Black Americans on Medicare are three times more likely than other patients to lose a leg to amputation because of complications with diabetes and peripheral arterial disease….
Even low-risk black patients with diabetes and peripheral arterial disease faced a higher risk of amputation than most nonblack patients, according to a new report.
Regional disparities are also apparent in the report. Amputation rates for black patients with diabetes and peripheral arterial disease in the rural Southeast can be as high as seven times the rate of other regions. There also was an eightfold difference across regions for black patients who were likely to have surgery to increase blood circulation to their legs, a measure that can help prevent amputation down the road.
The report’s authors examined Medicare claims from 2007 to 2011 and divided the country into 306 regional markets defined by hospital use. The Medicare data classified patients as either black or nonblack.
Mississippi showed some of the widest disparities by race. There were 14.2 amputations per 1,000 beneficiaries for black patients in Meridian and 16.1 in Tupelo, compared to 3.8 and 4.7, respectively, for nonblack patients.
The national average rate of leg amputation from 2007 to 2011 was 2.4 per 1,000 Medicare beneficiaries with diabetes and peripheral arterial disease. The amputation rate among black patients was 5.6 per 1,000, or almost three times higher than the rate among other beneficiaries.
In almost all cases, when comparing black and nonblack patients, the lowest-risk black patients had a higher risk of amputation than nearly all nonblack patients.
Nearly 100,000 leg amputations are performed annually in Medicare patients, and more than half of them occur in patients with diabetes.
The report also showed that black Americans on Medicare are less likely to seek routine preventive care. Preventive measures include foot exams and controlling cholesterol and blood sugar levels. Sometimes surgical methods, such as bypass surgery, are used, because patients can improve when blood flow to their feet is restored.
“We can’t really tell why some patients might not be engaged in pursuing care that might limit amputation, such as routine foot checks,” Dr. Philip Goodney, director of the Center for the Evaluation of Surgical Care at Dartmouth-Hitchcock Medical Center and co-author of the report, said in a call with reporters. “Sometimes the resources are there but for whatever reason patients don’t find their way to the right treatments.”
Dr. Marshall Chin, a University of Chicago professor, said, “This is a striking example of something that is entirely preventable. To reduce disparities, he said, health care providers need to address social and economic issues, such as barriers that prevent patients from eating healthy and the affordability of prescription medication patients receive. “This report leaves little doubt where the focus of amputation prevention needs to be directed,” Goodney said in a statement.
- Nearly 100,000 leg amputations are performed annually in Medicare patients
- Black Americans on Medicare are less likely to seek routine preventive care
- When comparing black and nonblack patients, the lowest-risk black patients had a higher risk of amputation than nearly all nonblack patients.
Dartmouth Atlas Project Oct. 2014