Racial, rural, and regional disparities in diabetes-related lower-extremity amputation rates, 2009-2017.
Open accessAbstract
OBJECTIVE To examine the racial/ethnic, rural-urban, and regional variations in the trends of diabetes-related lower-extremity amputations (LEAs) among hospitalized U.S. adults from 2009 to 2017. RESEARCH DESIGN AND METHODS We used the National Inpatient Sample (NIS) (2009–2017) to identify trends in LEA rates among those primarily hospitalized for diabetes in the U.S. We conducted multivariable logistic regressions to identify individuals at risk for LEA based on race/ethnicity, census region location (North, Midwest, South, and West), and rurality of residence. RESULTS From 2009 to 2017, the rates of minor LEAs increased across all racial/ethnic, rural/urban, and census region categories. The increase in minor LEAs was driven by Native Americans (annual percent change [APC] 7.1%, P < 0.001) and Asians/Pacific Islanders (APC 7.8%, P < 0.001). Residents of non-core (APC 5.4%, P < 0.001) and large central metropolitan areas (APC 5.5%, P < 0.001) experienced the highest increases over time in minor LEA rates. Among Whites and residents of the Midwest and non-core and small metropolitan areas there was a significant increase in major LEAs. Regression findings showed that Native Americans and Hispanics were more likely to have a minor or major LEA compared with Whites. The odds of a major LEA increased with rurality and was also higher among residents of the South than among those of the Northeast. A steep decline in major–to–minor amputation ratios was observed, especially among Native Americans. CONCLUSIONS Despite increased risk of diabetes-related lower-limb amputations in underserved groups, our findings are promising when the major–to–minor amputation ratio is considered.
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Among Medicare beneficiaries, patients identifying as non-Hispanic Black had twice the odds of lower extremity amputation within 1 year of foot ulcer diagnosis after adjusting for multiple covariates (OR, 1.98; 95% CI, 1.93-2.03) compared with those identifying as non-Hispanic White.
“Among Medicare beneficiaries (total sample, 643 287), patients identifying as non-Hispanic Black had twice the odds of lower extremity amputation within 1 year of foot ulcer diagnosis after adjusting for multiple covariates (odds ratio [OR], 1.98; 95% CI, 1.93-2.03;P < .001[absolute rates not provided]) compared with those identifying as non-Hispanic White.19”
From Diabetic Foot Ulcers (2023) · cites this paper as [19]
The 'Factors Associated With a Major Amputation' section reports higher adjusted odds for Black than White patients, but gives OR 1.12 (95% CI 1.08–1.16), not 1.98. The Abstract describes hospitalized U.S. adults in the National Inpatient Sample, not a Medicare cohort followed for one year after foot-ulcer diagnosis. Page numbers were not supplied for these passages. (LLM, conf=0.89)
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- Authors
- Akinlotan, M. A., Primm, K., Bolin, J. N., Ferdinand Cheres, A. L., Lee, J., Callaghan, T., & Ferdinand, A. O.
- Affiliations
- Texas A&M University (US)
- The University of Texas MD Anderson Cancer Center (US)
- University Hospitals - Portage, Geagua and Ahuja Medical Centers Department of Endocrinology, Diabetes and Metabolism, Cleveland, OH
- The University of Texas at San Antonio (US)
- Corresponding author
- Akinlotan, Marvellous A.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-07-22
- Volume
- 44
- Issue
- 9
- Pages
- 2053-2060
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W3184903838
- Cited by
- 42
- References
- 36
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 12 · 2023: 9 · 2022: 6
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services (U1CRH30040)
- Health Resources and Services Administration
- Office of Rural Health
- Federal Office of Rural Health Policy
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- racial and ethnic disparities, urban-rural differences, regional disparities, Native Americans, Hispanic Americans, hospitalization trends, underserved populations, diabetes complications
- MeSH terms
- Adult, Amputation, Surgical, Diabetes Mellitus, Extremities, Humans, Rural Population, White People
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