# Social Determinants of Diabetes‐Related Foot Ulcer Healing and Amputation in Australia: A Systematic Review

## TL;DR

This paper reviews how social factors like poverty and geography affect diabetes foot ulcer healing and amputation rates in Australia.

## Contribution

The study systematically evaluates the impact of social determinants on diabetes-related foot ulcer outcomes in Australia for the first time.

## Key findings

- Socioeconomic disadvantage is linked to worse DFU outcomes and longer healing times.
- Geographic remoteness correlates with increased amputation rates.
- Better access to healthcare services improves DFU healing outcomes.

## Abstract

In Australia, approximately 50,000 people suffer from diabetes‐related foot ulcers (DFU) with another 300,000 people at risk each year. Evidence suggests that social determinants of health may impact DFU outcomes; however, systematic evaluation of studies is lacking. The aim of this systematic review was to evaluate studies investigating the impact of social determinants of health on DFU outcomes.

MEDLINE, EMBASE, CINAHL and Scopus were searched from inception to December 2024. Original published studies conducted in Australia investigating the impact of social determinants of health on DFU outcomes, such as wound healing, hospital admission and amputation, were potentially eligible for inclusion. Social determinants of health had to meet the World Health Organisation definition. Authors independently screened studies for inclusion, extracted data and assessed risk of bias using the Quality in Prognostic Studies tool.

Twelve studies which investigated socioeconomic status (n = 5), geographical remoteness (n = 5) and access to healthcare services (n = 7) and their impact on DFU outcomes were included. Socioeconomic disadvantage and geographic remoteness were associated with worse DFU outcomes including longer healing times and increased rates of amputation. Access to health services, which aligned with guideline recommendations, was associated with improved DFU healing outcomes.

Social determinants of health impact DFU outcomes and are important for clinicians, policy makers and researchers to consider in the design and delivery of health care services. Further research is needed to explore the impact of social determinants of health on a broader range of DFU outcomes and across diverse geographical settings.