People with diabetes in low-income neighborhoods in California are twice as likely to have a leg or foot amputated as those living in wealthier areas, according to a study released Monday.
The study, published in the journal Health Affairs, underscores the stark differences in outcomes for diabetes patients throughout the state.
“We are not particularly surprised, but we are disturbed,” said Carl Stevens, one of the authors and a clinical professor at UCLA David Geffen School of Medicine. “Is it okay that we are losing limbs … in low-income people? Most Americans would find this inequality in outcomes unacceptable, regardless of their political leanings or their opinions.”
About one in seven Californians has diabetes, a metabolic disease that leads to high blood sugar. The vast majority are Type 2 cases, in which the body doesn’t use insulin properly. Amputations are a serious complication of the disease but are generally preventable with proper care. The disease can lead to blindness, kidney disease and death.
The study didn’t determine the cause of the higher rates of amputations, but researchers said less access to ongoing primary care, coordinated teams of providers and trained specialists likely contributes to the problem. In addition, patients in low-income neighborhoods may not be as educated about their health and may have fewer places to buy healthy food or to exercise safely.
As in the state as a whole, the amputation rates in Los Angeles County in 2009 were roughly double in poorer neighborhoods than more affluent ones. In parts of the county, however, the disparities were even greater. For example, there were about 11 amputations per 1,000 diabetics in Compton, compared to 1 per 1,000 patients in Beverly Hills.