Association Between Frailty and Diabetic Foot Ulceration: A Cross-Sectional Analysis of NHANES Data

Objective To investigate the association between frailty and diabetic foot ulcer (DFU) risk among patients with diabetes and to evaluate the frailty index as a potential predictive tool. Methods This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES). Participants were categorized into frailty Z-score quartiles. Survey-weighted generalized linear models (SWGLMs) were used to evaluate the association between Frailty and DFU, with restricted cubic spline (RCS) analysis to examine non-linear relationships. Subgroup and interaction analyses were also conducted. Results Among 831 adults with diabetes (mean age 59.2 years; 49.6% female), higher frailty scores were significantly associated with increased DFU risk. After multivariate adjustment, each standard deviation increase in frailty Z-score was linked to a 92% higher DFU risk (OR = 1.92, 95% CI: 1.34-2.73, P < 0.001). Participants in the highest frailty quartile had a nearly 5-fold increased risk compared to the lowest (OR = 5.95, 95% CI: 0.44-30.0, P = 0.033), with a significant dose-response trend (P for trend=0.023). RCS analysis supported a significant overall association (P < 0.001), showing a primarily linear relationship (P for nonlinearity=0.207). Subgroup analyses revealed consistent associations without significant interactions. Conclusions Frailty is independently associated with elevated DFU risk among patients with diabetes. The frailty index may serve as a useful adjunct to conventional risk factors for early identification of high-risk individuals.