August 04, 2014
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Diabetes-related lower-extremity amputations 10 times more likely in low-income areas

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People with diabetes who live in low-income areas may be 10 times more likely to have one of their lower extremities amputated than patients with high income, according to research published in Health Affairs.

Carl D. Stevens, MD, MPH, of the David Geffen School of Medicine at UCLA, and colleagues believe the mapping method that revealed urban and rural “hot spots” in California could help target interventions for other areas in need.

“When you have diabetes, where you live directly relates to whether you’ll lose a limb to the disease,” Stevens said in a press release.

Carl D. Stevens

Carl D. Stevens

The researchers identified 7,973 lower-extremity amputations in 6,828 adults with diabetes (aged ≥45 years) using statewide facility discharge data for California in 2009. Based on residential zip codes and data from the Census Bureau, the researchers mapped amputations and poverty rates.

Neighborhood-level map comparisons demonstrated an income-based amputation disparity. Low-income neighborhoods, where more than 40 percent of households have incomes below 200 percent of poverty, had double the amputations of higher-income neighborhoods, where fewer than 10 percent of households have incomes below 200 percent of poverty.

Similar relationships were observed when the researchers looked at the entire state, and did not appreciably diminish with exclusions for toe amputations, only below-knee or only above-knee.

“The finding that people living in lower-income areas bear a disproportionate share of disability and disfigurement from amputation is deeply disturbing in a society that espouses equality and that outspends all other nations on health care for its more affluent citizens,” the researchers wrote. “We believe that our findings dictate a vigorous response from the health policy community.”

“We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014,” Stevens said in the release.

Disclosure: The study was supported by the Korein Foundation and National Center for Advancing Translational Science of the NIH.