{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T23:57:13Z","timestamp":1791158233218,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic foot (DF) is a common complication among people with diabetes, typically caused by peripheral neuropathy (PN) and\/or peripheral arterial disease (PAD) of the lower limbs. The existing research mainly focuses on cases of diabetic foot ulcers, while the relationship between at-risk foot and all-cause and cardiovascular mortality in the general U.S. population remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study utilized data from National Health and Nutrition Examination Survey (NHANES) 1999\u20132004 to conduct a cohort study. At-risk foot are defined as those in diabetic people who have concurrent PAD and\/or PN, and without the presence of chronic ulcers in the lower extremities. Kaplan\u2013Meier survival analysis and Multivariable Cox regression models were used to analyze the association between at-risk foot and all-cause and cardiovascular mortality, with subgroup analyses conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 946 participants were included in the study, of which 301 had at-risk foot. The median follow-up time was 190\u202fmonths. Multivariable Cox regression analysis showed that the all-cause mortality (HR: 2.050, 95% CI: 1.524, 2.758) and cardiovascular mortality (HR: 2.494, 95% CI: 1.809, 3.438) in at-risk foot people were significantly higher than in those without at-risk foot. Additionally, people with ischemic at-risk foot had a higher risk of mortality compared to those with non-ischemic neuropathic at-risk foot.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with at-risk foot in the diabetic population are significantly associated with increased all-cause and cardiovascular mortality. Early diagnosis and intervention of PAD and PN in diabetes people are crucial for reducing mortality risk.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1584949","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T05:22:12Z","timestamp":1753075332000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The relationship between at-risk foot and all-cause and cardiovascular mortality among the population with diabetes"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhe","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e3657","DOI":"10.1002\/dmrr.3657","article-title":"Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)","volume":"40","author":"Schaper","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"j5064","DOI":"10.1136\/bmj.j5064","article-title":"Diabetic foot","volume":"359","author":"Mishra","year":"2017","journal-title":"BMJ"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e3268","DOI":"10.1002\/dmrr.3268","article-title":"Definitions and criteria for diabetic foot disease","volume":"36","author":"van Netten","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"s63","DOI":"10.2337\/diacare.27.2007.S63","article-title":"Preventive foot Care in Diabetes","volume":"27","year":"2004","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1053\/j.semvascsurg.2019.02.001","article-title":"The diabetic foot: pathophysiology, evaluation, and treatment","volume":"31","author":"Bandyk","year":"2018","journal-title":"Semin Vasc Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.2337\/dc15-0536","article-title":"Diabetes, lower-extremity amputation, and death","volume":"38","author":"Hoffstad","year":"2015","journal-title":"Diabetes Care"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.3390\/jcm9061780","article-title":"Prevalence, clinical aspects and outcomes in a large cohort of persons with diabetic foot disease: comparison between neuropathic and ischemic ulcers","volume":"9","author":"Meloni","year":"2020","journal-title":"J Clin Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"888924","DOI":"10.3389\/fendo.2022.888924","article-title":"Diabetic foot risk classification at the time of type 2 diabetes diagnosis and subsequent risk of mortality: a population-based cohort study","volume":"13","author":"Wang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.2337\/dc07-2145","article-title":"Long-term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5-year follow-up study","volume":"31","author":"Ghanassia","year":"2008","journal-title":"Diabetes Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1177\/15347346211009425","article-title":"Long-term mortality of a cohort of patients undergoing surgical treatment for diabetic foot infections. 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