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Study: Diabetic foot ulcer outcomes point to racial, rural disparities

Posted at 6:17 PM, Apr 22, 2022
and last updated 2022-04-22 19:17:44-04

MADISON (NBC 26) — Rural patients who identify as Black are at sharply increased risk of death or leg amputation due to diabetic foot ulcers, according to a new study from the University of Wisconsin School of Medicine and Public Health that analyzed national data on patient outcomes.

The study was published online Thursday in the Journal of the American Medical Association Network. Dr. Meghan Brennan, an assistant professor of medicine who treats people with diabetic foot ulcers, led the study.

Brennan and her coauthors analyzed Medicare data for 124,487 patients with diabetic foot ulcers who were hospitalized in 2013 and 2014. People with diabetes can suffer foot ulcers, infections and tissue death (known as gangrene), which can place them at risk of limb loss.

Researchers found that while the overall group had a 17.6% rate of major amputation or death, people who identified as Black had a rate of 21.9%, a 4.3% disparity. Those living in rural areas had a 0.7% increase in death or amputation. The amplified effect for rural people who identify as Black was not the sum of the two (5%), but rather an increase of 10.4% in death and amputation.

"There's a theory of what's called intersectionality, and it's kind of rooted in Black feminist movements, but you can apply it to any kind of different overlapping disparity," Brennan said. "And the general idea here is that when you have multiple marginalized populations, the effects of those disparities don't add together. Instead, they kind of are amplified. And that's exactly what we saw."

Brennan said the results may indicate a failure of the ambulatory health care system and of triage, as specialists like vascular surgeons and infectious disease specialists who make up wound salvage teams are much less common in rural health care settings.

"As a health services researcher, my next step is to try to kind of improve how the health system is set up to help rural people ... who identify as Black in particular, kind of make it through the system and get the care that they need," she said.

The Rural Wisconsin Health Cooperative, which represents 43 different rural health systems in the state, is working to design better triage tools so that patients who need to be seen by specialists can more easily be referred to larger hospitals to have faster access to necessary limb- and life-saving care, Brennan said.

Brennan is a UW Health infectious disease physician whose research focuses on the management of patients with diabetic foot ulcers. She co-directs the diabetic foot ulcer clinic at the William S. Middleton Veterans Hospital in Madison.

Brennan’s co-authors from the University of Wisconsin School of Medicine and Public Health include Dr. Christie Bartels, Dr. Ryan Powell, Dr. Farah Kaiksow, Joseph Kramer, MA, Dr. Yao Liu, and Dr. Amy Kind.