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. 2023 May 5;12(9):3288.
doi: 10.3390/jcm12093288.

Metrics of Gender Differences in Mortality Risk after Diabetic Foot Disease

Giuseppe Seghieri  1   2 , Elisa Gualdani  1 , Piergiorgio Francia  3 , Ilaria Campesi  4 , Flavia Franconi  4 , Graziano Di Cianni  5 , Paolo Francesconi  1
Affiliations

Metrics of Gender Differences in Mortality Risk after Diabetic Foot Disease

Giuseppe Seghieri et al. J Clin Med. .

Abstract

Background: The aim of this study was to clarify any gender differences in the mortality risk of people with DFD since patients with diabetic foot disease (DFD) are at a high risk of mortality and, at the same time, are more likely to be men.

Methods: From regional administrative sources, the survival probability was retrospectively evaluated by the Kaplan-Meier method and using the Cox proportional-hazards model comparing people with DFD to those without DFD across the years 2011-2018 in Tuscany, Italy. Gender difference in mortality was evaluated by the ratio of hazard ratios (RHR) of men to women after initial DFD hospitalizations (n = 11,529) or in a cohort with prior history of DFD hospitalizations (n = 11,246).

Results: In both cohorts, the survival probability after DFD was lower among women. Compared to those without DFD, after initial DFD hospitalizations, the mortality risk was significantly (18%) higher for men compared to women. This excess risk was particularly high after major amputations but also after ulcers, infections, gangrene, or Charcot, with a lower reduction after revascularization procedures among men. In the cohort that included people with a history of prior DFD hospitalizations, except for the risk of minor amputations being higher for men, there was no gender difference in mortality risk.

Conclusions: In people with DFD, the overall survival probability was lower among women. Compared to those without DFD after a first DFD hospitalization, men were at higher risk of mortality. This excess risk disappeared in groups with a history of previous DFD hospitalizations containing a greater percentage of women who were older and probably had a longer duration of diabetes and thus becoming, over time, progressively frailer than men.

Keywords: diabetic foot disease; first-incident hospitalization; gender differences; mortality risk; ratio of hazard ratios.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves in populations after first-incident DFD hospitalization (left) or in the cohort, including people with prior hospitalizations for DFD at baseline (right) by gender (red: women, blue: men).
Figure 2
Figure 2
Ratio of adjusted HRs: RHR, men to women of all-causes mortality by DFD complications comparing people with or without DFD after a first-ever DFD hospitalization (a) or in cohort with prior DFD hospitalizations at baseline (b). In red: RHR for all complications.
See this image and copyright information in PMC

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