{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:28:02Z","timestamp":1793914082193,"version":"4.8.0"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diabetic foot ulcers (DFUs) present a substantial clinical and economic burden to healthcare systems around the world, with significant reductions in quality of life for those affected. We aimed to analyse the clinical and economic burden of DFU via a 5\u2010year longitudinal multi\u2010ethnic cohort study. A longitudinal analysis of inpatient and outpatient DFUs data over 5\u2009years from a university tertiary hospital in Singapore was performed. Data included baseline characteristics, clinical outcomes, hospitalisation, and outpatient details. Descriptive statistics, Kaplan\u2013Meier survival analyses, and Cox proportional hazard models were performed. Patients treated for DFUs (n\u00a0=\u00a01729, mean patient age of 63\u00b74\u2009years) were assessed. The cohort consists of Chinese (61.4%), Malay (13.5%), and Indian (18.4%) patients. Common comorbidities included peripheral arterial disease (74.8%), peripheral neuropathy (14.5%), and a median haemoglobin A1c of 9.9%. Patients underwent toe(s) amputation (36.4%), transmetatarsal amputations (16.9%), or major amputations (6\u00b75%). The mean length of inpatient stay for ulcer\u2010only, minor amputation, and major amputation was 13.3, 20.5, and 59.6\u2009days, respectively. Mean cost per patient\u2010year was US $3368 (ulcer\u2010only), US $10468 (minor amputation), and US $30131 (major amputation). Minor amputation\u2010free survival was 80.9% at 1\u2009year and 56.9% at 5\u2009years, while major amputation\u2010free survival was 97.4% at 1\u2009year and 91.0% at 5\u2009years. In conclusion, within our multi\u2010ethnic cohort of patients from the tropics, there was significant clinical and economic burden of DFUs, with a high wound per patient ratio and escalating healthcare costs corresponding to more proximal amputation levels.<\/jats:p>","DOI":"10.1111\/iwj.13540","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T15:45:55Z","timestamp":1611675955000},"page":"375-386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":132,"title":["Clinical and economic burden of diabetic foot ulcers: A 5\u2010year longitudinal multi\u2010ethnic cohort study from the tropics"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2289-5266","authenticated-orcid":false,"given":"Zhiwen Joseph","family":"Lo","sequence":"first","affiliation":[{"name":"Centre for Population Health Sciences Lee Kong Chian School of Medicine, Nanyang Technological University  Singapore Singapore"},{"name":"Vascular Surgery Service, Department of General Surgery Tan Tock Seng Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4365-9863","authenticated-orcid":false,"given":"Naren Kumar","family":"Surendra","sequence":"additional","affiliation":[{"name":"Centre for Population Health Sciences Lee Kong Chian School of Medicine, Nanyang Technological University  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshar","family":"Saxena","sequence":"additional","affiliation":[{"name":"School of Social Sciences Nanyang Technological University  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josip","family":"Car","sequence":"additional","affiliation":[{"name":"Centre for Population Health Sciences Lee Kong Chian School of Medicine, Nanyang Technological University  Singapore Singapore"},{"name":"Department of Primary Care and Public Health School of Public Health, Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health OrganizationWorld Health Organization Fact Sheet on Diabetes.2019https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes. 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