(CR-014 (RPT-005)) Exploring Socioeconomic and Clinical Predictors of Diabetic Foot Ulcer Healing: A Post-Hoc Analysis

Nina Kovolyan, CRC – Clinical Research Coordinator, Kent State University

Introduction:

Diabetic foot ulcers (DFUs) are a major complication of diabetes, with healing outcomes influenced by clinical and social determinants. This post-hoc analysis investigates the relationship between Area Deprivation Index (ADI), clinical predictors and DFU healing among recent randomized clinical trial participants of in inner-city clinic.

Methods:

Data from 50 DFU patients were analyzed using their 9-digit ZIP codes to obtain ADI scores (scale 0–100). The primary outcome was ulcer healing (binary: healed vs. not healed). Explanatory variables included ADI, gender, age, race, and Wagner Grade. Statistical methods included point biserial correlation, Wilcoxon rank sum tests, binary logistic regression, and generalized additive models (GAMs).

Results:

• Correlation Analysis: ADI showed a weak positive correlation with healing (r = 0.216), though not statistically significant (Wilcoxon p = 0.1366).


• Regression Findings: Wagner Grade was a significant predictor of healing (β = -2.767, p = 0.0057), with higher grades associated with lower healing rates.


• GAM
  
  Results: Wagner Grade remained significant (β = -3.233, p = 0.0024). Hispanic race showed marginal significance (β = -1.961, p = 0.0567).


• Additional Insight: Wagner Grade correlated negatively with healing (r = -0.340), reinforcing its clinical importance.

Discussion:

While ADI showed a weak, non-significant trend toward improved healing with higher deprivation scores indicating that patients from more socioeconomically disadvantaged areas may experience slightly worse healing outcomes. However, Wagner Grade emerged as a highly significant predictor of healing (β = -2.767, p = 0.0057), with higher grades strongly associated with reduced healing likelihood. These findings highlight the need for further investigation into socioeconomic factors and their interaction with clinical severity in DFU outcomes.