Risk Factors for Foot-Related Hospitalisations in Adults With and Without Diabetes: A Systematic Review.

Eight risk factors were identified as reported in both multiple studies and low risk of bias studies for foot disease-related hospitalisations.

• The eight risk factors were: being male, having diabetes, increased HbA1c, insulin management, chronic kidney disease, peripheral neuropathy, peripheral artery disease, and no footcare within 12 months.
• These eight factors were selected because they appeared in both multiple studies and in studies rated as low risk of bias, providing a higher level of evidence.
• A total of 22 independent risk factors were reported across all 14 included studies.
• Seven of the 14 included studies were rated as low risk of bias using the Quality in Prognostic Studies (QUIPS) tool.

The systematic review identified only 14 eligible studies from 7824 screened studies investigating risk factors for foot-related hospitalisations.

• PubMed and Embase databases were searched for studies published since 1st January 2000.
• Two independent authors screened results for eligibility.
• Fourteen studies were ultimately included after full screening.
• The very low yield (14 from 7824) highlights the scarcity of research in this area.

The vast majority of included studies focused on diabetes populations, with very limited research on general or non-diabetes populations.

• Twelve of the 14 included studies investigated diabetes populations specifically.
• Only two studies investigated general populations (with and without diabetes).
• No studies were found that investigated hospitalisations for foot-related conditions other than foot disease (e.g., trauma, structural conditions).
• The authors noted 'few studies in nondiabetes populations' as a major gap in the literature.

All 14 included studies investigated only foot disease-related hospitalisation outcomes, revealing a complete absence of evidence on other foot-related hospitalisation causes.

• Foot-related conditions are described as 'a leading cause of all hospitalisations and amputations worldwide.'
• Half of foot-related hospitalisations are stated to occur in people without diabetes.
• Despite this, no studies investigated hospitalisations for other foot-related conditions such as fractures, sprains, or structural deformities.
• This represents a significant evidence gap given the broad spectrum of conditions that can lead to foot-related hospitalisation.

Being male was identified as a consistent risk factor for foot disease-related hospitalisations across multiple studies and low risk of bias studies.

• Male sex was one of the eight risk factors reported in both multiple studies and low risk of bias studies.
• It was identified alongside metabolic, vascular, neurological, and healthcare access-related factors.
• The review did not quantify a pooled effect size due to the heterogeneity of included studies.
• This finding applied primarily within diabetes populations given the study composition.

Lack of footcare within the preceding 12 months was identified as a modifiable risk factor for foot disease-related hospitalisations.

• 'No footcare within 12 months' was one of the eight key risk factors identified across multiple and low risk of bias studies.
• This is notable as it represents a potentially preventable and modifiable risk factor compared to demographic or disease-based factors.
• The finding was predominantly derived from diabetes population studies.
• The authors highlighted footcare access and utilisation as an important consideration in their conclusions.

Increased HbA1c and insulin management were identified as diabetes-specific metabolic risk factors for foot disease-related hospitalisations.

• Both increased HbA1c and insulin management were among the eight risk factors reported in multiple studies and low risk of bias studies.
• These factors reflect glycaemic control and disease severity within diabetes populations.
• Twelve of 14 studies focused on diabetes populations, meaning these factors were well-represented in the evidence base.
• Specific HbA1c thresholds or odds ratios were not reported in the abstract; findings reflect the systematic review's qualitative synthesis.

Peripheral neuropathy and peripheral artery disease were identified as consistent vascular and neurological risk factors for foot disease-related hospitalisations.

• Both peripheral neuropathy and peripheral artery disease appeared in the list of eight key risk factors supported by multiple studies and low risk of bias studies.
• These conditions are well-established complications of diabetes and contributors to foot ulceration and infection.
• Chronic kidney disease was also identified alongside these conditions as a systemic comorbidity risk factor.
• The co-occurrence of these factors in the evidence base reinforces the multifactorial nature of foot disease hospitalisation risk.