Disparities in outcomes of patients admitted with diabetic foot infections
The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs). The HCUP-Nationwide Inpatient Sample (2002 to 2015) was querie...
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| creator | Tan, Tze-Woei Shih, Chia-Ding Concha-Moore, Kirsten C Diri, Muhanad M Hu, Bo Marrero, David Zhou, Wei Armstrong, David G |
| description | The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs).
The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS). Incidence for amputation and open or endovascular revascularization were evaluated over the study period. Multivariable regression analyses were performed to assess the association between race/ethnicity and outcomes.
There were 150,701 admissions for DFI, including 98,361 Whites, 24,583 AAs, 24,472 Hispanics, and 1,654 Native Americans (NAs) in the study cohort. Overall, 45,278 (30%) underwent a minor amputation, 9,039 (6%) underwent a major amputation, 3,151 underwent an open bypass, and 8,689 had an endovascular procedure. There was a decreasing incidence in major amputations and an increasing incidence of minor amputations over the study period (P < .05). The risks for major amputation were significantly higher (all p |
| doi_str_mv | 10.1371/journal.pone.0211481 |
| format | Article |
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The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS). Incidence for amputation and open or endovascular revascularization were evaluated over the study period. Multivariable regression analyses were performed to assess the association between race/ethnicity and outcomes.
There were 150,701 admissions for DFI, including 98,361 Whites, 24,583 AAs, 24,472 Hispanics, and 1,654 Native Americans (NAs) in the study cohort. Overall, 45,278 (30%) underwent a minor amputation, 9,039 (6%) underwent a major amputation, 3,151 underwent an open bypass, and 8,689 had an endovascular procedure. There was a decreasing incidence in major amputations and an increasing incidence of minor amputations over the study period (P < .05). The risks for major amputation were significantly higher (all p<0.05) for AA (OR 1.4, 95%CI 1.4,1.5), Hispanic (OR 1.3, 95%CI 1.3,1.4), and NA (OR 1.5, 95%CI 1.2,1.8) patients with DFIs compared to White patients. Hispanics (OR 1.3, 95%CI 1.2,1.5) and AAs (OR 1.2, 95%CI 1.1,1.4) were more likely to receive endovascular intervention or open bypass than Whites (all p<0.05). NA patients with DFI were less likely to receive a revascularization procedure (OR 0.6, 95%CI 0.3, 0.9, p = 0.03) than Whites. The mean hospital length of stay (LOS) was significantly longer for AAs (9.2 days) and Hispanics (8.6 days) with DFIs compared to Whites (8.1 days, p<0.001).
Despite a consistent incidence reduction of amputation over the past decade, racial and ethnic minorities including African American, Hispanic, and Native American patients admitted to hospitals with DFIs have a consistently significantly higher risk of major amputation and longer hospital length of stay than their White counterparts. Native Americans were less likely to receive revascularization procedures compared to other minorities despite exhibiting an elevated risk of an amputation. Further study is required to address and limit racial and ethnic disparities and to further promote equity in the treatment and outcomes of these at-risk patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0211481</identifier><identifier>PMID: 30716108</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>African Americans ; Amputation ; Analysis ; Cardiovascular system ; Codes ; Cohort Studies ; Continental Population Groups - statistics & numerical data ; Development and progression ; Diabetes ; Diabetes mellitus ; Diabetic foot ; Diabetic Foot - diagnosis ; Diabetic Foot - ethnology ; Diabetic Foot - surgery ; Diabetics ; Endovascular Procedures ; Ethnic Groups - statistics & numerical data ; Ethnicity ; Feet ; Female ; Foot diseases ; Health aspects ; Health care disparities ; Healthcare Disparities - ethnology ; Heart surgery ; Hispanic Americans ; Hospital costs ; Hospitalization ; Hospitals ; Humans ; Identification methods ; Incidence ; Indigenous peoples ; Infection ; Infections ; Ischemia ; Male ; Medical research ; Medical schools ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Minorities ; Minority & ethnic groups ; Mortality ; Native Americans ; Patients ; People and Places ; Prognosis ; Race ; Racial differences ; Regression analysis ; Research design ; Risk ; Risk factors ; Social aspects ; Socioeconomic factors ; Treatment Outcome ; Trends ; Ulcers ; Veterans</subject><ispartof>PloS one, 2019-02, Vol.14 (2), p.e0211481-e0211481</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Tan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Tan et al 2019 Tan et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-466e3f40214b9895c69f276caa31037759108f1d8d582938228c085a701aa3f13</citedby><cites>FETCH-LOGICAL-c692t-466e3f40214b9895c69f276caa31037759108f1d8d582938228c085a701aa3f13</cites><orcidid>0000-0002-6658-9482 ; 0000-0001-9203-1899 ; 0000-0003-0035-5357</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361439/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361439/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30716108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Najafi, Bijan</contributor><creatorcontrib>Tan, Tze-Woei</creatorcontrib><creatorcontrib>Shih, Chia-Ding</creatorcontrib><creatorcontrib>Concha-Moore, Kirsten C</creatorcontrib><creatorcontrib>Diri, Muhanad M</creatorcontrib><creatorcontrib>Hu, Bo</creatorcontrib><creatorcontrib>Marrero, David</creatorcontrib><creatorcontrib>Zhou, Wei</creatorcontrib><creatorcontrib>Armstrong, David G</creatorcontrib><title>Disparities in outcomes of patients admitted with diabetic foot infections</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs).
