for the years 2011 to 2018 were analyzed. Participants (aged ≥ 20) with diabetes were categorized into White, Black, Hispanic, Asian, and others (including multiracial participants) based on self-reported race/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/ethnicity on the annual diabetic foot examination, controlling for age (≥ 65 years), gender, and health insurance.

Results

Among the 2,836 participants included in the study (weighted percentage 61.1% Whites, 13.9% Blacks, 15.1% Hispanics, 5.4% Asians, and 4.5% others), 2,018 (weighted percentage 71.6%) received annual diabetic foot examination over the past year. Hispanics (aOR 0.685, 95% CI 0.52-0.90) were significantly less likely than Whites to receive annual foot examination (Blacks: aOR 1.11, 95% CI 0.83-1.49; Asian: aOR 0.80, 95% CI 0.60-1.07; Others: 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).

Conclusions

Our findings suggest that Hispanics with diabetes are receiving disproportionately lower rates of preventive foot care as compared to their White counterparts. This significant variation in the standard of care for patients with diabetes reflects the need to further identify factors driving the disparities in preventive foot care services among minority groups.

Section snippetsVisual Abstract

Disparities in Preventive Diabetic Foot ExaminationRetrospective cross-sectional study
National Health and Nutrition Examination Survey (NHANES) data (2011-2018)ObjectiveResultsConclusionAssess differences in the standard of preventative foot care (examination by a medical professional) in persons with diabetes

Age ≥65 years and health insurance are associated with receipt of foot examination

Hispanic adults with diabetes are less likely to receive annual foot

Study Cohort

This is a retrospective cross-sectional study of questionnaire data from participants found within the National Health and Nutrition Examination Survey (NHANES) for the years 2011 through 2018 (www.cdc.gov/nchs/nhanes/index.htm). NHANES is a study program conducted in the United States that evaluates the health status of its participants with the goal of identifying the prevalence of chronic diseases and their associated risk factors.12 The NHANES program utilizes “a complex, multistage

Results

The study cohort comprised of 2,836 participants aged 20 years or older with a diagnosis of diabetes. There were 924 Whites, 761 Hispanics, 739 Blacks, 306 Asians, and 106 Others (weighted percentages 61.1%, 15.1%, 13.9%, 5.4%, and 4.5%, respectively). One thousand two hundred and eighty-five participants were 65 years or older (weighted percentage 40.6%), 1,355 were female (weighted percentage 48.4%), and 322 had no health insurance (weighted percentage 9.3%) (Table 1).

Overall, 2,018

Discussion

Using a national representative sample (NHANES data set), this study indicates that there are ethnic differences present in obtaining diabetes preventative care in terms of receiving an annual diabetic comprehensive foot examination. Compared to their White counterparts, Hispanics with diabetes were less likely to receive an indicated foot examinations by their healthcare professional. Our study also found that those who were 65 years or older and those who had health insurance were more likely

Conclusion

Our findings suggest that Hispanics with diabetes are receiving disproportionately lower rates of healthcare professional administered foot care as compared to their White counterparts. This significant variation in the standard of care for minority patients with diabetes reflects the need to further identify potential factors in association between racial/ethnic disparities, socioeconomic status, and delivery of preventive foot care services among minority groups. Continued dedication in

References1

Centers for Disease Control and Prevention. (2022, June 29). 2022 National Diabetes Statistics Report. Centers for Disease Control and Prevention. Retrieved November 25, 2022, from https://www.cdc.gov/diabetes/data/statistics-report/index.html?ACSTrackingID=DM72996&ACSTrackingLabel=New%20Report%20Shares%20Latest%20Diabetes%20Stats%20&deliveryName=DM72996.

2

American Diabetes Association. Statistics About Diabetes. Statistics About Diabetes | ADA. //www.diabetes.org/resources/statistics/statistics-about-diabetes

Conflict of interest

None to report

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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