OBJECTIVE To determine the association between social determinants of health (SDOH) and a diagnosis of diabetic foot ulcer (DFU) infection. RESEARCH DESIGN AND METHODS Targeted interrogation of electronic health record data using novel search engines to analyze individuals with a DFU infection during a 5-year period (2013–2017) was performed. We extracted geolocated neighborhood data and SDOH characteristics from the National Neighborhood Data Archive and used univariate and multiple logistic regression to evaluate associations with outcomes in the population with diabetes. RESULTS Among 4.3 million people overall and 144,564 individuals with diabetes seen between 2013 and 2017, 8,351 developed DFU, of which cases 2,252 were complicated by a DFU infection. Sex interactions occurred, as men who experienced a DFU infection more frequently identified as having nonmarried status than their female counterparts. For the population with DFU infection, there were higher rates for other SDOH, including higher neighborhood disadvantaged index score, poverty, nonmarriage, and less access to physician/allied health professionals (all P < 0.01). In multiple logistic regression, those individuals who developed DFU infection came from neighborhoods with greater Hispanic and/or foreign-born concentrations (odds ratio 1.11, P = 0.015). CONCLUSIONS We found significant differences in neighborhood characteristics driving a higher risk for DFU infection in comparisons with the grouping of individuals with diabetes overall, including increased risk for individuals with Hispanic and/or foreign-born immigration status. These data strongly support the need to incorporate SDOH, particularly ethnic and immigration status, into triage algorithms for DFU risk stratification to prevent severe diabetic foot complications and move beyond biologic-only determinants of health.

中文翻译：

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居住地址扩大了糖尿病足溃疡患者的健康差异和感染风险

目的 确定健康社会决定因素 (SDOH) 与糖尿病足溃疡 (DFU) 感染诊断之间的关联。研究设计和方法 使用新型搜索引擎对电子健康记录数据进行有针对性的询问，以分析 5 年期间（2013-2017 年）DFU 感染的个体。我们从国家邻里数据档案中提取了地理定位的邻里数据和 SDOH 特征，并使用单变量和多元逻辑回归来评估与糖尿病人群结果的关联。结果 2013 年至 2017 年间，共有 430 万人、144,564 名糖尿病患者，其中 8,351 人发展为 DFU，其中 2,252 人并发 DFU 感染。发生了性相互作用，因为经历 DFU 感染的男性比女性同行更常被认为处于未婚状态。对于 DFU 感染人群，其他 SDOH 的发生率较高，包括较高的社区弱势指数评分、贫困、未婚以及较少获得医生/专职医疗专业人员的帮助（所有 P < 0.01）。在多元逻辑回归中，那些发生 DFU 感染的人来自西班牙裔和/或外国出生人口集中的社区（比值比 1.11，P = 0.015）。结论 我们发现，与总体糖尿病患者分组相比，社区特征存在显着差异，导致 DFU 感染风险更高，包括西班牙裔和/或外国出生移民身份的个体风险增加。这些数据强烈支持将 SDOH（特别是种族和移民身份）纳入 DFU 风险分层的分诊算法中，以预防严重的糖尿病足并发症，并超越仅生物学的健康决定因素。