Racial disparities in healthcare with timing to amputation following diabetic foot ulcer

Objective: To examine variations in timing of lower limb amputation (LLA) across race/ethnicity and gender 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 to non-Hispanic/Whites, and more males would receive LLA earlier post-DFU compared to females.

Research Design and Methods: Retrospective cohort analysis of enrolled Medicare fee-for-service 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 sub-sample 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 gender and race/ethnicity. 

Results: Black/AA beneficiaries had 1.98 (95% CI: 1.93-2.03) times the odds of receiving a LLA within 1 year of DFU diagnosis compared to non-Hispanic/White beneficiaries relative to no amputation. Female beneficiaries had increased odds (OR: 1.07 95% CI: 1.02-1.11 between 1-3 years and OR: 1.08 95% CI: 1.03-1.12 in 3+ years) of a delayed LLA compared to males among those that have LLA.

Conclusions: Notably these results present novel evidence on timing of LLA between racial groups and gender 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.