Amputation Rate 10 Times Higher for Poor Patients, UCLA Study Finds

UCLA researchers yesterday released a study that found poor Californians with diabetes were up to 10 times more likely to undergo amputation as a consequence of diabetes than wealthier patients.

The study’s results have implications beyond the particular health consequences involved, said Carl Stevens, lead author of the study and a clinical professor of medicine at UCLA’s David Geffen School of Medicine.

“The reason we undertook this study is there’s a general understanding of poor health outcomes among poor people, but there are not many studies that document a specific problem like this,” Stevens said.

“This is a particularly graphic example of the failure of the safety net,” he said.

The study, presented yesterday in the magazine Health Affairs, found:

  • Amputation rates in California were 10 times higher in the poorest neighborhoods — such as Compton and East Los Angeles — than in the richest neighborhoods — such as Malibu and Beverly Hills;
  • In some cases, rich and poor neighborhoods abutted each other and the statistical differences remained;
  • Less than 6% of diabetic Californians are black, yet blacks accounted for nearly 13% of the diabetic patient population undergoing one or more amputations in 2009; and
  • Amputation patients were most likely to be black or non–English speaking, male and older than 65.

Diabetes is particularly prevalent in the Latino community and a high number of Latino amputations reflects that, Stevens said.

“Unquestionably there’s a cultural component to it,” Stevens said. Less preventive care, less health education about diabetes treatment and general mistrust of the medical system have all contributed to high rates of Latino amputations, he said.

“In California, it’s not limited to Latino cultures, the rates are higher among African Americans, as well. We have a challenging environment to overcome,” he said.  

Many people have a sense that poor people can always get care in an emergency department, so nothing seriously awful can happen to them, Stevens said.

“The principal take-home message is we have a 10-fold difference in care depending on income level,” Stevens said. “That’s a level of disparity I think many would find distasteful enough to do something about it.”

The expansion of Medi-Cal likely won’t help in this case, Stevens said, because the proper care facilities don’t really exist in poor neighborhoods.

“So just giving someone Medi-Cal, that doesn’t make the problem any better,” he said. “They need a multi-disciplinary clinic to go to, and they don’t have those in Compton. Just expanding coverage is not a panacea or magic bullet in its own right.”

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