Racial Disparities in Healthcare with Timing to Amputation Following Diabetic Foot Ulcer

Diabetes Care Journey Study
September 7, 2022
Hanger Clinic


Diabetes Care
Read Online


Taavy A. Miller, PhD1,2, James H. Campbell, PhD1, Nick Bloom, PhD3, Shane R. Wurdeman, PhD1

  1. Hanger Institute for Clinical Research and Education, Austin, TX, USA
  2. School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
  3. CareJourney, Arlington, VA, USA


Diabetes affects over 37 million people in the U.S.,1 with 25 percent of those individuals likely to experience a diabetic foot ulcer (DFU) in their lifetime. Although DFUs are a known risk factor for future lower limb amputation (LLA), DFUs and LLAs do not seem to affect everyone equally and little is known about the timing of when LLA occurs based on different patient factors.

This study, conducted by the Hanger Institute for Clinical Research and Education in partnership with CareJourney, a leading source of provider and quality data, sought to provide a foundation for future research to address health inequities among individuals who require prosthetic care. Published in the American Diabetes Association’s peer-reviewed journal, Diabetes Care, the study demonstrated pronounced disparities in the timing for female and Black patients with diabetes. This foundational work provides a springboard to address disparities and understand the positive and negative impact of earlier or delayed amputation on long-term outcomes, promoting better guidance for evidence-based decision-making.


To examine the timing of lower limb amputation between racial groups and gender for Medicare fee-for-service (FFS) beneficiaries following DFU.




Black/AA Medicare Beneficiaries

Black/AA Medicare beneficiaries had 1.98 (95% CI: 1.93-2.03) times the odds of receiving a LLA within 1 year of DFU diagnosis compared to non-Hispanic/White beneficiaries, relative to no amputation.

Care Journey Figure 1

Female Beneficiaries

Female beneficiaries had increased odds (OR: 1.07 95% CI: 1.02-1.11 between 1-3 years and OR: 1.08 95% CI: 1.03-1.12 in 3+ years) of a delayed LLA compared to males among those that have LLA.


These results present novel evidence on timing of a LLA between racial groups and gender for Medicare FFS beneficiaries post-DFU.

1. National Diabetes Statistics Report. Centers for Disease Control and Prevention, 18 Jan. 2022, https://www.cdc.gov/diabetes/data/statistics-report/index.html

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