Racial, Rural, and Regional Disparities in Diabetes-Related Lower-Extremity Amputation Rates, 2009–2017

Abstract

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 METHODSWe 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. RESULTSFrom 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. CONCLUSIONSDespite 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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Geographic and Ethnic Inequalities in Diabetes-Related Amputations

“…More recently, a large longitudinal analysis on the National Inpatient Sample identified trends in LEAs rates in patients primarily hospitalized with diabetes in the US between 2009 and 2017. The Authors found an increasing annual incidence in LEAs across all racial/ethnic and rural/urban groups, which was primarily driven by increase of minor amputations – by roughly 87% from 2009 to 2017 – whereas major amputations increased by 42% ( 21 ). Interestingly, the odds of a major amputation were significantly higher (from 10 to 30% of increase) for Black, Native American and Hispanic ethnicities compared with White groups ( 21 ), with similar figures observed in the economically disadvantaged areas compared to more developed ones.…”

“…The Authors found an increasing annual incidence in LEAs across all racial/ethnic and rural/urban groups, which was primarily driven by increase of minor amputations – by roughly 87% from 2009 to 2017 – whereas major amputations increased by 42% ( 21 ). Interestingly, the odds of a major amputation were significantly higher (from 10 to 30% of increase) for Black, Native American and Hispanic ethnicities compared with White groups ( 21 ), with similar figures observed in the economically disadvantaged areas compared to more developed ones. These findings are consistent with other recent reports of disproportionately higher rates of LEAs and other diabetes-related complications among racial and ethnic minority populations ( 10 , 22 – 24 ).…”