Monday , November 20 2017
Home / Specialties / Podiatry / Amputation Rates Linked to Low-Income Neighborhoods in California

Amputation Rates Linked to Low-Income Neighborhoods in California

Rates for patients with diabetes are two times higher in low-income neighborhoods compared to high-income neighborhoods in California…. 

A new study conducted by Dr. Carl Stevens and his colleagues from the David Geffen School of Medicine at the University of California, Los Angeles revealed that amputation rates for patients with diabetes are two times higher in low-income neighborhoods compared to high-income neighborhoods in California.

Using statewide discharge data for California in 2009, Dr. Stevens and colleagues were able to identify 6,828 diabetic patients with 7,973 lower-extremity amputations. They mapped amputation rates using the patients’ zip code, and the poverty rates using Census Bureau data. The primary outcome was the rate of diabetic patients aged 45 years or older who underwent 1 or more non-traumatic lower-extremity amputation. The results of the analysis indicated that amputation "hot spots" were mostly in the lower-income urban and rural areas of California. In addition, the prevalence of amputation rates could vary up to ten-fold between the high-income and low-income areas. "Amputation rates per 1000 residents with diabetes were 0 to 1.9 for the highest-income quartile, 2.0 to 3.3 for the second quartile, 3.4 to 5.0 for the third, and 5.1 to 14.4 in the quartile of lowest-income neighborhoods." San Fernando, Compton and San Pedro were among the cities with highest amputation rates while Malibu, Beverly Hills and Santa Clarita were among the cities with lowest amputation rates.

According to Dr. Stevens, problems associated with these amputation "hot spots" are poor quality of care, language barriers and low health literacy. Many low-income patients tend to delay seeking care when they have a foot infection. Besides patient factors, the lack of health care coverage and the shortage of primary-care providers in both low-income urban and rural areas may also contribute to the high amputation rates. In a comment regarding the shortage of primary-care providers, Dr. Stevens noted, "That’s a tougher problem to solve. That requires changing the incentives to make it more attractive to practice in those low-income areas and opening up more residency training slots in family medicine and general medicine. All of those are longer-term, bigger challenges." In addition, Dr. Stevens expressed his view that a multidisciplinary team approach is the ideal approach to prevent amputations.

Practice Pearls:
  • Amputation rates for patients with diabetes are two times higher in low-income neighborhoods compared to high-income neighborhoods in California.
  • San Fernando, Compton and San Pedro were among the cities with highest amputation rates while Malibu, Beverly Hills and Santa Clarita were among the cities with lowest amputation rates
  • Problems associated with these amputation "hot spots" are poor quality of care, language barriers, low health literacy, lack of healthcare coverage and a shortage of primary care providers.

Steven C, Schriger D, Raffetto B, et al. Geographic Clustering of Diabetic Lower-Extremity Amputations In Low-Income Regions of California. Health Affairs. 2014. 33(8): 1383-1390.