Risk of life and limb is not just a metaphor for low-income diabetics.
A University of California, Los Angeles, study published Monday found that people with diabetes in low-income neighborhoods are 10 times more likely than diabetics from wealthy neighborhoods to get their limbs amputated because of a diabetes-related infection.
The study, published in the August issue of Health Affairs, found that California neighborhoods with high amputation rates had a greater concentration of households below the federal poverty level. Amputation patients were most likely to be minorities, non-English speaking, male and older than 65, researchers said.
“Neighborhoods where highest rates were seen tend to be where first-generation immigrants lived as their first neighborhood,” said Carl Stevens, lead author of the study and a clinical professor of medicine at the David Geffen School of Medicine at UCLA.
These amputations could be prevented with earlier diagnosis and treatment of diabetes, the researchers said. People who don’t properly manage their diabetes can lower their immunity to bacterial infections. Numbed nerves in the feet due to reduced blood circulation can result in a blister or cut on the foot turning into a life-threatening infection. In this case, amputations are the last and only resort, said Ann Albright, the director for the diabetes division at the Centers for Disease Control and Prevention.
Many factors contribute to the high amputation rates in those neighborhoods, Stevens said, including lack of education and inadequate access to primary care. Diabetic patients need a full team of medical practitioners, including a primary care physician, a nutritionist and pharmacist.
The data were pulled from Census numbers and hospital discharge statistics from 2009, as well as the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated the prevalence of diabetes in low-income areas. Stevens said this study was conducted before the Affordable Care Act was implemented in California, so he would expect results today to be different.
“The impact of the Affordable Care Act will be positive and will be substantial but will be limited by the number of primary care physicians in urban areas,” Stevens said.