People with diabetes in low-income neighborhoods are 10 times more likely than those from wealthy areas to have their lower limbs (legs, foot, or toes) amputated because of a diabetes-related complication, a study published Monday reports.
Researchers from the University of California, Los Angeles, observed that residents from low-income ZIP codes in California had as many as 10.7 amputations per 1,000 diabetic adults over age 45. This is in stark contrast to 1.5 surgeries per 1,000 diabetics from wealthier neighborhoods.
The neighborhoods with the highest amputation rates include San Fernando, Compton and South and East Los Angeles, while the wealthier ZIP codes with the lowest amputation rates included Malibu, Beverly Hills and Santa Clarita.
The researchers identified 8,000 diabetes-related amputations in 6,828 people from hospital discharge records from the California Office of Statewide Health Planning and Development for the year 2009. These “non-traumatic” amputations in patients were the categorized by ZIP codes. Then census data was used to identify income levels for each ZIP code, as well as their own internal health interview survey that measured the prevalence of diabetes by ZIP code.
The findings show that less than 6 percent of diabetics in California are Black, but yet account for 13 percent of those who had one or more amputation.
In most cases, those who needed a limb removed were most likely to be Black or non-English speaking men over the age of 65.
“This represents an intolerable health disparity,” says study lead author Carl Stevens to the Los Angeles Times. Stevens, a professor of medicine at UCLA’s David Geffen School of Medicine, added, “Where the poor people are is where the amputations are.”
A major obstacle facing patients in low-income neighborhoods is access to primary care stemming from lack of transportation and the cost of care. Unfortunately, there are also other risk factors prevalent that increase the likelihood of diabetic-related complications such as obesity or hypertension. But amputations are generally considered preventable.
Since the data is from 2009, it doesn’t take into account the Affordable Care Act, which has since insured many families, especially Blacks and Latinos from low-income brackets. Scientists are hopeful that the ACA — which is intended to increase access to primary care, prevention screenings, and early diagnosis — will have a profound effect on this community.
“We’re already making big strides in California,” says Stevens. “I suspect if we repeated this two years from now, we’d see fewer disparities.”
The study was published online Monday by the journal Health Affairs.
S.C. Rhyne is a blogger and novelist in New York City. Follow the author on Twitter @ReporterandGirl, http://Facebook.com/TheReporterandTheGirl and visit her website at http://www.TheReporterandTheGirl.com