Geographic Clustering Of Diabetic Lower-Extremity Amputations In Low-Income Regions Of California

Abstract

A large body of work demonstrates income-related disparities in access to coordinated preventive care in patients with diabetes and other chronic conditions. Much less information exists on associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns linking household incomes to major, preventable complications of chronic diseases. Using statewide facility discharge data for California during 2009, we identified 7,973 lower extremity amputations in 6,828 diabetic adults. We mapped amputation events based on residential zip codes, and used US census data to produce corresponding maps of poverty rate. Comparisons of the maps show amputation “hotspots” in lower income urban and rural regions of California. Prevalence-adjusted amputation rates varied ten-fold between high-income and low-income regions. While our analysis does not support detailed causal inferences, our method for mapping complication “hot spots” using existing public data sources may help target interventions to communities most in need.

Hemoglobin A1c Testing and Amputation Rates in Black, Hispanic, and White Medicare Patients

“…The extent of this disparity in amputation risk has been reported to be as high as 10-fold. 20 A combination of patient, structural, and ecologic factors have been cited—persistent hypertension and obesity, 21 poor care delivery in remote settings, 22 and poor engagement in health care systems. 23–25 Moreover, these risk factors often are seen in care settings wherein patients at the highest risk for amputation are often those least likely to receive preventive care.…”

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California

“…In addition, prevalence-adjusted amputation rates vary up to tenfold between high-and lowincome regions. 9 Therefore, the rate of amputations per 1,000 diabetic individuals is likely higher in most cases, resulting in these projections possibly underestimating the cost and potential savings.…”

“…8 The prevalence of diabetes may be underestimated because the OSHPD discharge files rely on accurate coding by the hospitals and the California Health Interview Survey relies on self-reported data, which may neglect undiagnosed cases. 9 Per 1,000 diabetic patients, we calculated averages of 1.52 amputations (range, 1.52-1.62); 9.72 hospital admissions (range, 9.39-10.02); and 1.27 SNF admissions (range, 1.25-1.30). The cases identified were divided into three categories: uncomplicated acute-care stay, discharged to SNF, and lower-extremity amputation during acute-care stay.…”

Small-area Variation in Hypertension Prevalence among Black and White Medicaid Enrollees

“…This method has been used to strengthen community-based disease prevention and management efforts by identifying areas of high need to guide resource allocation and inform health services policy, planning, and delivery. [5][6][7][8] Although hotspot analysis has the potential to identify areas and subpopulations at greatest risk for hypertension and related adverse health outcomes, few studies have applied this technique to examine whether hypertension clustering varies by race among high-risk groups. Recent empirical evidence indicates that such community contextual characteristics as poverty, 9 racial/ ethnic residential segregation, 10 and health care accessibility 11 may contribute to small-area variation in hypertension.…”