Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
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DOI：
10.1136/bmjdrc-2022-003185
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发表时间：
2023-04
影响因子：
4.1
通讯作者：
Brennan, Meghan B.
中科院分区：
文献类型：
--
作者：
Taylor, Lindsay;Gangnon, Ronald;Powell, W. Ryan;Kramer, Joseph;Kind, Amy J. H.;Bartels, Christie M.;Brennan, Meghan B.
患有糖尿病足溃疡的农村患者，特别是那些被认为是黑人的患者，面临着更大的截肢风险。专业护理可以降低这种风险。然而，护理差异可能导致结果差异。我们的目的是确定与全国比例相比，农村患者，特别是那些被确定为黑人的患者，接受专科护理的比例是否较小。这项100%的国家回顾性队列研究了因糖尿病足溃疡住院的医疗保险受益人（2013-2014）。我们报告观察到的差异，在专科护理，包括：内分泌，传染病，骨科手术，整形外科，足科，或血管外科。我们使用逻辑回归来检查农村和种族之间可能的交叉性，控制社会人口统计学，合并症和溃疡严重程度，并包括农村和确定为黑色之间的相互作用。总体而言，32.15%（n= 124487）的糖尿病足溃疡住院患者接受了专科护理。在农村患者中（n= 13100），比例下降到29.57%。对于确定为黑人的患者（n=21 649），比例为33.08%。在农村黑人患者（n=1239）中，26.23%接受了专科护理。这比整个队列少了>5个绝对百分点。农村与城市黑人患者接受专科治疗的调整OR为0.61（95% CI 0.53 - 0.71），低于农村与城市白色患者接受专科治疗的调整OR（aOR 0.85，95% CI 0.80 - 0.89）。这一指标支持乡村性和确定为黑人之间的交叉性的作用。与整个队列相比，农村患者，特别是那些确定为黑人的患者，在住院时接受糖尿病足溃疡专科护理的比例较小。这可能会导致大截肢的已知差异。需要进一步的研究来确定因果关系。
Rural patients with diabetic foot ulcers, especially those identifying as black, face increased risk of major amputation. Specialty care can reduce this risk. However, care disparities might beget outcome disparities. We aimed to determine whether a smaller proportion of rural patients, particularly those identifying as black, receive specialty care compared with the national proportion. This 100% national retrospective cohort examined Medicare beneficiaries hospitalized with diabetic foot ulcers (2013–2014). We report observed differences in specialty care, including: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, or vascular surgery. We used logistic regression to examine possible intersectionality between rurality and race, controlling for sociodemographics, comorbidities, and ulcer severity and including an interaction term between rurality and identifying as black. Overall, 32.15% (n=124 487) of patients hospitalized with a diabetic foot ulcer received specialty care. Among rural patients (n=13 100), the proportion decreased to 29.57%. For patients identifying as black (n=21 649), the proportion was 33.08%. Among rural patients identifying as black (n=1239), 26.23% received specialty care. This was >5 absolute percentage points less than the overall cohort. The adjusted OR for receiving specialty care among rural versus urban patients identifying as black was 0.61 (95% CI 0.53 to 0.71), which was lower than that for rural versus urban patients identifying as white (aOR 0.85, 95% CI 0.80 to 0.89). This metric supported a role for intersectionality between rurality and identifying as black. A smaller proportion of rural patients, particularly those identifying as black, received specialty care when hospitalized with a diabetic foot ulcer compared with the overall cohort. This might contribute to known disparities in major amputations. Future studies are needed to determine causality.
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影响因子：
4.9
作者：
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通讯作者：
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影响因子：
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DOI：
10.1016/j.ejvs.2010.03.008
发表时间：
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