151-OR: Social Determinants of Health Predict Diabetic Foot Infection Development

The objective was to identify social determinants of health (SDOH) associated with development of diabetic foot infection using the CDC Healthy People Framework at a tertiary care center. Targeted interrogation of structured and unstructured data using novel electronic medical record search engines was used to analyze patient encounters in individuals with diabetes and a concomitant diabetic foot complication during a twenty-year period (2001-2021). Among ~ 200 million encounters from people with diabetic foot complications, 8351 developed diabetic foot ulcers (DFU), and 1671 suffered a DFU infection. The risk of infection development in people with a DFU was assessed with the neighborhood disadvantaged index score from over 200 million separate patient encounters. The neighborhood disadvantaged index based on available geolocation data, provides a unitless value to describe the relative socioeconomic background of an individual as determined by the proportion (%) of non-Hispanic black, proportion (%) of female headed families with children, and the proportion of households (%) with public assistance income or food stamps in a defined area. The average disadvantaged index score for the DFU population was 0.06 and was comparable to the state of Michigan's average disadvantaged index of 0.05. In those persons who developed DFU infection, the index score averaged 0.13, 2.2x higher than the DFU population (p<0.05). Additionally, divorced individuals represented 2% of all individuals with DFU but accounted for 5% of those who developed DFU infection. This was disproportionate to other marriage statuses. These data strongly support the need to incorporate SDOH into updated DFU standard of care guidelines. Moreover, we clearly demonstrate that SDOH, more specifically geolocation data, can be used to identify individuals who are more likely to develop DFU infection. Thus, it is essential that SDOH are included in patient risk stratification to prevent severe diabetic foot complications. Disclosure B.M.Schmidt: None. A.Burant: None. N.Baker: None. A.Katona: None. C.Martin: Advisory Panel; Nevro Corp. C.M.Holmes: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK131261-01A1, 5U01DK119083-05)