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In a unique academic center serving urban public, private, and veteran patients, we investigated amputation and healing rates and specific risk factors for disparate treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review of diabetic patients with a new diagnosis of a foot ulcer at geographically adjacent, but independent public, private, and <jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>eterans <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>dministration (<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>) hospitals was conducted. Healing and lower extremity amputation outcomes were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across the three hospitals, 234 patients met the inclusion criteria. Patients at the <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> hospital were older (mean 72.5 years; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and had gangrenous ulcers (mean 14.1%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) compared with patients in the private and public hospitals. Public hospital patients were mostly <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ispanic (mean 54%; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) with a shorter duration of diabetes (mean 12.8 years; <jats:italic>P<\/jats:italic>\u2009=\u20090.02), but were more poorly controlled than <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> and private hospital patients (<jats:italic>P<\/jats:italic>\u2009\u2264\u20090.001). Prior amputation (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] 1.97; <jats:italic>P<\/jats:italic>\u2009=\u20090.016) and non\u2010<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>aucasian race (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.42; <jats:italic>P<\/jats:italic>\u2009=\u20090.004) increased the risk of amputation on multivariate analysis. Osteomyelitis (<jats:italic>P<\/jats:italic>\u2009=\u20090.0371) and gangrene (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) are independent risk factors for amputation. Across all three hospitals, 42.3% of patients were treated by amputation (6.8% private, 12% public and 23.5% <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a single triumvirate health care system where the patient population is stratified primarily by insurance, <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> patients have significantly higher amputation rates compared with patients at adjacent private and public hospitals. The <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> patients are largely racial minorities with advanced <jats:styled-content style=\"fixed-case\">DFU<\/jats:styled-content> progression to gangrenous ulcers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.12050","type":"journal-article","created":{"date-parts":[[2013,4,2]],"date-time":"2013-04-02T07:26:42Z","timestamp":1364887602000},"page":"68-75","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Disparities in initial presentation and treatment outcomes of diabetic foot ulcers in a public, private, and Veterans Administration hospital (\u5728\u516c\u7acb\u3001\u79c1\u7acb\u4ee5\u53ca\u9000\u4f0d\u519b\u4eba\u7ba1\u7406\u5c40\u533b\u9662\u4e2d\u7684\u7cd6\u5c3f\u75c5\u8db3\u6e83\u75a1\u7684\u6700\u521d\u8868\u73b0\u4e0e\u6cbb\u7597\u7ed3\u679c\u7684\u5dee\u5f02)"],"prefix":"10.1111","volume":"6","author":[{"given":"Sheila N.","family":"Blumberg","sequence":"first","affiliation":[{"name":"Department of Surgery New York University School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen M.","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery New York University School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,29]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011","author":"Centers for Disease Control and Prevention","year":"2011"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.5.1047"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-2425"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-1296"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.13.5.513"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.06.006"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.03.06.dc05-1992"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2005.07.005"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-006-0431-0"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2006.03.006"},{"key":"e_1_2_8_12_1","first-page":"490","article-title":"The influence of sepsis and ischemia on the natural history of the diabetic foot","volume":"53","author":"Klamer TW","year":"1987","journal-title":"Am Surg"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2006.08.002"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-9017"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2005.00083.x"},{"key":"e_1_2_8_16_1","first-page":"334","article-title":"Family poverty accounts for differences in lower\u2010extremity amputation rates of minorities 50 years old or more with diabetes","volume":"97","author":"Wachtel MS","year":"2005","journal-title":"J Natl Med Assoc"},{"key":"e_1_2_8_17_1","unstructured":"Centers for Disease Control and Prevention.2011 National Diabetes Fact Sheet 2011. 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