Social determinants of diabetes‐related foot disease among older adults in New South Wales, Australia: evidence from a population‐based study

Abstract

Background Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. Methodology The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. Results The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. Conclusion Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households.

The burden of diabetes‐related foot disease among older adults in Australia

“…Our finding is also corroborated by the study by Zhang et al (2020), where they reported that the burden disproportionately affected males and the older aged population globally 7 . Although females in Australia have a higher life expectancy, the higher YLD burden could be due to the higher prevalence of diabetic foot complications among males for most age groups, as documented by several studies 23,31‐34 …”

“…7 Although females in Australia have a higher life expectancy, the higher YLD burden could be due to the higher prevalence of diabetic foot complications among males for most age groups, as documented by several studies. 23,[31][32][33][34] Our study found that the number of deaths due to DFUIG was 7 per 100 000 people in 2011 among individuals aged 45 years and older. At this rate, the total number of deaths due would equate to 587 deaths due to DFUIG in Australia.…”

“… 7 Although females in Australia have a higher life expectancy, the higher YLD burden could be due to the higher prevalence of diabetic foot complications among males for most age groups, as documented by several studies. 23 , 31 , 32 , 33 , 34 …”

A higher incidence of diabetic peripheral neuropathy may be associated with decreased sleep and increased depression in older adults

“…A population survey study of 33,663 people, in which demographic data but no comparisons were given, found that as the marriage rate decreased, more serious complications increased (18). This situation can be interpreted as married people being more motivated to care for their chronic illnesses, and their partners can help in their care.…”

Complications in Diabetes Mellitus: Social Determinants and Trends

“…Work status, stability, job kind, and working circumstances have all been considered. Employees of significant corporations have their work situations, qualifications, and salary recorded in occupational tiers of job categories [ 4 ].…”