Top

Journal of Foot and Ankle Research

Published in:

Open Access 01-12-2021 | Diabetic Foot | Research

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

Authors: Moin Uddin Ahmed, Wadad Kathy Tannous, Kingsley Emwinyore Agho, Frances Henshaw, Deborah Turner, David Simmons

Published in: Journal of Foot and Ankle Research | Issue 1/2021

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.

Available only for authorised users

van Netten JJ, Bus SA, Apelqvist J, Lipsky BA, Hinchliffe RJ, Game F, et al. Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev. 2019:e3268. https://doi.org/10.1002/dmrr.3268.

Schaper NC, Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(S1). https://doi.org/10.1002/dmrr.3266.

Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75. https://doi.org/10.1056/nejmra1615439.CrossRefPubMed

Lazzarini PA, Pacella RE, Armstrong DG, Van Netten JJ. Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med. 2018;35(9):1297–9. https://doi.org/10.1111/dme.13680.CrossRef

Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106–16. https://doi.org/10.1080/07853890.2016.1231932.CrossRefPubMed

Zhang Y, Lazzarini PA, Mcphail SM, Van Netten JJ, Armstrong DG, Pacella RE. Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care. 2020;43(5):964–74. https://doi.org/10.2337/dc19-1614.CrossRefPubMed

Australian Institute of Health and Welfare. Indicators for the Australian National Diabetes Strategy 2016–2020: data update. 2020; Available from https://www.aihw.gov.au/reports/diabetes/diabetes-indicators-strategy-2016-2020 Accessed 15 July 2021.

Kerr M, Barron E, Chadwick P, Evans T, Kong WM, Rayman G, et al. The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet Med. 2019;36(8):995–1002. https://doi.org/10.1111/dme.13973.CrossRefPubMed

Skrepnek GH, Mills JL, Lavery LA, Armstrong DG. Health care service and outcomes among an estimated 6.7 million ambulatory care diabetic foot cases in the US. Diabetes Care. 2017. https://doi.org/10.2337/dc16-2189

10.

Lazzarini PA, Gurr JM, Rogers JR, Schox A, Bergin SM. Diabetes foot disease: the Cinderella of Australian diabetes management? J Foot Ankle Re. 2012;5(1):24. https://doi.org/10.1186/1757-1146-5-24.CrossRef

11.

Australian Institute of Health and Welfare. Diabetes: Australian facts 2008. 2008; Available from https://www.aihw.gov.au/reports/diabetes/diabetes-australian-facts-2008/contents/summary Accessed 15 July 2021.

12.

Comino EJ, Harris MF, Islam MF, Tran DT, Jalaludin B, Jorm L, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study. BMC Health Serv Res. 2015;15(1):12. https://doi.org/10.1186/s12913-014-0666-2.CrossRefPubMedPubMedCentral

13.

Australian Institute of Health and Welfare. Admitted patient care 2017–18: Australian hospital statistics. 2019; Available from https://www.aihw.gov.au/reports/hospitals/admitted-patient-care-2017-18/contents/at-a-glance Accessed 19 July 2021.

14.

Armstrong DG, Kanda VA, Lavery LA, Marston W, Mills JL, Boulton AJ. Mind the gap: disparity between research funding and costs of care for diabetic foot ulcers. Diabetes Care. 2013;36(7):1815–7. https://doi.org/10.2337/dc12-2285.CrossRefPubMedPubMedCentral

15.

Braveman P, Gottlieb L. The social determinants of Health: It's time to consider the causes of the causes. Public Health Rep. 2014;129(1_suppl2):19–31. https://doi.org/10.1177/00333549141291s206.CrossRefPubMedPubMedCentral

16.

World Health Organization. Social determinants approaches to public health: from concept to practice. 2011; Available from https://www.who.int/social_determinants/tools/SD_Publichealth_eng.pdf Accessed 12 Oct 2021.

17.

Australian Institute of Health and Welfare. Australia’s health 2016. 2016; Available from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/summary Accessed 13 Oct 2021.

18.

Bergin SM, Brand CA, Colman PG, Campbell DA. The impact of socio-economic disadvantage on rates of hospital separations for diabetes-related foot disease in Victoria, Australia. J Foot Ankle Res. 2011;4(1). https://doi.org/10.1186/1757-1146-4-17.

19.

Singh AA. Socio-economic, geographic, and aboriginal and Torres strait islander inequalities in diabetic foot disease and diabetes-related lower extremity amputations. Queensland: Queensland University of Technology; 2018. https://eprints.qut.edu.au/119222/1/Adrian_Singh_Thesis.pdf

20.

Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, et al. Foot complications in a representative Australian inpatient population. J Diabetes Res. 2017;2017:4138095–12. https://doi.org/10.1155/2017/4138095.CrossRefPubMedPubMedCentral

21.

Perrin BM, Allen P, Gardner MJ, Chappell A, Phillips B, Massey C, et al. The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study. J Foot Ankle Res. 2019;12(1):56. https://doi.org/10.1186/s13047-019-0366-6.CrossRefPubMedPubMedCentral

22.

Tapp RJ, Shaw JE, De Courten MP, Dunstan DW, Welborn TA, Zimmet PZ. Foot complications in type 2 diabetes: an Australian population-based study. Diabet Med. 2003;20(2):105–13. https://doi.org/10.1046/j.1464-5491.2003.00881.x.CrossRefPubMed

23.

Australian Bureau of Statistics. National Health Survey: First Results, Australia, 2014–15. 2015; Available from https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Accessed 15 July 2021.

24.

45 and Up Study Collaborators. Cohort Profile: The 45 and Up Study. Int J Epidemiol. 2008;37(5):941–7. https://doi.org/10.1093/ije/dym184.CrossRef

25.

Centre for Health Record Linkage (CHeReL). How record linkage works. 2021; Available from http://www.cherel.org.au/how-record-linkage-works Accessed 15 July 2021.

26.

Lowe JR, Raugi G, Reiber GE, Whitney JD. Changes in classifications of chronic lower-limb wound codes in patients with diabetes: ICD-9-CM versus ICD-10-CM. Adv Skin Wound Care. 2015;28(2):84–92. https://doi.org/10.1097/01.ASW.0000459576.85574.3f.CrossRefPubMed

27.

Toscano CM, Sugita TH, Rosa MQM, Pedrosa HC, Rosa RDS, Bahia LR. Annual direct medical costs of diabetic foot disease in Brazil: a cost of illness study. Int J Environ Res Public Health. 2018;15(1). https://doi.org/10.3390/ijerph15010089.

28.

Lavery LA, Lavery DC, Hunt NA, La Fontaine J, Ndip A, Boulton AJ. Amputations and foot-related hospitalisations disproportionately affect dialysis patients. Int Wound J. 2015;12(5):523–6. https://doi.org/10.1111/iwj.12146.CrossRefPubMed

29.

Hopkins RB, Burke N, Harlock J, Jegathisawaran J, Goeree R. Economic burden of illness associated with diabetic foot ulcers in Canada. BMC Health Serv Res. 2015;15:13. https://doi.org/10.1186/s12913-015-0687-5.CrossRefPubMedPubMedCentral

30.

Centers for Disease Control and Prevention. International Classification of Diseases,Ninth Revision, Clinical Modification (ICD-9-CM). 2013; Available from http://www.cdc.gov/nchs/icd/icd9cm.htm Accessed 15 July 2021.

31.

Lazzarini PA, O'Rourke SR, Russell AW, Derhy PH, Kamp MC. Reduced Incidence of Foot-Related Hospitalisation and Amputation amongst Persons with Diabetes in Queensland, Australia. Plos One. 2015;10:e0130609-e. https://doi.org/10.1371/journal.pone.0130609.CrossRef

32.

Commons RJ, Robinson CH, Gawler D, Davis JS, Price RN. High burden of diabetic foot infections in the top end of Australia: an emerging health crisis (DEFINE study). Diabetes Res Clin Pract. 2015;110(2):147–57. https://doi.org/10.1016/j.diabres.2015.09.016.CrossRefPubMedPubMedCentral

33.

Lipsky BA, Peters EJG, Senneville E, Berendt AR, Embil JM, Lavery LA, et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev. 2012;28:163–78. https://doi.org/10.1002/dmrr.2248.CrossRefPubMed

34.

Maple-Brown L, Cunningham J, Dunne K, Whitbread C, Howard D, Weeramanthri T, et al. Complications of diabetes in urban indigenous Australians: the DRUID study. Diabetes Res Clin Pract. 2008;80(3):455–62. https://doi.org/10.1016/j.diabres.2008.01.011.CrossRefPubMed

35.

Skinner T, Allen P, Peach E, Browne JL, Pouwer F, Speight J, et al. Does the shortage of diabetes specialists in regional and rural Australia matter? Results from diabetes MILES—Australia. Diabetes Res Clin Pract. 2013;100(2):222–9. https://doi.org/10.1016/j.diabres.2013.03.015.CrossRefPubMed

36.