The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS). Incidence for amputation and open or endovascular revascularization were evaluated over the study period. Multivariable regression analyses were performed to assess the association between race/ethnicity and outcomes.
There were 150,701 admissions for DFI, including 98,361 Whites, 24,583 AAs, 24,472 Hispanics, and 1,654 Native Americans (NAs) in the study cohort. Overall, 45,278 (30%) underwent a minor amputation, 9,039 (6%) underwent a major amputation, 3,151 underwent an open bypass, and 8,689 had an endovascular procedure. There was a decreasing incidence in major amputations and an increasing incidence of minor amputations over the study period (P < .05). The risks for major amputation were significantly higher (all p<0.05) for AA (OR 1.4, 95%CI 1.4,1.5), Hispanic (OR 1.3, 95%CI 1.3,1.4), and NA (OR 1.5, 95%CI 1.2,1.8) patients with DFIs compared to White patients. Hispanics (OR 1.3, 95%CI 1.2,1.5) and AAs (OR 1.2, 95%CI 1.1,1.4) were more likely to receive endovascular intervention or open bypass than Whites (all p<0.05). NA patients with DFI were less likely to receive a revascularization procedure (OR 0.6, 95%CI 0.3, 0.9, p = 0.03) than Whites. The mean hospital length of stay (LOS) was significantly longer for AAs (9.2 days) and Hispanics (8.6 days) with DFIs compared to Whites (8.1 days, p<0.001).
Despite a consistent incidence reduction of amputation over the past decade, racial and ethnic minorities including African American, Hispanic, and Native American patients admitted to hospitals with DFIs have a consistently significantly higher risk of major amputation and longer hospital length of stay than their White counterparts. Native Americans were less likely to receive revascularization procedures compared to other minorities despite exhibiting an elevated risk of an amputation. Further study is required to address and limit racial and ethnic disparities and to further promote equity in the treatment and outcomes of these at-risk patients.</description><subject>African Americans</subject><subject>Amputation</subject><subject>Analysis</subject><subject>Cardiovascular system</subject><subject>Codes</subject><subject>Cohort Studies</subject><subject>Continental Population Groups - statistics & numerical data</subject><subject>Development and progression</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic foot</subject><subject>Diabetic Foot - diagnosis</subject><subject>Diabetic Foot - ethnology</subject><subject>Diabetic Foot - surgery</subject><subject>Diabetics</subject><subject>Endovascular Procedures</subject><subject>Ethnic Groups - statistics & numerical data</subject><subject>Ethnicity</subject><subject>Feet</subject><subject>Female</subject><subject>Foot diseases</subject><subject>Health aspects</subject><subject>Health care disparities</subject><subject>Healthcare Disparities - ethnology</subject><subject>Heart surgery</subject><subject>Hispanic Americans</subject><subject>Hospital costs</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Incidence</subject><subject>Indigenous peoples</subject><subject>Infection</subject><subject>Infections</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Minorities</subject><subject>Minority & ethnic groups</subject><subject>Mortality</subject><subject>Native Americans</subject><subject>Patients</subject><subject>People and Places</subject><subject>Prognosis</subject><subject>Race</subject><subject>Racial differences</subject><subject>Regression analysis</subject><subject>Research design</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Social aspects</subject><subject>Socioeconomic factors</subject><subject>Treatment 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in outcomes of patients admitted with diabetic foot infections</title><author>Tan, Tze-Woei ; Shih, Chia-Ding ; Concha-Moore, Kirsten C ; Diri, Muhanad M ; Hu, Bo ; Marrero, David ; Zhou, Wei ; Armstrong, David G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-466e3f40214b9895c69f276caa31037759108f1d8d582938228c085a701aa3f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>African Americans</topic><topic>Amputation</topic><topic>Analysis</topic><topic>Cardiovascular system</topic><topic>Codes</topic><topic>Cohort Studies</topic><topic>Continental Population Groups - statistics & numerical data</topic><topic>Development and progression</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetic foot</topic><topic>Diabetic Foot - diagnosis</topic><topic>Diabetic Foot - ethnology</topic><topic>Diabetic Foot - 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One</addtitle><date>2019-02-04</date><risdate>2019</risdate><volume>14</volume><issue>2</issue><spage>e0211481</spage><epage>e0211481</epage><pages>e0211481-e0211481</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The purpose of this study was to evaluate the disparities in the outcomes of White, African American (AA) and non-AA minority (Hispanics and Native Americans (NA)), patients admitted in the hospitals with diabetic foot infections (DFIs).
