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The rate of diabetes-related amputations is rising in Ethiopia. However, the incidence of diabetic foot ulcer and its predictors were less studied in Ethiopia, particularly in the study area. An institution-based retrospective cohort study was conducted. Systematic random sampling was used to select a sample of 321 patients out of 1050 diabetes patients. Data were entered into EpiData and analysed using SPSS. Kaplan-Meier survivor functions were used for survival analysis. Cox proportional hazard regression was used to identify predictors, and multivariable analysis was declared with a\n                    <jats:italic>p<\/jats:italic>\n                    \u2009\u2264\u20090.25. The incidence of diabetic foot ulcers was 1.01 per 100 person-years (95%: CI, 0.74\u20131.40. Obesity (AHR\u2009=\u20092.94: 95% CI: 1.11\u20137.79), neuropathy (AHR\u2009=\u20092.94: 95% CI: 1.47\u20135.90), rural residence (AHR\u2009=\u20092.73: 95% CI: 1.27\u20135.88), hypertension (AHR\u2009=\u20095.61: 95% CI: 2.49\u201312.90), age\u2009\u2265\u200970 years (AHR\u2009=\u200915.03: 95% CI: 3.58\u201363.10) and abnormal high-density lipoprotein (AHR\u2009=\u20093.71: 95% CI: 1.81\u20137.62) increased the hazard of diabetic foot ulcer. The overall incidence of diabetic foot ulcers was relatively low in this cohort. We recommend targeted intervention, including regular screening, patient education, and early therapeutic management.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-19253-7","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T09:24:42Z","timestamp":1760088282000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Incidence of diabetic foot ulcer and its predictors among adult diabetes patients in Northern Ethiopia: a retrospective cohort study"],"prefix":"10.1038","volume":"15","author":[{"given":"Yohannes Terefe","family":"Ayalew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behailu Tariku","family":"Derseh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enguday Demeke","family":"Gebeyaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6163-5527","authenticated-orcid":false,"given":"Hailemelekot Bekele","family":"Kebede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"Supplement_1","key":"19253_CR1","first-page":"S27","volume":"48","author":"ADAPP Committee","year":"2024","unstructured":"Committee, A. 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The studies involving humans were approved by the Institutional Review Board of Debre Berhan University, Asrat Weldeyes Health Science Campus (IRB-021\/2022). The ethical letter was submitted to the Debre Berhan Comprehensive Specialised Hospital manager to get permission for data extraction. Then we got a permission letter from the hospital manager. Data extractors and concerned official bodies in the hospital were informed about the purpose of the study. All participants were provided informed consent during the study. In addition, consent was obtained from the hospital administration to access patient charts and other necessary records. Information retrieved from the charts was kept strictly confidential, and no personal identifiers were disclosed. 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