Impact of Geographic Socioeconomic Disadvantage on Minor Amputation Outcomes in Patients With Diabetes

Abstract

Background: Socioeconomic disadvantage is a known contributor to adverse events and higher admission rates in the diabetic population. However, its impact on outcomes after lower extremity amputation is unclear. We aimed to assess the association of geographic socioeconomic disadvantage with short-and long-term outcomes after minor amputation in patients with diabetes.Materials and methods: Geographic socioeconomic disadvantage was determined using the area deprivation index (ADI). All patients from the Maryland Health Services Cost Review Commission database (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) who underwent minor amputation with a concurrent diagnosis of diabetes were included and stratified by the ADI quartile. Associations of the ADI quartile with 30-day readmission and 1-year reamputation were evaluated using KaplaneMeier survival analyses and multivariable logistic regression models adjusting for baseline differences.Results: A total of 7415 patients with diabetes underwent minor amputation (70.1% male, 38.7% black race), including 28.1% ADI1 (least deprived), 42.8% ADI2, 22.9% ADI3, and 6.2% ADI4 (most deprived). After adjusting for demographic and clinical factors, the odds of 30day readmission were greater in the intermediate ADI groups than those in the ADI1 group, but not among the most deprived. Adjusted odds of 1-year reamputation were greater among ADI4 than those among ADI1. KaplaneMeier analysis confirmed a greater likelihood of reamputation with an increasing ADI quartile over a 1-year period (P < 0.001).Conclusions: Geographic socioeconomic disadvantage is independently associated with both short-and long-term outcomes after minor diabetic amputations in Maryland. A targeted approach addressing the health care needs of deprived regions may be beneficial in optimizing postoperative care in this vulnerable population.

Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

“…Targeted initiatives directed at improving the postoperative management of chronic disease progression in highly deprived patients undergoing major amputation are needed to improve access to postoperative care and rehabilitation in this high-risk group. 15) 7 ( 13) 1 ( 4) 8 (17) .191…”

“…ADI has been previously associated with outcomes such as postoperative discharge destination after elective hip surgery, minor foot amputations, all-cause hospital readmissions, and mortality. [13][14][15][16][17] Arya et al 18 previously demonstrated that the risk of major amputation is higher with increasing ADI (ie, more deprivation) in a cohort of patients with incident peripheral artery disease (PAD). Additionally, work from the state of California has demonstrated the clustering of diabetic lower extremity amputations among areas of lower household income.…”

Social Aspects of Diabetic Foot: A Scoping Review

“…As Al Ayed et al report, in Saudi Arabia, the prevalent constraints of gender segregation and the restrictions imposed by the male guardianship system negatively affect the health-related QoL of females, and for this reason, they have larger ulcer sizes, higher frequencies of unhealed ulcers, and advanced Wagner grades (Al Ayed et al 2020). A study by Zhang et al reports that there are certain demographic factors associated with increased odds of 30-day readmission, such as female sex, black race (vs. white), older age, and others (Zhang et al 2021). There are some studies that claim there is no difference between genders, such as the study by Goodridge et al that reports that between unhealed and healed ulcer groups, there were no significant differences in gender distribution, age, and general health self-rating (Goodridge et al 2005), and a study by Salameh et al reported that there are no differences between DFU and non-DFU groups in terms of gender, as well as other factors (Salameh et al 2020).…”

“…First of all, socioeconomic status (SES) is a complicated and multifactorial index that allows one to understand the socio-economic position of an individual based on different sub-categories of indicators (Zhang et al 2021). In diabetic patients, this index is related to DFU (Hicks et al 2018).…”

“…Patients with DFU, especially if it does not heal or recurs, report poor quality of life (QoL) (Polikandrioti et al 2020). DFU is associated with frequent hospitalization and rising costs of treatment (Polikandrioti et al 2020;Zhang et al 2021;Reis et al 2020). DFU pathophysiology is due to neuropathy, trauma, and peripheral artery occlusive disease (PAOD) (Misliza and Ayu 2009;Korzon-Burakowska and Dziemidok 2011).…”