A decade-long study of Medicare beneficiaries reveals stark racial and regional disparities in major lower extremity amputation (MLEA) rates among older adults with diabetes. The research focused on the “diabetes belt,” a region in the southeastern U.S. with high diabetes prevalence, and found that Black patients living there are at significantly higher risk of losing limbs than their White counterparts.
In 2006, Black patients in the diabetes belt experienced 8.5 amputations per 1,000, compared to 2.4 for White patients. By 2015, rates declined to 4.8 and 1.5 respectively, but the racial gap remained wide. Even after adjusting for health conditions and access to care, Black patients in the belt had nearly twice the odds of undergoing an amputation compared to White patients in surrounding counties.
The study found that rurality and race compound the risk. Over 80% of rural counties with majority Black populations are designated health professional shortage areas, many of which overlap with the diabetes belt. Despite federal efforts like Medicaid expansion and the Affordable Care Act, disparities persisted. Federally Qualified Health Centers, while expanded, often failed to reach rural communities.
Researchers call for targeted policies to prevent amputations among Black patients, especially in the diabetes belt. Recommendations include investing in rural healthcare infrastructure, improving access to preventive care, and implementing multidisciplinary care teams for diabetic foot management.
See: “Regional and racial disparities in major amputation rates among Medicare beneficiaries with diabetes: a retrospective study in the southeastern USA” (December 12, 2023)
