A national study of Medicare data has uncovered alarming disparities in major lower extremity amputation rates, revealing that urban communities with high proportions of Black residents and low socioeconomic status face risks comparable to rural areas. While rural ZIP codes had higher average amputation rates, nearly 80% of patients who underwent amputations lived in metropolitan areas.
Between 2010 and 2018, ZIP codes with the highest amputation rates had a significantly greater proportion of Black residents—17.5% compared to 4.4% in the lowest quartile. These high-rate ZIP codes also had lower median household incomes and higher Distressed Communities Index scores. In cities like Philadelphia, Detroit, and Atlanta, maps showed a clear overlap between majority Black neighborhoods and ZIP codes with top-quartile amputation rates.
The study found that every $10,000 drop in median income was associated with a 4.4% increase in amputation rates in metropolitan areas. A 10-point rise in the Distressed Communities Index correlated with a 3.8% increase. These disparities persisted even after adjusting for clinical conditions like diabetes and peripheral vascular disease.
Despite geographic proximity to vascular specialists, urban patients in under-resourced communities often lacked access to timely diagnosis and treatment for peripheral artery disease. The authors call for community-based tools—such as screening programs and home-based therapies—to reduce these inequities.
See: “Geographic and Socioeconomic Disparities in Major Lower Extremity Amputation Rates in Metropolitan Areas” (August 25, 2021)
