Social and Geographical Inequalities in the Choice of Foot Therapy as Preventive Care of Diabetic Foot Ulcers: A Nationwide Registry Study on Danish Diabetes Patients

OBJECTIVES: Serious complication of diabetes are associated with high costs and adverse sequelae. One complication is diabetic foot ulcer that might lead to lower-extremity amputations. International guidelines recommend that all people with diabetes should have their feet inspected at least once a year. The aim of this study is to determining socioeconomic factors that influence the frequency of feet inspections on a nationally representative sample of diabetes patients.

METHODS: A nationwide registry for all Danish diabetes patients is used. We estimate a Logit model for the choice determinants of diabetes-related foot inspections among these diabetes patients.

RESULTS: In total, 73% of all diabetes patients fail to follow the international recommendations of annually feet inspections. Further, the study indicate social and geographical inequality with regard to diabetic foot care. Especially for ethnic minorities, people with low income and people living in rural and remote areas. The western and non-western immigrants have a 3.13% and 13.40% lower probability, respectively. The 13.40% higher probability is high considering that the average probability in the sample is approximately 25%.

CONCLUSIONS: The number of people with diabetes who use foot therapy to prevent foot ulcer is low in relation to the recommendations, and further, the use is unevenly distributed among patient characteristics. Recognising health inequalities in preventive treatments are a first step when aiming to reducing health inequalities in serious complications for people with diabetes.