Background
Methods
Data sources
1. | Aborig* |
2. | Indigenous |
3. | 1 or 2 |
4. | Australia* |
5. | 3 and 4 |
6. | Lower limb |
7. | Foot |
8. | Leg |
9. | Ankle |
10. | Ulcer |
11. | Neuro* |
12. | Amputat* |
13. | Vascular |
14. | Peripheral arterial disease |
15. | Ischaemi* |
16. | 6–15/or |
17. | 5 and 16 |
Data extraction
Assessment of study quality
Analysis
Results
Overview of included studies
Characteristics of included studies
Study ID | Study design | Location | n. of ATSI (as % of sample) | Finding |
---|---|---|---|---|
Commons [22] | Prospective single sample review of consecutive inpatients with diabetic foot infections | Darwin, NT | 144 (81.4) | Indigenous people had a greater incidence of admission (RR: 5.1; 95%CI: 3.8 to 7.0), were younger (mean difference: 11.1 years; p < 0.001), and more likely to undergo major amputations (RR: 4.1; 95%CI: 1.6 to 10.7), and minor amputation (RR: 6.2; 95%CI: 3.5 to 11.1). Non-multiresistant methicillin resistant S. aureus was present in more wounds for Indigenous people than non-Indigenous patients (44.7% vs. 20.6%; OR: 3.1; 95%CI: 1.5 to 6.4), whereas P. aeruginosa presence was significantly less (15.8% versus 46.0%; OR: 0.22; 95%CI: 0.11 to 0.45). Rate of known peripheral vascular disease was lower among Indigenous people (13.2% vs. 34.9%; p = 0.001). Rate of prior amputation among indigenous people was higher (33.3% vs. 19.0%; p = 0.043). There was no important difference in prevalence of osteomyelitis between ATSI (36.0%) and non-ATSI (34.9%). |
Ewald [25] | Clinical audit of two hospitals in Alice Springs and Tennant Creek | Tennant Creek, NT | Not reported | Indigenous people made up 89% of individuals with foot complications and 91% of separations for diabetic foot but comprised only 38% of the total regional population. |
Gilhotra [20] | Clinical audit of Dialysis Centre | Townsville, QLD | 113 (51.8) | Indigenous status was independently associated with lower limb amputation (OR: 4.98; 95%CI: 1.3 to 19.23; p = 0.02) in people with end-stage renal failure on dialysis. |
Norman [26] | Clinical audit of all lower limb amputations in WA | WA, state wide | Not reported | Among people 25 to 49 years of age with diabetes, major amputations were 38 times more likely and minor amputations 27 times more likely in ATSI than non-ATSI. 98% of amputations in Indigenous people were associated with diabetes. |
O’Rourke [27] | Clinical audit of 143 diabetes mellitus-related major amputations between 1998 and 2008 | Cairns Base Hospital, QLD | 74 (51.7) | ATSI people accounted for 51.7% of the 143 major diabetes-related amputations performed yet comprised about 9.6% of the regional population. PAD was diagnosed in 48.6% of ATSI and 11.6% of non-ATSI who underwent amputation. The mean age at the time of amputation was 56.3 years for ATSI, 14 years younger than that for non-ATSI. Pressure ulcers necessitated amputation in 4.1% of ATSI and 4.3% of non-ATSI. |
Rodrigues [28] | Clinical audit of people attending the high risk foot clinic | Townsville, QLD | 23 (17.8) | In people with diabetic foot ulcers, Indigenous ethnicity was independently associated with lower limb amputation (OR: 3.1; 95%CI: 1.17 to 9.16; p = 0.001). The mean age at amputation was similar between ATSI (mean yrs. 62.6; SD 12.5) and non-ATSI (mean yrs. 62.0; SD 11.5). |
Steffen [29] | Clinical audit of 51 patients admitted to with diabetic foot complications that required surgical intervention | Cairns Base Hospital, QLD | 29 (56.9) | Indigenous people accounted for 57% of audit cases yet comprised 13% of the regional population. Mean age at surgical intervention was 9.5 years younger in ATSI than non-ATSI people (56.5 vs. 66.0). |
Davis [30)] | Series of longitudinal observational studies | Fremantle, WA | 18 (2.2) | At baseline in people with type 2 diabetes, there were no statistically significant differences between ATSI and non-ATSI in prevalence of neuropathy (41.2% vs. 32.9%; p = 0.45); PAD (16.7% vs. 29.5%; p = 0.30) or foot ulceration (5.6% vs. 1.2%; p = 0.22). |
Davis [24] | Baseline = 37 (3.0) | In 1237 people with type 2 diabetes, Aboriginal background was identified as an independent risk factor for neuropathy (OR: 3.7; 95%CI: 1.17–11.70; p = 0.03) | ||
