Is race associated with referral disparities for patients with diabetic foot complications?

Abstract

Introduction: Racial minorities, including African Americans, American Indians, Asian Americans, Hispanic/Latinos, and Pacific Islanders are more likely to deve lop Type II diabetes and experience associated microvascular complications. Amputation rates related to diabetes and/or peripheral arterial disease are three times higher for African Americans, suggesting that race, access, and/or mistrust of the medical community may contribute to adverse outcomes for certain minority groups. Determining where the breakdown along the care continuum occurs is fundamental for achieving equitable outcomes among minority groups. This retrospective study sought to examine specialist referral rates for patients diagnosed with diabetic foot complications. Methods: Patients were extracted from the medical record based on a diagnosis related to diabetic foot complications made between January 01, 2018, and June 01, 2023, in the family medicine or endocrinology clinics at the University of Missouri (MU). Referral incidence to specialty orthopaedic foot clinic at the Missouri Orthopaedic Institute (MOI) and patient demographics were collected and analyzed. Results: 597 patients were eligible for inclusion. Patients referred to MOI (n=133, 22.3%) were significantly younger (56.5 ± 10.9 years vs.61.1 ± 12.5, p [less than] 0.001), and significantly more likely to have Medicaid insurance (p=0.01). No significant differences in referrals were seen for race, sex, or marital status, suggesting minority patients with diabetic foot complications are referred to specialists equally at MU compared to non-minority patients. Future research should explore additional factors contributing to adverse outcomes in minority patients. Conclusion: Patient race was not associated with decreased referral rate to specialty clinic for diabetic foot complications.