Housing area and foot health in diabetics: association with socioeconomic profile, clinical conditions, and self-care

Abstract

Introduction: Diabetic foot is one of the chronic complications with the highest morbidity, mortality, and socioeconomic impact, especially among more vulnerable individuals and those living in rural areas. Objective: To assess the relationship between area of residence and foot health in individuals with Diabetes Mellitus (DM), considering socioeconomic profile, clinical conditions, and self-care practices. Methods: This is an observational, cross-sectional, and quantitative study approved by the Ethics and Research Committee of the Federal University of the São Francisco Valley. It was conducted in Primary Health Care Units in Petrolina, Pernambuco (PE) and included 103 individuals with diabetes, residing in urban (n=75) and rural (n=28) areas. Data collection involved a structured questionnaire addressing socioeconomic variables, clinical conditions, and foot self-care practices, as well as an assessment of protective sensation loss (PSL) using a 10 g Semmes-Weinstein monofilament. Results: The sample had a mean age of 58.3± years, mostly composed of women (75.7%), self-declared as Brown (55.3%) and Black (29.1%), and single, widowed, or divorced (55.3%). There was a predominance of low educational attainment (illiterate or with incomplete primary education) (61.2%) and low socioeconomic levels – class C (63.1%). Most participants had been diagnosed with DM for over 5 years (54.4%), were non-insulin dependent (69.9%), and had comorbidities such as obesity combined with hypertension (37.9%) or isolated hypertension (25.2%), as well as complications like diabetic retinopathy (15.9%). The majority (85.4%) had no history of previous foot ulcers. Adherence to regular physical activity was low (26.2%), but health monitoring indicators were satisfactory (70% had undergone two or more monitoring tests, and 88.4% attended two or more medical consultations in the past year). Periodic foot assessments were reported by 59.2% of participants, and PSL was found in 31.1%. The comparison between housing areas revealed a significant association only with lower education levels among rural residents and higher PSP among urban residents (p<0.005). Social class did not predict previous ulcers, therapeutic choices, or protective sensation loss (p>0.05). Conclusions: The findings suggest that protective sensation loss is more associated with urban residence, contradicting the expected greater vulnerability in rural areas.