title: Foot ulcer risk is lower in South-Asian and african-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study.
abstract: OBJECTIVE
  To determine 1) foot ulcer rates for European, South-Asian, and African-Caribbean diabetic patients in the U.K and 2) the contribution of neuropathy and peripheral arterial disease (PAD) differences to altered ulcer risk between the groups.
  
  
  METHODS
  In this U.K. population-based study, we screened 15,692 type 1 and type 2 diabetic patients in the community health care setting for foot ulcers, foot deformities, neuropathy, and PAD plus other characteristics. In total, 13,409 were European (85.5%), 1,866 were South Asian (11.9%), and 371 were African Caribbean (2.4%).
  
  
  RESULTS
  The age-adjusted prevalence of diabetic foot ulcers (past or present) for Europeans, South Asians, and African Caribbeans was 5.5, 1.8, and 2.7%, respectively (P < 0.0001). Asians and African Caribbeans had less neuropathy, PAD, and foot deformities than Europeans (P = 0.003). The unadjusted risk of ulcer (odds ratio [OR]) for Asians versus Europeans was 0.29 (95% CI 0.20-0.41) (P < 0.0001). PAD, neuropathy, foot deformities, and insulin use attenuated the age-adjusted OR from 0.32 to 0.52 (0.35-0.76) (P < 0.0001). African-Caribbean versus European ulcer risk in males was attenuated from 0.60 to 0.71 by vibration sensation.
  
  
  CONCLUSIONS
  South Asians with diabetes in the U.K. have about one-third the risk of foot ulcers of Europeans. The lower levels of PAD, neuropathy, insulin usage, and foot deformities of the Asians account for approximately half of this reduced foot ulcer risk. Lower neuropathy is the main contributor to the reduced African-Caribbean ulcer rate, particularly in men. The reasons for these ethnic differences warrant further investigation.
authors.affiliation: Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, UK. ca.abbott@btinternet.com
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Abbott
authors.forename: Adam P
authors.initials: AP
authors.lastname: Garrow
authors.forename: Anne L
authors.initials: AL
authors.lastname: Carrington
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: Ernest R
authors.initials: ER
authors.lastname: Van Ross
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D001208:Asia / Q000453:epidemiology; D044466:Asian People; D044383:Black People; D017691:Caribbean Region / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000628:therapy; D017719:Diabetic Foot / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology