Epidemiology and healthcare access inequities in diabetic foot disease: a retrospective study in Central Queensland, Australia

Abstract

Objectives: Diabetic foot disease (DFD) requires proactive healthcare management to minimise the risk of complications. Healthcare delivery has been shown to present significant challenges in rural and regional settings with Central Queensland being a large geographic area with limited local healthcare resources. Our objectives are to describe the distribution of DFD in a regional setting and assess the impact of remoteness on healthcare accessibility for this cohort.

Design: A retrospective analysis of hospital admissions for DFD data between January 2017 and December 2023.

Setting, participants: All recorded episodes of care for DFD patients provided by Central Queensland Hospital and Health Service (CQHHS) were included.

Primary and secondary outcome measures: Primary outcome was the number of DFD episodes. Secondary outcomes included the number of hospital bed days used by DFD cases, the number of lower extremity amputations and the number of interhospital transfers (IHTs) for DFD cases.

Results: 1597 DFD episodes, 15 528 bed days, 340 lower extremity amputations and 452 IHTs were recorded. Population-adjusted outcomes showed 1054 DFD episodes per 100 000 males compared with 383 per 100 000 females (incidence rate ratio (IRR) 2.75, 95% CI: 2.46 to 3.07), and 1384 per 100 000 Indigenous Australians compared with 669 per 100 000 non-Indigenous Australians (IRR 2.07, 95% CI: 1.80 to 2.38). Remoteness was associated with lower DFD treatment completion rates at local hospitals, with only 9.3% of patients from the most remote regions completing treatment locally, compared with 76.3% from the least remote regions (p<0.001). The number of IHTs and amputations referred to healthcare facilities external to CQHHS increased throughout the study period.

Conclusions: Males and Indigenous Australians were disproportionately affected by DFD in Central Queensland. Remoteness poses a significant risk factor to completing treatment for DFD at a local facility. Further research into key drivers leading to the disproportionate outcomes demonstrated in this study between specific cohorts of people with DFD is suggested to help design future interventions to improve accessibility and outcomes.

Keywords: Australian Aboriginal and Torres Strait Islander Peoples; Diabetic foot; Health Equity; Health Services Accessibility; PUBLIC HEALTH.

Figure 1. Line graph of total annual and average bed days for DFD in CQHHS between January 2017 and December 2023. CQHHS, Central Queensland Hospital and Health Service; DFD, diabetic foot disease; IHT, interhospital transfer.

Figure 2. Line graph of amputations for DFD for CQHHS patients between January 2017 and December 2023. CQHHS, Central Queensland Hospital and Health Service; DFD, diabetic foot disease.

Figure 3. Line graph of interhospital transfers for DFD in CQHHS between January 2017 and December 2023. CQHHS, Central Queensland Hospital and Health Service; DFD, diabetic foot disease; IHTs, interhospital transfers.