Bachmann MO, Eachus J, Hopper CD, Davey Smith G, Propper C, Pearson NJ, et al. Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med. 2003;20(11):921–9. https://doi.org/10.1046/j.1464-5491.2003.01050.x.CrossRefPubMed

37.

Nather A, Siok Bee C, Keng Lin W, Qi Odelia KS, Yiong Huak C, Xinyi L, et al. Socioeconomic profile of diabetic patients with and without foot problems. Diabet Foot Ankle. 2010;1(1). https://doi.org/10.3402/dfa.v1i0.5523.

38.

Henry AJ, Hevelone ND, Belkin M, Nguyen LL. Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. J Vasc Surg. 2011;53(2):330–9. https://doi.org/10.1016/j.jvs.2010.08.077.CrossRefPubMed

39.

Parisi MCR, Moura Neto A, Menezes FH, Gomes MB, Teixeira RM, de Oliveira JEP, et al. Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study. Diabetol Metab Syndr. 2016;8(1):25. https://doi.org/10.1186/s13098-016-0126-8.CrossRefPubMedPubMedCentral

40.

Madarshahian F, Hassanabadi M, Koshniat NM. Cognitive status and foot self care practice in overweight diabetics, engaged in different levels of physical activity. J Diabetes Metab Disord. 2014;13:31. https://doi.org/10.1186/2251-6581-13-31.CrossRefPubMedPubMedCentral

41.

Shamshirgaran SM, Jorm L, Lujic S, Bambrick H. Health related outcomes among people with type 2 diabetes by country of birth: result from the 45 and up study. Prim Care Diabetes. 2019;13(1):71–81. https://doi.org/10.1016/j.pcd.2018.08.003.CrossRefPubMed

42.

Astell-Burt T, Feng X, Kolt GS. Is neighborhood green space associated with a lower risk of type 2 diabetes? Evidence from 267,072 Australians. Diabetes Care. 2014;37(1):197–201. https://doi.org/10.2337/dc13-1325.CrossRefPubMed

43.

Ding D, Chong S, Jalaludin B, Comino E, Bauman AE. Risk factors of incident type 2-diabetes mellitus over a 3-year follow-up: results from a large Australian sample. Diabetes Res Clin Pract. 2015;108(2):306–15. https://doi.org/10.1016/j.diabres.2015.02.002.CrossRefPubMed

44.

Shamshirgaran SM, Jorm L, Bambrick H, Hennessy A. Independent roles of country of birth and socioeconomic status in the occurrence of type 2 diabetes. BMC Public Health. 2013;13(1):1223. https://doi.org/10.1186/1471-2458-13-1223.CrossRefPubMedPubMedCentral

45.

Australian Bureau of Statistics. Information Paper: an Introduction to Socio-Economic Indexes for Areas (SEIFA),2006. 2008; Available from https://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/2039.0Main%20Features62006?opendocument&tabname=Summary&prodno=2039.0&issue=2006&num=&view=#Figure%204.1%20IRSD%20Scores%20Histogram Accessed 15 July 2021.

46.

Services Australia, Australian Government,. Concession and health care cards. Available from https://www.servicesaustralia.gov.au/individuals/subjects/concession-and-health-care-cards Accessed 15 Sept 2021.

47.

Department of Veterans’ Affairs, Australian Government,. Veteran healthcare cards. Available from https://www.dva.gov.au/health-and-treatment/veteran-healthcare-cards Accessed 15 Sept 2021.

48.

Australian Institute of Health and Welfare. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. 2003; Available from https://www.aihw.gov.au/reports/physical-activity/active-australia-survey/summary Accessed 19 July 2021.

49.

The Department of Health, Australian Government. Australia’s physical activity and sedentary behaviour guidelines;. 2014; Available from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines Accessed 15 July 2021.

50.

National Health and Medical Research Council. Australian Dietary Guidelines. 2013; Available from https://www.eatforhealth.gov.au/sites/default/files/content/n55_australian_dietary_guidelines.pdf Accessed 15 July 2021.

51.

National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. 2013; Available from https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity#block-views-block-file-attachments-content-block-1 Accessed 15 July 2021.

52.

