Poor people with diabetes are much more likely to have a leg or foot amputated than affluent diabetic patients, according to a new study published in the Health Affairs journal.
Researchers from the University of California Los Angeles (UCLA) found rates of lower limb were 10 times higher in the poorest neighbourhoods – findings which they say highlight the need for new laws to help improve access to health care in the U.S.
The study was based on analysis of household income data and hospital discharge statistics from 2009, as well as information from a UCLA health survey, which estimated the rate of diabetes in low-income areas of California.
The team, led by Dr. Carl Stevens, of the David Geffen School of Medicine at UCLA, pinpointed diabetes-related amputation “hot spots” such as San Fernando, Compton and East Los Angeles, where as many as 10.7 out of 1,000 diabetic adults ages 45 and older lost a leg, foot or toe due to complications of diabetes.
Overall, nearly 8,000 lower limb amputations were carried out on 6,828 people with diabetes in California in 2009, with the researchers noting that patients were most likely to be of ethnic minority, non-English speaking, male and older than 65.
Explaining the higher incidence of diabetic amputations in lower-income areas, Dr. Stevens highlighted difficulties patients in those neighbourhoods have in getting access to primary care and understanding how to manage their condition.
He did note, however, that the situation in California is likely to have improved since 2009, as this was before the rollout of the Affordable Care Act, which greatly increased the number of Californians covered through the state’s healthcare program for the poor.
“We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014,” he added.

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