Black residents of rural areas are at especially high risk for a foot amputation or death if they are hospitalized with diabetic foot ulcers — a higher risk than would be expected by looking separately at the risks linked to being Black or living in a rural area, according to a new study published in the journal JAMA Network Open.
Researchers have long known about certain racial disparities in diabetes outcomes and risks, especially when it comes to Black Americans. Black Americans have been shown to face an increased risk of death from diabetes — with greater disparities between white and Black Americans seen in some U.S. cities than in others. One study showed that while waist size is a predictor of diabetes risk in all people, this measurement is especially likely to predict diabetes in Black adults. And consuming ultra-processed foods has been shown to raise the risk for high blood pressure by a greater amount in Black adults, compared with members of other racial or ethnic groups.
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For the latest study, researchers looked at data from 124,487 adults who were hospitalized with diabetic foot ulcers. The average age of participants was 71.5, and all of them were Medicare beneficiaries. The study group consisted of 57.3% men, 10.5% rural residents, and 17.4% Black participants.
Increased risk for major amputation or death in Black rural residents
Overall, 17.6% of study participants underwent a major amputation, defined as above the ankle, or died within 30 days of their hospital discharge. For rural residents, this number was slightly higher at 18.3%, and for Black participants the risk was 21.9%. But for study participants who were both rural residents and Black, the risk for major amputation or death was much higher at 28.0%.
The researchers noted that this evaluated risk for amputation or death in Black rural residents is more than twice as large as would be expected, based on looking separately at rural residents and Black participants. After adjusting for several factors known to increase the risk for foot amputation or death, the researchers found that the risk among Black rural residents remained elevated at 24.7% — showing a significant interaction between race and rural residence when it comes to poor outcomes in people hospitalized with diabetic foot ulcers.
“Rural patients identifying as Black had a more than 10% absolute increased risk of major leg amputation or death compared with the overall cohort,” the researchers concluded, adding that these findings “support using an intersectionality lens to investigate and address disparities in major leg amputation and mortality for patients with diabetic foot ulcers.”
Want to learn more about foot ulcers? Read “Diabetic Foot Ulcers: What They Are and How You Can Avoid Them?”