Int Wound J. 2026 Jun;23(6):e70969. doi: 10.1111/iwj.70969.
ABSTRACT
Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados’ sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.
PMID:42249595 | DOI:10.1111/iwj.70969
