A new UCLA study demonstrates that California diabetics who live in low-income neighborhoods are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas of the state.

Earlier diagnosis and proper treatment could prevent many of these amputations, the researchers say. The study authors hope their findings, published in the August issue of Health Affairs, will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire policymakers to adopt legislation to reduce barriers to care.

The authors used data from the UCLA Center for Health Policy Research's California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by ZIP code. They blended these statistics with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetes-related amputations by ZIP code.

The result was a detailed set of maps showing diabetic amputation rates by neighborhood for patients 45 and older--the age range at greatest risk for amputation from disease complications.

The researchers found that not only did diabetic residents of low-income neighborhoods like San Fernando have a tenfold higher risk of at least one amputation, compared with patients in more affluent Hermosa Beach, for example, but that race also played a significant role.

Less than 6 percent of diabetic Californians are African American, yet they accounted for nearly 13 percent of the patient population undergoing one or more amputations in 2009. Conversely, Asian Americans made up 12 percent of the diabetic population yet had less than 5 percent of diabetes-related amputations that year.

Amputation patients were most likely to be African American or non–English speaking, male, and older than 65.

The UCLA researchers' next step will be to tease out the most important factors contributing to amputation and to develop strategies for lowering the risk for diabetic people living in impoverished neighborhoods.

The study is available here.

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