Davis [23] | Phase 1 = 19 (2.3) Phase 2 = 106 (11.8) | At baseline in phase 1, there were no statistically significant differences between ATSI and non-ATSI in prevalence of peripheral sensory neuropathy (38.9% vs. 33.6%; p = 0.62) or PAD (15.8% vs. 29.7%; p = 0.31). At baseline in phase 2, there were statistically significant differences between ATSI and non-ATSI in the prevalence of peripheral sensory neuropathy (48.5% vs. 63.3%; p = 0.005) and PAD (30.7% vs. 21.5%; p = 0.04). | ||
Baba [21] | 120 (4.3) | Aboriginality was independently associated with foot ulcer at baseline in pooled phase samples (OR: 4.8; 95%CI: 1.7–13.7; p = 0.004). |
Rates of foot complications in reported populations
Reported Theme | Study | Key findings |
---|---|---|
Amputation | Commons [22] | Indigenous people had a greater incidence of major amputations (RR: 4.1; 95% CI: 1.6 to 10.7), and minor amputation (RR: 6.2; 95% CI: 3.5 to 11.1). Rate of prior amputation among indigenous people was higher (33.3% vs. 19.0%; p = 0.043). |
Ewald [25] | Indigenous people made up 89% of individuals with foot complications and 91% of separations for diabetic foot but comprised only 38% of the total regional population. | |
Gilhotra [20] | Indigenous status was independently associated with lower limb amputation (OR: 4.98; 95% CI: 1.3 to 19.23; p = 0.02) in people with end-stage renal failure on dialysis. | |
Norman [26] | Among people 25 to 49 years of age with diabetes, major amputations were 38 times more likely and minor amputations 27 times more likely in ATSI than non-ATSI. 98% of amputations in Indigenous people were associated with diabetes. | |
O’Rourke [27] | ATSI people accounted for 51.7% of the 143 major diabetes-related amputations performed yet comprised about 9.6% of the regional population. The mean age at the time of amputation was 56.3 years for ATSI, 14 years younger than that for non-ATSI. | |
Rodrigues [28] | Indigenous ethnicity was independently associated with lower limb amputation (OR: 3.1; 95% CI: 1.17 to 9.16; p = 0.001). The mean age at amputation was similar between ATSI (mean yrs. 62.6; SD 12.5) and non-ATSI (mean yrs. 62.0; SD 11.5). | |
Steffen [29] | Indigenous people accounted for 57% of audit cases yet comprised 13% of the regional population. Mean age at surgical intervention was 9.5 years younger in ATSI than non-ATSI people (56.5 vs. 66.0). | |
PAD | Commons [22] | Rate of known peripheral vascular disease was lower among Indigenous people (13.2% vs. 34.9%; p = 0.001) |
O’Rourke [27] | PAD was diagnosed in 48.6% of ATSI and 11.6% of non-ATSI who underwent amputation. | |
Davis [23] | At baseline in people with type 2 diabetes, there were no statistically significant differences between ATSI and non-ATSI in prevalence of); PAD (16.7% vs. 29.5%; p = 0.30) At baseline in phase 1, there were no statistically significant differences between ATSI and non-ATSI in prevalence of PAD (15.8% vs. 29.7%; p = 0.31). At baseline in phase 2, there were statistically significant differences between ATSI and non-ATSI in the prevalence of PAD (30.7% vs. 21.5%; p = 0.04). | |
Peripheral Neuropathy | Davis [30] | At baseline in people with type 2 diabetes, there were no statistically significant differences between ATSI and non-ATSI in prevalence of neuropathy (41.2% vs. 32.9%; p = 0.45); |
Davis [24] | In 1237 people with type 2 diabetes, Aboriginal background was identified as an independent risk factor for neuropathy (OR: 3.7; 95% CI: 1.17–11.70; p = 0.03 | |
Davis [23] | At baseline in phase 1, there were no statistically significant differences between ATSI and non-ATSI in prevalence of peripheral sensory neuropathy (38.9% vs. 33.6%; p = 0.62) At baseline in phase 2, there were statistically significant differences between ATSI and non-ATSI in the prevalence of peripheral sensory neuropathy (48.5% vs. 63.3%; p = 0.005 | |
Ulceration | O’Rourke [27] | Pressure ulcers necessitated amputation in 4.1% of ATSI and 4.3% of non-ATSI. |
Rodrigues [28] | In people with diabetic foot ulcers, Indigenous ethnicity was independently associated with lower limb amputation (OR: 3.1; 95%CI: 1.17 to 9.16; p = 0.001). | |
Baba [21] | Aboriginality was independently associated with foot ulcer at baseline in pooled phase samples (OR: 4.8; 95% CI: 1.7–13.7; p = 0.004). | |
Infection | Commons [22] | Non-multi-resistant methicillin resistant S. aureus was present in more wounds for Indigenous people than non-Indigenous patients (44.7% vs. 20.6%; OR: 3.1; 95%CI: 1.5 to 6.4), whereas P. aeruginosa presence was significantly less (15.8% versus 46.0%; OR: 0.22; 95% CI: 0.11 to 0.45). |