Table 2 Summary of included studies

Commons [22]

Prospective single sample review of consecutive inpatients with diabetic foot infections

Darwin, NT

144 (81.4)

Indigenous people had a greater incidence of admission (RR: 5.1; 95%CI: 3.8 to 7.0), were younger (mean difference: 11.1 years; p < 0.001), and more likely to undergo major amputations (RR: 4.1; 95%CI: 1.6 to 10.7), and minor amputation (RR: 6.2; 95%CI: 3.5 to 11.1).

Non-multiresistant methicillin resistant S. aureus was present in more wounds for Indigenous people than non-Indigenous patients (44.7% vs. 20.6%; OR: 3.1; 95%CI: 1.5 to 6.4), whereas P. aeruginosa presence was significantly less (15.8% versus 46.0%; OR: 0.22; 95%CI: 0.11 to 0.45). Rate of known peripheral vascular disease was lower among Indigenous people (13.2% vs. 34.9%; p = 0.001). Rate of prior amputation among indigenous people was higher (33.3% vs. 19.0%; p = 0.043). There was no important difference in prevalence of osteomyelitis between ATSI (36.0%) and non-ATSI (34.9%).

Ewald [25]

Clinical audit of two hospitals in Alice Springs and Tennant Creek

Tennant Creek, NT

Not reported

Indigenous people made up 89% of individuals with foot complications and 91% of separations for diabetic foot but comprised only 38% of the total regional population.

Gilhotra [20]

Clinical audit of Dialysis Centre

Townsville, QLD

113 (51.8)

Indigenous status was independently associated with lower limb amputation (OR: 4.98; 95%CI: 1.3 to 19.23; p = 0.02) in people with end-stage renal failure on dialysis.

Norman [26]

Clinical audit of all lower limb amputations in WA

WA, state wide

Not reported

Among people 25 to 49 years of age with diabetes, major amputations were 38 times more likely and minor amputations 27 times more likely in ATSI than non-ATSI. 98% of amputations in Indigenous people were associated with diabetes.

O’Rourke [27]

Clinical audit of 143 diabetes mellitus-related major amputations between 1998 and 2008

Cairns Base Hospital, QLD

74 (51.7)

ATSI people accounted for 51.7% of the 143 major diabetes-related amputations performed yet comprised about 9.6% of the regional population. PAD was diagnosed in 48.6% of ATSI and 11.6% of non-ATSI who underwent amputation. The mean age at the time of amputation was 56.3 years for ATSI, 14 years younger than that for non-ATSI. Pressure ulcers necessitated amputation in 4.1% of ATSI and 4.3% of non-ATSI.

Rodrigues [28]

Clinical audit of people attending the high risk foot clinic

Townsville, QLD

23 (17.8)

In people with diabetic foot ulcers, Indigenous ethnicity was independently associated with lower limb amputation (OR: 3.1; 95%CI: 1.17 to 9.16; p = 0.001). The mean age at amputation was similar between ATSI (mean yrs. 62.6; SD 12.5) and non-ATSI (mean yrs. 62.0; SD 11.5).

Steffen [29]

Clinical audit of 51 patients admitted to with diabetic foot complications that required surgical intervention

Cairns Base Hospital, QLD

29 (56.9)

Indigenous people accounted for 57% of audit cases yet comprised 13% of the regional population. Mean age at surgical intervention was 9.5 years younger in ATSI than non-ATSI people (56.5 vs. 66.0).

Davis [30)]

Series of longitudinal observational studies

Fremantle, WA

18 (2.2)

At baseline in people with type 2 diabetes, there were no statistically significant differences between ATSI and non-ATSI in prevalence of neuropathy (41.2% vs. 32.9%; p = 0.45); PAD (16.7% vs. 29.5%; p = 0.30) or foot ulceration (5.6% vs. 1.2%; p = 0.22).

Davis [24]

Baseline = 37 (3.0)

In 1237 people with type 2 diabetes, Aboriginal background was identified as an independent risk factor for neuropathy (OR: 3.7; 95%CI: 1.17–11.70; p = 0.03)

Davis [23]

Phase 1 = 19 (2.3)

Phase 2 = 106 (11.8)

At baseline in phase 1, there were no statistically significant differences between ATSI and non-ATSI in prevalence of peripheral sensory neuropathy (38.9% vs. 33.6%; p = 0.62) or PAD (15.8% vs. 29.7%; p = 0.31). At baseline in phase 2, there were statistically significant differences between ATSI and non-ATSI in the prevalence of peripheral sensory neuropathy (48.5% vs. 63.3%; p = 0.005) and PAD (30.7% vs. 21.5%; p = 0.04).

Baba [21]

120 (4.3)

Aboriginality was independently associated with foot ulcer at baseline in pooled phase samples (OR: 4.8; 95%CI: 1.7–13.7; p = 0.004).