Poor People With Diabetes Are Up to 10 Times More Likely to Lose A Limb
ByLow-income diabetics may be more likely to lose a limb than wealthier patients, according to a recent study USA Today reported.
Researchers from the University of California, Los Angeles (UCLA) found that poor people with diabetes are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas. Earlier diagnosis and proper treat could prevent many of these amputations.
"When you have diabetes, where you live directly relates to whether you'll lose a limb to the disease," Carl Stevens, lead author of the study and emergency physicians for 30 years at Harbor-UCLA Medical Center, said in a statement. "Millions of Californians have undergone preventable amputations due to poorly managed diabetes. 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."
For the study, researchers analyzed data from the UCLA Center for Health Policy Research's California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by ZIP code. They blended these statistics with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetes-related amputations by ZIP code.
"Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level," said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. "Amputation rates in California were 10 times higher in the poorest neighborhoods, like Compton and East Los Angeles, than in the richest neighborhoods, such as Malibu and Beverly Hills."
In 2009, California doctors surgically removed nearly 8,000 legs, feet and toes from 6,800 people with diabetes. Roughly 1,000 of these patients underwent two or more amputations. On average, 20 diabetic Californians were wheeled into the operating room each day for an amputation.
Based on the findings, not only did diabetic residents of low-income neighborhoods like San Fernando have a tenfold higher risk of at least one amputation, compared with patients in, say, tonier Hermosa Beach, but that race also played a significant role.
Less than 6 percent of diabetic Californians are African American, yet blacks accounted for nearly 13 percent of the patient population undergoing one or more amputations in 2009. Conversely, Asians made up 12 percent of the diabetic population yet had less than 5 percent of diabetes-related amputations that year.
Amputation patients were most likely to be black or non-English speaking, male, and older than 65.
"The [United States] spends more health care dollars per person than any country in the world," said co-author David Schriger, a professor of emergency medicine at the Geffen School of Medicine. "Yet we still can't organize our health care system in a way that gives everyone adequate treatment. Should we tolerate a tenfold disparity for the loss of a limb and a patient's ability to walk when we can prevent amputations with proper care?"
Researchers hope their findings will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire policymakers to adopt legislation to reduce barriers to care.
The findings were recently published in the journal Health Affairs.