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Table 3 Thematic summary of included study findings

From: Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians

Reported Theme Study Key findings
Amputation Commons [22] Indigenous people had a greater incidence of 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).
Rate of prior amputation among indigenous people was higher (33.3% vs. 19.0%; p = 0.043).
Ewald [25] 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] 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] 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] ATSI people accounted for 51.7% of the 143 major diabetes-related amputations performed yet comprised about 9.6% of the regional population.
The mean age at the time of amputation was 56.3 years for ATSI, 14 years younger than that for non-ATSI.
Rodrigues [28] 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] 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).
PAD Commons [22] Rate of known peripheral vascular disease was lower among Indigenous people (13.2% vs. 34.9%; p = 0.001)
O’Rourke [27] PAD was diagnosed in 48.6% of ATSI and 11.6% of non-ATSI who underwent amputation.
Davis [23] At baseline in people with type 2 diabetes, there were no statistically significant differences between ATSI and non-ATSI in prevalence of); PAD (16.7% vs. 29.5%; p = 0.30)
At baseline in phase 1, there were no statistically significant differences between ATSI and non-ATSI in prevalence of 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 PAD (30.7% vs. 21.5%; p = 0.04).
Peripheral Neuropathy Davis [30] 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);
Davis [24] 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] 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)
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
Ulceration O’Rourke [27] Pressure ulcers necessitated amputation in 4.1% of ATSI and 4.3% of non-ATSI.
Rodrigues [28] 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).
Baba [21] 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).
Infection Commons [22] Non-multi-resistant 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).