The HCUP-Nationwide Inpatient Sample (2002 to 2015) was queried to identify patients who were admitted to the hospital for management of DFI using ICD-9 codes. Outcomes evaluated included minor and major amputations, open or endovascular revascularization, and hospital length of stay (LOS). Incidence for amputation and open or endovascular revascularization were evaluated over the study period. Multivariable regression analyses were performed to assess the association between race/ethnicity and outcomes.
There were 150,701 admissions for DFI, including 98,361 Whites, 24,583 AAs, 24,472 Hispanics, and 1,654 Native Americans (NAs) in the study cohort. Overall, 45,278 (30%) underwent a minor amputation, 9,039 (6%) underwent a major amputation, 3,151 underwent an open bypass, and 8,689 had an endovascular procedure. There was a decreasing incidence in major amputations and an increasing incidence of minor amputations over the study period (P < .05). The risks for major amputation were significantly higher (all p<0.05) for AA (OR 1.4, 95%CI 1.4,1.5), Hispanic (OR 1.3, 95%CI 1.3,1.4), and NA (OR 1.5, 95%CI 1.2,1.8) patients with DFIs compared to White patients. Hispanics (OR 1.3, 95%CI 1.2,1.5) and AAs (OR 1.2, 95%CI 1.1,1.4) were more likely to receive endovascular intervention or open bypass than Whites (all p<0.05). NA patients with DFI were less likely to receive a revascularization procedure (OR 0.6, 95%CI 0.3, 0.9, p = 0.03) than Whites. The mean hospital length of stay (LOS) was significantly longer for AAs (9.2 days) and Hispanics (8.6 days) with DFIs compared to Whites (8.1 days, p<0.001).
Despite a consistent incidence reduction of amputation over the past decade, racial and ethnic minorities including African American, Hispanic, and Native American patients admitted to hospitals with DFIs have a consistently significantly higher risk of major amputation and longer hospital length of stay than their White counterparts. Native Americans were less likely to receive revascularization procedures compared to other minorities despite exhibiting an elevated risk of an amputation. Further study is required to address and limit racial and ethnic disparities and to further promote equity in the treatment and outcomes of these at-risk patients.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30716108</pmid><doi>10.1371/journal.pone.0211481</doi><tpages>e0211481</tpages><orcidid>https://orcid.org/0000-0002-6658-9482</orcidid><orcidid>https://orcid.org/0000-0001-9203-1899</orcidid><orcidid>https://orcid.org/0000-0003-0035-5357</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-02, Vol.14 (2), p.e0211481-e0211481 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2175867780 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | African Americans Amputation Analysis Cardiovascular system Codes Cohort Studies Continental Population Groups - statistics & numerical data Development and progression Diabetes Diabetes mellitus Diabetic foot Diabetic Foot - diagnosis Diabetic Foot - ethnology Diabetic Foot - surgery Diabetics Endovascular Procedures Ethnic Groups - statistics & numerical data Ethnicity Feet Female Foot diseases Health aspects Health care disparities Healthcare Disparities - ethnology Heart surgery Hispanic Americans Hospital costs Hospitalization Hospitals Humans Identification methods Incidence Indigenous peoples Infection Infections Ischemia Male Medical research Medical schools Medicine Medicine and Health Sciences Middle Aged Minorities Minority & ethnic groups Mortality Native Americans Patients People and Places Prognosis Race Racial differences Regression analysis Research design Risk Risk factors Social aspects Socioeconomic factors Treatment Outcome Trends Ulcers Veterans |
| title | Disparities in outcomes of patients admitted with diabetic foot infections |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-02T22%3A31%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Disparities%20in%20outcomes%20of%20patients%20admitted%20with%20diabetic%20foot%20infections&rft.jtitle=PloS%20one&rft.au=Tan,%20Tze-Woei&rft.date=2019-02-04&rft.volume=14&rft.issue=2&rft.spage=e0211481&rft.epage=e0211481&rft.pages=e0211481-e0211481&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0211481&rft_dat=%3Cgale_plos_%3EA572493122%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2175867780&rft_id=info:pmid/30716108&rft_galeid=A572493122&rft_doaj_id=oai_doaj_org_article_fc922fb090714a6a83f94c016550bcbf&rfr_iscdi=true |