Background: Foot amputation rates in Black patients with diabetic foot complications have been historically higher than White patients. To determine if improvements in this disparity occurred, we carried out trend analysis of lower extremity amputation rates for patients hospitalized with diabetic foot ulcers and infections (DFU/Is).
Methods: Using the National Inpatient Sample database, we conducted a retrospective cohort study in adult White and Black patients 18 years and older admitted with DFU/Is between the years 2003 and 2014 to study trends in major lower extremity amputations. We used Pearson χ2 testing for categorical variables and linear regression analysis for continuous variables. Multiple logistic and linear regression models were conducted to assess outcome measures.
Results: There were 215,928 White and 46,996 Black patients hospitalized with DFUs/DFIs between 2003-2014. Black patients were younger (mean, [SE] age 57.4 , [0.4] vs 62.9, [0.2]), more likely to be female (45.5% vs 39.1%) and uninsured (7.9% vs 5.7%). Following adjustment for proportion of amputations, trends in major lower extremity amputations significantly decreased for both White and Black patients (P trend = 0.007 and 0.021, respectively). In 2014, there was not a significant difference in major amputation rates between Black and White patients (1.5% vs 1.7% p =0.69). Rates of minor amputations also decreased over time for both groups over time (P trend <0.001 in Blacks and Whites). Though Blacks had a higher percentage of minor amputations when compared to Whites in 2014, the difference was not statistically significant (10.3% vs 8.4% p=0.12).
Conclusions: While amputation rates declined for Black and White patients over the studied 12 year period, disparities between the two groups were absent in 2014. This study supports possible improvement in one domain of a clinically important longstanding health disparity.