Is ethnicity an appropriate measure of health care marginalization? A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in Aboriginal populations
Open Access
- 22 September 2021
- journal article
- review article
- Published by CMA Impact Inc. in Canadian Journal of Surgery
- Vol. 64 (5), E476-E483
- https://doi.org/10.1503/cjs.004619
Abstract
Background Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. Methods We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). Results Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04–3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. Conclusion Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.Keywords
This publication has 28 references indexed in Scilit:
- Incidence and Prevalence of Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta, CanadaPLOS ONE, 2015
- Temporal changes in the prevalence and associates of foot ulceration in type 2 diabetes: The Fremantle Diabetes StudyJournal of Diabetes and its Complications, 2015
- Economic burden of illness associated with diabetic foot ulcers in CanadaBMC Health Services Research, 2015
- Pilot study to assess measures to be used in the prospective audit of the management of foot ulcers in people with diabetesDiabetic Medicine, 2014
- Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal peopleFoot and Ankle Surgery, 2008
- Estimating chronic disease prevalence among the remote Aboriginal population of the Northern Territory using multiple data sourcesAustralian and New Zealand Journal of Public Health, 2008
- Foot and Ankle Problems of Aboriginal and Non-Aboriginal Diabetic Patients with End-Stage Renal DiseaseFoot & Ankle International, 2007
- Incidence and risk factors for newly acquired hepatitis C virus infection among Aboriginal versus non-Aboriginal Canadians in six regions, 1999–2004European Journal of Clinical Microbiology & Infectious Diseases, 2007
- Diabetic lower extremity infection: Influence of physical, psychological, and social factorsJournal of Diabetes and its Complications, 2005
- The Effect of Race and Sex on Physicians' Recommendations for Cardiac CatheterizationThe New England Journal of Medicine, 1999