Slade T, Grove R, Burgess P. Kessler psychological distress scale: normative data from the 2007 Australian National Survey of mental Health and wellbeing. Aust N Z J Psychiatry. 2011;45(4):308–16. https://doi.org/10.3109/00048674.2010.543653.CrossRefPubMed

53.

van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18(6):681–94. https://doi.org/10.1002/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R.CrossRefPubMed

54.

Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338(jun29 1):b2393. https://doi.org/10.1136/bmj.b2393.CrossRefPubMedPubMedCentral

55.

Spratt M, Carpenter J, Sterne JAC, Carlin JB, Heron J, Henderson J, et al. Strategies for multiple imputation in longitudinal studies. Am J Epidemiol. 2010;172(4):478–87. https://doi.org/10.1093/aje/kwq137.CrossRefPubMed

56.

Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, et al. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J. 2017;14(4):716–28. https://doi.org/10.1111/iwj.12683.CrossRefPubMed

57.

Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, et al. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open. 2016;6:e010811-e. https://doi.org/10.1136/bmjopen-2015-010811.CrossRef

58.

Tan T-W, Armstrong DG, Concha-Moore KC, Marrero DG, Zhou W, Calhoun E, et al. Association between race/ethnicity and the risk of amputation of lower extremities among medicare beneficiaries with diabetic foot ulcers and diabetic foot infections. BMJ Open Diabetes Res Care. 2020;8(1):e001328. https://doi.org/10.1136/bmjdrc-2020-001328.CrossRefPubMedPubMedCentral

59.

Morbach S, Lutale JK, Viswanathan V, Möllenberg J, Ochs HR, Rajashekar S, et al. Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabet Med. 2004;21(1):91–5. https://doi.org/10.1046/j.1464-5491.2003.01069.x.CrossRefPubMed

60.

Skrepnek GH, Mills JL Sr, Armstrong DG. A Diabetic Emergency One Million Feet Long: Disparities and Burdens of Illness among Diabetic Foot Ulcer Cases within Emergency Departments in the United States, 2006–2010. Plos One. 2015;10:e0134914-e. https://doi.org/10.1371/journal.pone.0134914.CrossRef

61.

Sämann A, Tajiyeva O, Müller N, Tschauner T, Hoyer H, Wolf G, et al. Prevalence of the diabetic foot syndrome at the primary care level in Germany: a cross-sectional study. Diabet Med. 2008;25(5):557–63. https://doi.org/10.1111/j.1464-5491.2008.02435.x.CrossRefPubMed

62.

Sanderson KJ, van Rij A, Wade CR, Sutherland WHF. Lipid peroxidation of circulating low density lipoproteins with age, smoking and in peripheral vascular disease. Atherosclerosis. 1995;118(1):45–51. https://doi.org/10.1016/0021-9150(95)05591-J.CrossRefPubMed

63.

Matos M, Mendes R, Silva AB, Sousa N. Physical activity and exercise on diabetic foot related outcomes: a systematic review. Diabetes Res Clin Pract. 2018;139:81–90. https://doi.org/10.1016/j.diabres.2018.02.020.CrossRefPubMed

64.

McEwen LN, Ylitalo KR, Herman WH, Wrobel JS. Prevalence and risk factors for diabetes-related foot complications in translating research into action for diabetes (TRIAD). J Diabetes Complicat. 2013;27(6):588–92. https://doi.org/10.1016/j.jdiacomp.2013.08.003.CrossRef

65.

Ewald D, Patel M, Hall G. Hospital separations indicate increasing need for prevention of diabetic foot complications in Central Australia. Aus J Rural Health. 2001;9(6):275–9. https://doi.org/10.1046/j.1038-5282.2001.00371.x.CrossRef

Title: Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia: evidence from a population-based study
Authors: Moin Uddin Ahmed
Wadad Kathy Tannous
Kingsley Emwinyore Agho
Frances Henshaw
Deborah Turner
David Simmons
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Diabetic Foot
Published in: Journal of Foot and Ankle Research / Issue 1/2021
Electronic ISSN: 1757-1146
DOI: https://doi.org/10.1186/s13047-021-00501-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methodology

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methodology

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Morphological characteristics of the plantar calcaneocuboid ligaments

Sustainable healthcare – Time for ‘Green Podiatry’

COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study

An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs

HAPPi Kneecaps! A double-blind, randomised, parallel group superiority trial investigating the effects of sHoe inserts for adolescents with patellofemoral PaIn: phase II feasibility study

Online questionnaire, clinical and biomechanical measurements for outcome prediction of plantar heel pain: feasibility for a cohort study