Are people with diabetes on an equal footing? Examining administrative healthcare data for variables associated with diabetes foot-related hospital admissions in Aotearoa New Zealand
Aim: We investigated hospitalisations caused by diabetes-related foot disease (DFD) in Aotearoa New Zealand, focusing on inequalities between Māori and non-Māori, preceding contacts with the health service as opportunities for earlier intervention, strategies to improve outcomes, and gaps in routine data collection to guide improvements in care. Methods: Hospitalisations caused by DFD in people aged ≥15 years were identified using ICD10-AM discharge codes in (a) Auckland City Hospital (ACH) between 1 Jul 2014 to 30 Jun 2019 and (b) 2016 national cohort from the Virtual Diabetes Register (VDR) between 1 January 2017 to 31 December 2021. Data from 4,944 individuals in the ACH study was used to examine trends, length of stay, and preceding contacts with the health service. Data from 236,871 individuals in the VDR was used to examine sociodemographic and clinical predictors of DFD-caused hospitalisations and patterns of health service utilisation. A scoping review of DFD interventions for Indigenous populations in high-income countries was conducted. Findings: At ACH, DFD-caused hospitalisations accounted for 14% of admissions and 24% of bed days in people with diabetes, with amputations in approximately 20% of cases. Hospitalisation rates increased by 86% over five years, with Māori experiencing the highest rate (7.5 per 1,000 person-years) compared to non-Māori (4.1). Nationally, Māori had a 1.7-fold higher unadjusted risk of DFD-caused hospitalisation. After adjustment, key predictors included renal replacement therapy, high comorbidity burden, >15% cardiovascular risk, and use of insulin or anti-gout medication. Māori had fewer podiatry and vascular visits and more emergency department contacts. Data on foot screening and referrals for preventive podiatry care could not be tracked. As a result, a national foot screening indicator was proposed. The scoping review highlighted the Feet for Life programme, an Indigenous-led, community-based approach to DFD prevention in Aotearoa reported in 2010. Conclusion: DFD-caused hospitalisations in Aotearoa are a growing burden which disproportionately affects Māori, underscoring the need for culturally responsive Preventive interventions. Cardio-renal metabolic disease was strongly associated with DFD complications. Monitoring DFD-caused hospitalisations when combined with integrated linked data and enhanced foot screening data collection offers greater potential to inform system-level improvements.
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