Review of Socioeconomic Disparities in Lower Extremity Amputations: A Continuing Healthcare Problem in the United States.

Raghavendra L Girijala,Ruth L Bush

doi:10.7759/cureus.3418

Raghavendra L Girijala, Ruth L Bush

Open Access

https://doi.org/10.7759/cureus.3418

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Journal: Cureus	Publication Date: Oct 5, 2018
Citations: 17	License type: cc-by

Affiliation: Texas A&M University, University of Houston

Abstract

Lower extremity amputation is one of the most unfortunate, yet preventable, consequences of uncontrolled lower limb ischemia occurring secondary to diabetes mellitus or peripheral arterial disease. In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients. Due to shifting demographics and the uncertain state of healthcare coverage, lower extremity amputation rates are only projected to increase in the future. Given the potential societal and individual costs associated with the loss of a limb, this review seeks to summarize the recent findings on disparities in the identification, treatments offered, and outcomes of lower limb ischemia in order to elucidate potential interventions at the practitioner and policy levels.

Highlights

BackgroundIn 2005, the United States had 1.6 million amputees, equating to one in every 190 persons
In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients
The authors concluded that lower extremity amputation rates decreased from 1999 to 2006 (4.8 per 1000 to 4.4 per 1000 patients), the proportion of amputees that were high risk with diabetes increased from 33% to 50% over the same time interval

Summary

Introduction

In 2005, the United States had 1.6 million amputees, equating to one in every 190 persons. Zhao et al studied a prospective cohort of 19,808 African American and 15,560 Caucasian diabetics for an average of 6.83 years in order to determine the relative risk of lower extremity amputation They focused on patients from low-income communities, determining that a graded relationship between HbA1c existed with amputation among both groups. This ranges from national publicity campaigns that can increase the general awareness of the underlying conditions and potential outcomes, and local community-organized events that connect care providers with patients and provide sufficient time for patient-provider interaction These efforts are important, given that lower educational levels have been associated with higher rates of long-term mortality after amputation [32]. While racial disparities have been shown, an analysis at a state level, such as in the Massachusetts study, may shed light on geographic and healthcare coverage disparities that can be targeted

Conclusions

Disclosures

Findings

Overview of race and hispanic origin