Geographic clustering of diabetic lower-extremity amputations in low-income regions of California.
Open accessAbstract
For patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases. Using statewide facility discharge data for California in 2009, we identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. We mapped amputations based on residential ZIP codes and used data from the Census Bureau to produce corresponding maps of poverty rates. Comparisons of the maps show amputation "hot spots" in lower-income urban and rural regions of California. Prevalence-adjusted amputation rates varied tenfold between high-income and low-income regions. Our analysis does not support detailed causal inferences. However, our method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.
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People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.
“People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.[16][17][18]”
From Diabetic Foot Ulcers (2023) · cites this paper as [18]
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References 29 · Cited by 88
- Authors
- Stevens, C. D., Schriger, D. L., Raffetto, B., Davis, A. C., Zingmond, D., & Roby, D. H.
- Affiliations
- University of California, Los Angeles (US)
- University of Southern California (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2014-08
- Volume
- 33
- Issue
- 8
- Pages
- 1383-1390
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC4242846
- OpenAlex
- W2133537013
- Cited by
- 88
- References
- 29
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 10 · 2023: 11 · 2022: 8 · 2021: 10 · 2020: 11 · 2019: 7 · 2018: 4 · 2017: 6 · 2016: 8 · 2015: 2
- FWCI
- 4.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (TL1TR000121)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- geographic clustering, poverty, income inequality, diabetes complications, urban-rural disparities, California, targeted interventions
- MeSH terms
- Aged, Amputation, Surgical, California, Female, Humans, Male, Middle Aged, Poverty Areas, Rural Population, Prevalence, Small-Area Analysis, Censuses, Lower Extremity, Diabetes Complications, Healthcare Disparities, Geography, Medical
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