Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations

Brennan, Meghan B.; Tan, Tze-Woei; Schechter, Marcos C.; Fayfman, Maya

doi:10.1053/j.semvascsurg.2023.01.002

Cited by 5 publications

(7 citation statements)

References 119 publications

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“…However, the latter is likely reflective of the region that UM Health serves. While in general these data are consistent with prior reports ( 32 ), they highlight a critical need to further investigate SDOH on a neighborhood level in underserved communities where disparities are commonly present ( 7 – 9 , 33 , 34 ). On disaggregation of demographic data by sex and racial categories, disparities in DFU infection became dissimilar in comparison with the population with diabetes.…”

Section: Discussionsupporting

confidence: 88%

“…Individuals who develop a DFU infection have a 155-fold increased risk of amputation compared with those who do not ( 4 ), and in 85% of lower-extremity amputation events the amputations are preceded by the presence of a DFU ( 5 , 6 ). More striking is that an individual’s social determinants of health (SDOH), specifically location, play a critical role with regard to amputation: those living in rural areas have a 35% higher odds of amputation compared with their urban counterparts ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Neighborhood disadvantage has been shown to be associated with greater risk of lower-extremity amputation ( 20 , 21 ), poor health care quality and diabetes outcomes ( 22 ), and lost productivity among people of marginalized communities afflicted with DFU ( 9 ). Evaluating a neighborhood, generally, where a person lives, goes to school, works, plays, and receives care, may provide a nuanced understanding of the interaction between SDOH and disease status at an individual level.…”

Section: Introductionmentioning

confidence: 99%

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Residential Address Amplifies Health Disparities and Risk of Infection in Individuals With Diabetic Foot Ulcers

Schmidt,

Huang,

Banerjee

et al. 2024

Diabetes Care

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OBJECTIVE To determine the association between social determinants of health (SDOH) and a diagnosis of diabetic foot ulcer (DFU) infection. RESEARCH DESIGN AND METHODS Targeted interrogation of electronic health record data using novel search engines to analyze individuals with a DFU infection during a 5-year period (2013–2017) was performed. We extracted geolocated neighborhood data and SDOH characteristics from the National Neighborhood Data Archive and used univariate and multiple logistic regression to evaluate associations with outcomes in the population with diabetes. RESULTS Among 4.3 million people overall and 144,564 individuals with diabetes seen between 2013 and 2017, 8,351 developed DFU, of which cases 2,252 were complicated by a DFU infection. Sex interactions occurred, as men who experienced a DFU infection more frequently identified as having nonmarried status than their female counterparts. For the population with DFU infection, there were higher rates for other SDOH, including higher neighborhood disadvantaged index score, poverty, nonmarriage, and less access to physician/allied health professionals (all P < 0.01). In multiple logistic regression, those individuals who developed DFU infection came from neighborhoods with greater Hispanic and/or foreign-born concentrations (odds ratio 1.11, P = 0.015). CONCLUSIONS We found significant differences in neighborhood characteristics driving a higher risk for DFU infection in comparisons with the grouping of individuals with diabetes overall, including increased risk for individuals with Hispanic and/or foreign-born immigration status. These data strongly support the need to incorporate SDOH, particularly ethnic and immigration status, into triage algorithms for DFU risk stratification to prevent severe diabetic foot complications and move beyond biologic-only determinants of health.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Residential Address Amplifies Health Disparities and Risk of Infection in Individuals With Diabetic Foot Ulcers

Schmidt,

Huang,

Banerjee

et al. 2024

Diabetes Care

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“…The disparities in health care access among individuals with diabetes and PAD in the study can be classified into proximal, intermediate, and distal determinants. 9,34 Proximal determinants refer to individual behaviors and decisions that affect health care choices, such as delaying prescription refills and purchasing medications from other countries. One approach is to increase the number of Spanish-speaking health care providers, which can improve patient–provider relationships, chronic disease management, patient satisfaction, and treatment adherence.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 This highlights the urgent need to identify and address the underlying factors driving this trend, including access to high-quality care, diabetes management, and preventive measures for individuals at risk of developing diabetes-related foot complications and amputations. 9 Disproportionate rates of diabetes and PAD are observed among ethnic minority groups, with extensive research consistently showing an inequitable relationship between these groups and diabetes-related limb loss and cardiovascular disease. [10][11][12][13] Hispanic adults have 50% higher prevalence of concurrent diabetes and PAD than White adults.…”

Section: Introductionmentioning

confidence: 99%

Examining health care access disparities in Hispanic populations with peripheral artery disease and diabetes

Bazikian,

Urbina,

Hsu

et al. 2023

Vasc Med

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Introduction: This study investigated disparities in health care access for Hispanic adults with diabetes and peripheral artery disease (PAD) who are at risk of lower-extremity amputation and other cardiovascular morbidities and mortalities. Methods: We utilized the health care access survey data from the All of US research program to examine adults (⩾ 18 years) with either diabetes and/or PAD. The primary associations evaluated were: could not afford medical care and delayed getting medical care in the past 12 months. Multivariable logistic regression models were used to assess the association of Hispanic ethnicity and survey responses, adjusting for age, sex, income, health insurance, and employment status. Results: Among 24,104 participants, the mean age was 54.9 years and 67% were women. Of these, 8.2% were Hispanic adults. In multivariable analysis, Hispanic adults were more likely to be unable to afford seeing a health care provider, and receiving emergency care, follow-up care, and prescription medications ( p < 0.05) than non-Hispanic adults. Furthermore, Hispanic adults were more likely to report being unable to afford medical care due to cost (odds ratios [OR] 1.72, 95% CI 1.50–1.99), more likely to purchase prescription drugs from another country (OR 2.20, 95% CI 1.69–2.86), and more likely to delay getting medical care due to work (OR 1.46, 95% CI 1.22–1.74) and child care (OR 1.80, 95% CI 1.35–2.39) issues than non-Hispanic White adults. Conclusion: The Hispanic population with diabetes and PAD faces substantial barriers in health care access, including a higher likelihood of delaying medical care and being unable to afford it.

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Creation of a Limb Loss and Preservation Registry for Improving the Quality of Patient Care in the United States

Kaufman,

Bernhardt,

Murphy

et al. 2024

Archives of Rehabilitation Research and Clinical Translation

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Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations

Cited by 5 publications

References 119 publications

Residential Address Amplifies Health Disparities and Risk of Infection in Individuals With Diabetic Foot Ulcers

Residential Address Amplifies Health Disparities and Risk of Infection in Individuals With Diabetic Foot Ulcers

Examining health care access disparities in Hispanic populations with peripheral artery disease and diabetes

Creation of a Limb Loss and Preservation Registry for Improving the Quality of Patient Care in the United States

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