Ethnic disparities in mortality following hospitalization for diabetic foot ulcer

To examine ethnicity-based differences in mortality among Arab and Jewish patients hospitalized with a diabetic foot ulcer (DFU) in Israel, aiming to address disparities in diabetes care.

We conducted a single-center retrospective cohort study including all adults admitted to the multidisciplinary diabetic foot unit (2015-2019) with a DFU. Baseline demographics, comorbidities, ulcer severity, laboratory data, and outcomes were collected from electronic medical records. Outcomes included in-hospital mortality, vascular interventions, amputations, one-year mortality, and long-term mortality through 2023. We assessed the association between ethnicity and survival using Cox proportional regression models adjusted for multiple covariates. Sex-stratified analyses were also performed.

The cohort comprised 535 patients (325 [60.7%] Jews, 210 [39.3%] Arabs). DFU severity was similar across ethnicities. Arabs presented younger (62.9 ± 11.4 vs. 66.0 ± 12.8 years, p = 0.004) with higher admission glucose-levels (13.8 ± 6.7 vs. 11.4 ± 5.7 mmol/L, p < 0.001). In-hospital mortality was comparable overall (6.5% vs. 5.2%, p = 0.560), but Jewish women had higher rates than Arab women (14.3% vs. 3.1%, p = 0.022). One-year mortality was higher among Arabs (27.1% vs. 19.7%, p = 0.044), driven by men (29.7% vs. 19.6%, p = 0.022). Over a median follow-up of 3.8 years, Arab ethnicity was associated with poor survival (HR 1.31, 95% CI 1.01-1.71; p = 0.043), driven by poor survival among Arab men (HR 1.36, 95% CI 1.04-1.78; p = 0.024).

Among patients hospitalized with DFU, Arab men experienced higher long-term mortality despite comparable inpatient care. These findings highlight the importance of equitable post-discharge care and culturally tailored chronic disease management strategies to address persistent disparities in social determinants of health.