Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019
Introduction There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.Research design and methods We used visit-level data from the Georgia 2016–2019 Healthcare Cost and Utilization Project database and...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/12/6/e004461.full |
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| author | Mohammed K Ali Lance Waller Rohan D'Souza Howard H Chang Lauren T Vanasse Marcos C Schechter |
| author_facet | Mohammed K Ali Lance Waller Rohan D'Souza Howard H Chang Lauren T Vanasse Marcos C Schechter |
| author_sort | Mohammed K Ali |
| collection | DOAJ |
| description | Introduction There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.Research design and methods We used visit-level data from the Georgia 2016–2019 Healthcare Cost and Utilization Project database and obtained transportation variables from open sources. Using Bayesian spatial-temporal models, we assessed the associations between transportation and DFU-related amputations within each quartile of poverty status indicators at the ZIP code tabulation area (ZCTA) level. We used the proportion of adults who use public transportation to commute, distance to nearest transit stop, and per capita expense on public transportation as proxies for public transportation reliance, availability, and both, respectively.Results Of 114 606 DFUs, 21 388 (19%) were associated with a major or minor amputation. Among ZCTAs at the highest income quartile, reduced amputation risk was associated with the proportion of adults who use public transportation to commute to work (relative risk (RR)=0.29, 95% CI 0.09 to 0.97 per IQR increase of 1.13%) and per capita expense on public transportation (RR=0.78, 95% CI 0.63 to 0.78 per IQR increase of 6 cents). In metropolitan Georgia, a 1 IQR (261 m) increase in distance to the nearest transit stop was associated with lower amputation risk among ZCTAs at the lowest income quartile (RR=0.47, 95% CI 0.26 to 0.85).Conclusion In Georgia, public transportation reliance and availability are protective against DFU-related amputations in high-income but not among low-income ZCTAs. Reducing disparities in DFU-related amputations requires interventions to mitigate transportation barriers to care. |
| format | Article |
| id | doaj-art-8167a02b1d1e467285e8920404bb3cff |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-8167a02b1d1e467285e8920404bb3cff2025-01-09T12:30:12ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972024-12-0112610.1136/bmjdrc-2024-004461Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019Mohammed K Ali0Lance Waller1Rohan D'Souza2Howard H Chang3Lauren T Vanasse4Marcos C Schechter5Family and Preventive Medicine, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USADepartment of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA2 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory Univeristy, Atlanta, Georgia, USA1 Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA2 Emory University, Atlanta, Georgia, USADeparment of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia, USAIntroduction There are limited data regarding the associations between public transportation reliance, availability, and diabetic foot ulcer (DFU)-related amputations.Research design and methods We used visit-level data from the Georgia 2016–2019 Healthcare Cost and Utilization Project database and obtained transportation variables from open sources. Using Bayesian spatial-temporal models, we assessed the associations between transportation and DFU-related amputations within each quartile of poverty status indicators at the ZIP code tabulation area (ZCTA) level. We used the proportion of adults who use public transportation to commute, distance to nearest transit stop, and per capita expense on public transportation as proxies for public transportation reliance, availability, and both, respectively.Results Of 114 606 DFUs, 21 388 (19%) were associated with a major or minor amputation. Among ZCTAs at the highest income quartile, reduced amputation risk was associated with the proportion of adults who use public transportation to commute to work (relative risk (RR)=0.29, 95% CI 0.09 to 0.97 per IQR increase of 1.13%) and per capita expense on public transportation (RR=0.78, 95% CI 0.63 to 0.78 per IQR increase of 6 cents). In metropolitan Georgia, a 1 IQR (261 m) increase in distance to the nearest transit stop was associated with lower amputation risk among ZCTAs at the lowest income quartile (RR=0.47, 95% CI 0.26 to 0.85).Conclusion In Georgia, public transportation reliance and availability are protective against DFU-related amputations in high-income but not among low-income ZCTAs. Reducing disparities in DFU-related amputations requires interventions to mitigate transportation barriers to care.https://drc.bmj.com/content/12/6/e004461.full |
| spellingShingle | Mohammed K Ali Lance Waller Rohan D'Souza Howard H Chang Lauren T Vanasse Marcos C Schechter Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 BMJ Open Diabetes Research & Care |
| title | Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 |
| title_full | Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 |
| title_fullStr | Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 |
| title_full_unstemmed | Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 |
| title_short | Spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of Georgia: 2016–2019 |
| title_sort | spatial associations between measures of public transportation and diabetic foot ulcer outcomes in the state of georgia 2016 2019 |
| url | https://drc.bmj.com/content/12/6/e004461.full |
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