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The Impact Of Rural Vs. Metropolitan Community Health Factors On Diabetic Foot Ulcers In Central Appalachia
Lauren Benner Grimsley, MD MBA, Jordan G. Tasman, MPH, Devin J. Clegg, MD, Thomas W. Mazonas, MD, Brett J. Salomon, MD, Mitchell H. Goldman, MD FACS, Scott Stevens, MD FACS, Patricia Roberson, PhD.
University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
OBJECTIVE: Patients with diabetes have higher rates of amputation after development of diabetic foot ulcer (DFU). Research has demonstrated patients with diabetes have higher mortality in rural counties across age, sex and ethnicity groups. Based on prior studies of DFU, we wanted to examine the data from a community lens. We reviewed the impact of community factors on patients who developed a DFU and risk of amputation in 1 year related to rural vs. metropolitan county designation.
METHODS: A retrospective review of DFU patients from January 2011 to December 2021 performed. Patients with type II diabetes and 18yo and up included. Rural and metropolitan community status was defined by the Rural Urban Community Codes patient zipcode. Characterization of DFU wounds and amputation rate at 1 year were evaluated in context of primary care providers in the county, percent uninsured under 65yo, county poverty rate, food insecurity, number of emergency rooms and county low-income housing.
RESULTS: Based on the rural and metropolitan definitions, 82 patients were identified in the rural group and 396 patients in the metropolitan. In table 1, patients living in rural counties are shaded in green and metropolitan counties are shaded blue. We have mathematically evaluated the correlation between the county (rural vs. metropolitan) and effect community factors have on the likelihood a patient with a DFU would require amputation at 1 year. We have
bolded and coded effects between DFU characteristics and community factors that are significant based on the p values: **, p < .001; *, p < .05; t, p < .10.
CONCLUSIONS: By examining the differences between DFU characteristics/outcomes and community factors for rural and metropolitan patients, we find that rural patients experience (1) a greater number of significant associations between community factors and their health and (2) the effects between these community variables and their health are consistently stronger. Amputations for patients living in rural areas might be most closely linked to county poverty and county food insecurity rates. County information is important in providing adequate support for patient’s needs to be successful and avoid amputation after development of DFU.
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