Review of Socioeconomic Disparities in Lower Extremity Amputations: A Continuing Healthcare Problem in the United States

Abstract

Lower extremity amputation is one of the most unfortunate, yet preventable, consequences of uncontrolled lower limb ischemia occurring secondary to diabetes mellitus or peripheral arterial disease. In the United States, racial and socioeconomic disparities are associated with significant differences seen in the incidence and type or level of lower extremity amputation among patients. Due to shifting demographics and the uncertain state of healthcare coverage, lower extremity amputation rates are only projected to increase in the future. Given the potential societal and individual costs associated with the loss of a limb, this review seeks to summarize the recent findings on disparities in the identification, treatments offered, and outcomes of lower limb ischemia in order to elucidate potential interventions at the practitioner and policy levels.

Effect of Collagen Scaffold With Bcl-2-Modified Adipose-Derived Stem Cells on Diabetic Mice Wound Healing

“…Diabetic ulcers, or chronic wounds, in lower extremities can lead to incapacitation, limb loss, and unsatisfactory healing. 13 Current clinical treatments such as antibiotics, hyperbaric oxygen therapy, and moist dressings fail to attain desired healing of diabetic wounds. 14 MSCs have been shown to promote wound healing.…”

Use of Flap Salvage for Lower Extremity Chronic Wounds Occurs Most Often in Competitive Hospital Markets

“…Lower extremity amputation due to a chronic wound is a preventable consequence of peripheral vascular disease and diabetes. 1 In the diabetic population, a new onset diabetic foot ulcer has an associated mortality rate between 43% and 55% and rises to 75% after amputation. 2 – 4 When amputation occurs, data suggest that there is an exacerbation of existing comorbidities, rather than a new disease process, which results in increased mortality.…”

Education Level Among Patients with Major Limb Amputation

“…Goodney et al reported an amputation rate of more than 23 per 10,000 Medicare patients with the peripheral arterial disease (PAD) in Florence, South Carolina [6]. Certain factors, such as age, gender, race, co-existing diseases, smoking, and socioeconomic status, among others, have been associated with higher rates of amputation [6,[8][9][10][11][12]. For example, Ciocan et al identified age as a risk factor for amputation [8].…”