Researchers analyzed racial/ethnic and gender differences in initiating lower-limb amputation (LLA) among older persons with a diabetic foot ulcer (DFU). It was expected that after DFU, more men would obtain LLA sooner than women and that more Blacks/African Americans would receive LLA sooner than non-Hispanic Whites/others. Investigators looked at Medicare FFS enrollees who received a DFU diagnosis throughout the study period (2012-2017), with follow-up allowed for up to 5 years after the DFU diagnosis. The full sample for statistical analysis included 643,287 people, and the subsample included 68,633 people who exclusively had LLA. The key finding was the formation of disjoint cohorts determined by LLA onset dates. Post-DFU group membership probabilities were analyzed using multinomial logistic regression, taking into account variables like gender and race/ethnicity. When comparing no amputation versus receiving an LLA within 1 year of a DFU diagnosis, the likelihood of receiving an LLA among Black/African American beneficiaries was 1.98 (95% CI 1.93-2.03). Among those who underwent LLA, female beneficiaries were more likely to have a delay (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). These findings shed new light on the differences in LLA timing by race and gender among Medicare FFS recipients after DFU. Individuals with both Medicare FFS and DFU may be included in the results. Care decisions informed by evidence-based medicine are clinically more precise and present an opportunity to address health disparities resulting from LLA’s social determinants.

Source: diabetesjournals.org/care/article/45/10/2336/147454/Racial-Disparities-in-Health-Care-With-Timing-to