Cardiovascular

Long-Term Mortality in Diabetic Foot Disease is Higher Than That of Overall Cancer: Results From Three International Cohorts.

TL;DR

Patients with diabetic foot disease showed 38%, 45%, and 499% higher risks of mortality than patients with overall cancer in the NHANES, UK Biobank, and Chongqing Diabetes Registration cohorts, respectively.

Key Findings

Diabetic foot disease was associated with significantly higher overall mortality risk compared to overall cancer across all three international cohorts.

  • DFD patients showed 38% higher risk of mortality than overall cancer patients in NHANES
  • DFD patients showed 45% higher risk of mortality than overall cancer patients in UK Biobank
  • DFD patients showed 499% higher risk of mortality than overall cancer patients in the Chongqing Diabetes Registration cohort
  • Cohorts included 527, 1784, and 601 patients with DFD respectively across NHANES, UKB, and CDR
  • Cancer cohorts included 1219, 100,643, and 152 patients respectively across NHANES, UKB, and CDR

Mortality risk in diabetic foot disease was significantly higher than in skin cancer across both NHANES and UK Biobank cohorts.

  • Hazard ratio for DFD vs. skin cancer was 10.69 (95% CI: 1.37–2.07) in NHANES
  • Hazard ratio for DFD vs. skin cancer was 3.8 (95% CI: 3.72–448) in UK Biobank
  • This represented one of the largest site-specific mortality differentials observed

Mortality risk in diabetic foot disease was significantly higher than in breast cancer across both NHANES and UK Biobank cohorts.

  • Hazard ratio for DFD vs. breast cancer was 1.35 (95% CI: 1.0–1.83) in NHANES
  • Hazard ratio for DFD vs. breast cancer was 1.95 (95% CI: 1.67–227) in UK Biobank

Mortality risk in diabetic foot disease was significantly higher than in prostate cancer across both NHANES and UK Biobank cohorts.

  • Hazard ratio for DFD vs. prostate cancer was 1.4 (95% CI: 1.8–179) in NHANES
  • Hazard ratio for DFD vs. prostate cancer was 2.61 (95% CI: 2.35–289) in UK Biobank

The mortality rate of diabetic foot disease was similar to that of several intermediate-prognosis cancers including colon cancer, lymphoma, and kidney cancer.

  • DFD mortality was comparable to colon cancer, lymphoma, and kidney cancer
  • DFD mortality was lower than that of a minority of cancers including lung, pancreatic, and liver cancers
  • These comparisons were made within the same cohorts using concurrent follow-up data

Diabetic foot disease was defined according to IWGDF 2023 guidelines and cancer was defined using ICD-10 codes across three international cohorts.

  • Cohorts used were the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and Chongqing Diabetes Registration (CDR)
  • DFD definition followed the International Working Group on the Diabetic Foot (IWGDF) 2023 guidelines
  • Cancer classification used ICD-10 codes
  • Mortality comparisons were made between DFD and both overall and site-specific cancers within the same cohort

What This Means

This research suggests that diabetic foot disease — a serious complication of diabetes involving wounds, infections, or tissue damage to the feet — carries a higher long-term risk of death than cancer overall. Analyzing data from three large international studies involving thousands of patients in the United States, United Kingdom, and China, the researchers found that people with diabetic foot disease were between 38% and 499% more likely to die during follow-up than people diagnosed with cancer in general. This challenges the common clinical assumption that diabetic foot disease has a mortality risk merely 'comparable' to cancer, suggesting the true burden may be even greater. When comparing diabetic foot disease to specific types of cancer, the picture became more nuanced. Diabetic foot disease carried a substantially higher risk of death than common cancers with relatively good survival rates, such as skin cancer, breast cancer, and prostate cancer. Its mortality was roughly similar to intermediate-prognosis cancers like colon cancer, lymphoma, and kidney cancer. Only a small number of particularly aggressive cancers — including lung, pancreatic, and liver cancers — were associated with higher mortality than diabetic foot disease. This research suggests that diabetic foot disease is a life-threatening condition whose severity is often underappreciated compared to cancer. The findings highlight a potential gap in how seriously this condition is treated and resourced in clinical practice and public health policy. Recognizing that diabetic foot disease carries mortality risks comparable to or exceeding many cancers may help justify more aggressive prevention, early intervention, and dedicated care resources for people living with diabetes.

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Citation

Zeng Q, Tang Z, Chen X, Zhan L, Balasubramanian V, Chen Z, et al.. (2026). Long-Term Mortality in Diabetic Foot Disease is Higher Than That of Overall Cancer: Results From Three International Cohorts.. Diabetes/metabolism research and reviews. https://doi.org/10.1002/dmrr.70221