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Diabetics who are Poorer are more likely to Lose a Limb

Update Date: Aug 04, 2014 04:12 PM EDT

People's wealth or lack thereof can greatly affect the level of medical care they receive. In a new study, researchers from the University of California, Los Angeles (UCLA) compared the health statuses of poor and wealthy people suffering from type 2 diabetes. They found that poor diabetics were more likely to lose a limb than wealthy diabetics.

"I've stood at the bedsides of diabetic patients and listened to the surgical residents say, 'We have to cut your foot off to save your life,'" said lead author Dr. Carl Stevens, a clinical professor of medicine at the David Geffen School of Medicine at UCLA according to the press release. "When you have diabetes, where you live directly relates to whether you'll lose a limb to the disease. Millions of Californians have undergone preventable amputations due to poorly managed diabetes. We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014."

For this study, the researchers examined data taken from the UCLA Center for Health Policy Research's California Health Interview Survey, the U.S. Census Bureau and the Office of Statewide Health Planning and Development. The information included diabetic people's zip code, household-income and hospital discharge forms. The researchers analyzed the data in combination with the amputation rate for diabetic patients aged 45 and older.

The researchers found that in 2009, around 6,800 people with diabetes lost legs, feet and toes due to complications from diabetes. Around 1,000 patients needed two or more amputations. The researchers reported that the amputation rates were higher in low-income neighborhoods. Residents from these areas that had diabetes were 10 times more likely to undergo a limb amputation when compared to people with diabetes who lived in higher income neighborhoods.

"Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level," said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health according to the press release.

The researchers found that race also played a factor. They reported that even though African Americans made up less than six percent of all diabetic people living within California, this group of people accounted for almost 13 percent of the patients who needed one or more amputations in 2009. Asian Americans, on the other hand, made up roughly 12 percent of the diabetic population and they had a less than five percent amputation rate.

"The U.S. spends more health care dollars per person than any country in the world," said co-author Dr. David Schriger, a professor of emergency medicine at the Geffen School of Medicine. "Yet we still can't organize our health care system in a way that gives everyone adequate treatment. Should we tolerate a tenfold disparity for the loss of a limb and a patient's ability to walk when we can prevent amputations with proper care?"

The study was published in the journal, Health Affairs.

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