Patient insurance status and race modify outcomes for diabetic patients undergoing care for diabetic foot ulcers and infections.

Introduction: This study aims to understand the impact of lowering the age of Medicare eligibility from 65 to 60 years on outcomes for patients with diabetic foot ulcer/infection. Furthermore, it aims to provide greater insight into how insurance status, insurance provider, and patient demographic factors modify outcomes for these patients.

Methods: This study queried National Inpatient Sample data from the years 2015 to 2019 for hospitalized patients ages 60-65 who experienced diabetic foot ulcers and/or infections and examined outcomes for these patients based on a variety of factors, including their insurance status/provider, race, and sex. 38,610 patients met criteria for inclusion. Outcomes of interest included amputations (the primary outcome), limb salvage surgeries, in-hospital mortality, and disposition. Bivariate associations between the patient factors and outcomes of interest were determined, and those that were significant were used in a multivariate linear model to determine their association with our primary outcome.

Results: 38,610 patients met inclusion criteria. Patients without insurance were significantly more likely to undergo lower extremity amputation than those with insurance (aOR 1.20, 95% CI 1.09-1.33, p<.0002). Additionally, the demographic factors of male sex, Black, Hispanic, and Asian/Pacific Islander racial/ethnic identity were all significantly associated with greater odds of undergoing lower extremity amputation (all p<.05).

Conclusions: Lack of insurance is associated with increased odds of undergoing lower extremity amputation for inpatients with diabetes who have diabetic foot ulcers or infections. There is potential that lowering the Medicare age based on the present study may benefit patients with diabetic foot ulcers.