Introduction and Objective: Low-income populations often use public transit to access healthcare. We hypothesized transit access impacts diabetic foot ulcer (DFU) outcomes as limb salvage requires frequent outpatient visits. We investigated the association between public transit availability and amputation-free survival after DFU hospitalizations.Methods: All patients residing in metropolitan Atlanta and admitted with a DFU to four Atlanta hospitals between 2016-21 were included. We calculated post-hospitalization amputation-free survival to estimate amputation hazard ratio (HR) with death as a competing risk. Census tract per square mile and per capita public transit frequency were the independent variables, and we calculated adjusted HRs (aHR) for age, sex, race, PAD, and ESRD.Results: Among 2864 patients, 949 (33%) died or had an amputation post-hospital discharge (table). For every 0.1 additional transit opportunities per capita, the amputation aHR was 0.969 (95%CI 0.939-0.999, p=.03). For every 100 additional transit opportunities per square mile, the amputation aHR was 1.008 (95%CI 1.006-1.177, p=0.4).Conclusion: Public transit frequency per capita protected against limb loss, but the frequency per square mile had an adverse impact on limb loss. Patient-centric data on transit barriers and use of transit for healthcare access is needed to explain these apparently contradictory census tract level findings.
M. Schechter: None. J.W. Wei: None. R.R. DSouza: None. H. Zhang: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. L.A. Waller: None. H.H. Chang: None.
This study was supported by the National Institute on Minority Health and Health Disparities (R21MD017943) and the Emory University Woodruff Health Sciences Center Synergy Award
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