Who’s really footing the bill? Sex and ethnicity disparities in the cost of diabetic foot ulcer-related amputations in a major healthcare system.
By: M. Hashmi, N. Shiraliyeva, A. Herrera, H. Tabassum, C. Schechter, J.P. Daily, A. Myers | Published in: The Journal of Foot and Ankle Surgery | February 2025
[No openly-licensed figure was available for this post.]
Diabetic foot ulcers and the amputations they sometimes lead to carry an enormous human cost — loss of mobility, independence, and in too many cases, life. But the financial cost is staggering too, and it is not shared equally. Clinicians and health systems have long observed that certain communities — racial and ethnic minorities, people with low incomes, those with multiple chronic conditions — seem to bear a disproportionate burden of severe diabetic foot disease. What a new study from Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, New York, adds is a close look at who actually pays more when amputation happens — and the numbers are sobering.
The research team analysed records from 140 patients insured through HealthFirst, a Medicaid-managed plan, who were admitted for DFU-related amputation between 2021 and 2023. The cohort was majority male (65%), mean age 60.6 years, predominantly Type 2 diabetes (96%), and over half (56%) identified as Hispanic-Latino. Common comorbidities included chronic kidney disease (58%) and hypertension (86%). After adjusting for demographics and labs, Hispanic-Latino patients faced amputation charges nearly twice as high as non-Hispanic counterparts — a relative risk of 1.97 (95% CI 1.04–3.71). Patients with chronic kidney disease faced a 36% higher charge burden (RR 1.36), and there was a moderate association with female sex as well. Notably, markers of glycaemic control — HbA1c, blood glucose, BMI — were not independently linked to higher costs. It is the demographic and comorbidity profile, not how “poorly controlled” the diabetes was, that predicts who gets the biggest bill.
The study has limitations inherent to its design: this is a single-payer, single-system retrospective analysis, and HealthFirst’s Medicaid population in the South Bronx is not representative of every clinical setting. The mechanism driving higher charges for Hispanic-Latino patients is not fully explained — it may reflect later presentation, more complex wounds, language barriers, or differential coding practices. What the study cannot do is tell us how much of the disparity is preventable. But that is partly the point: the authors argue that these findings should be a prompt for targeted prevention in the communities most affected, not just a billing curiosity. For any clinician or health system serious about health equity, this paper is a concrete reminder that the starting line is not the same for everyone — and that DFU prevention, early foot screening, and culturally aligned care are investments in fairness as much as medicine.
📌 Source: Hashmi M, Shiraliyeva N, Herrera A, Tabassum H, Schechter C, Daily JP, Myers A. Who’s really footing the bill? Sex and ethnicity disparities in the cost of diabetic foot ulcer-related amputations in a major healthcare system. J Foot Ankle Surg. 2025;64(4):441–445. https://doi.org/10.1053/j.jfas.2025.01.017 | PubMed PMID: 39900332
Tags: health equity, diabetic foot ulcer, amputation, healthcare disparities, Hispanic Latino, chronic kidney disease, diabetic foot prevention, social determinants of health
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