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Clinical Orthopaedics and Related Research®

, Volume 469, Issue 7, pp 1941–1950 | Cite as

Disparities in Amputations in Minorities

  • Kristin M. Lefebvre
  • Lawrence A. Lavery
Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Abstract

Background

As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration.

Questions/purposes

The purposes of our review are to highlight current data on disparities in amputation in minorities and to consider future goals related to an elimination of this disparity.

Methods

Studies on disparities in amputation were accessed using the following databases: PubMed, Cinahl, OVID/Medline, Embase, and Cochrane databases. In each database, a search of title/abstract was performed for the search terms “disparities and amputation,” “race and amputation,” and “diabetes and amputation.” Each search was limited by human and English language.

Where are we now? A disparity exists in both frequency and level of amputation in minorities both in the presence and absence of a diagnosis of diabetes.

Where do we need to go? A need exists for future research involving a more deliberate examination of the use of preventive screening for patients at high risk for amputation across medical settings.

How do we get there? Research in this area would benefit from funding, large-scale data collection, and physician exposure to education on high-risk patients and preventive screening opportunities.

Keywords

Peripheral Arterial Disease Black Race Lower Extremity Amputation Racial Health Disparity Patient Treatment File 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Aboyans V, McClelland RL, Allison MA, McDermott MM, Goff DC, Manolio TA. Intrinsic contribution of gender and ethnicity to normal ankle-brachial index values: the Multi-Ethnic Study of Atherosclerosis (MESA). J Vasc Surg. 2007;45:319–327.PubMedCrossRefGoogle Scholar
  2. 2.
    Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–1711.Google Scholar
  3. 3.
    Allen J, Szanton S. Gender, ethnicity, and cardiovascular disease. J Cardiovasc Nurs. 2005;20:1–6.PubMedGoogle Scholar
  4. 4.
    Ashry HR, Lavery LA. Armstrong DG. Lavery DC. Cost of diabetes related amputations in minorities. J Foot Ankle Surg. 1998;37:186–190.PubMedCrossRefGoogle Scholar
  5. 5.
    Ayanian JZ. Heart disease in black and white. N Engl J Med. 1993;329:656–658.PubMedCrossRefGoogle Scholar
  6. 6.
    Brothers TE, Robison JG, Sutherland SE, Elliott BM. Racial differences in operation for peripheral vascular disease: results of a population-based study. Cardiovasc Surg. 1997;5:2631.Google Scholar
  7. 7.
    Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, Rosamond W, Crow RS, Rautaharju PM, Heiss G. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 1995;26:386–391.PubMedGoogle Scholar
  8. 8.
    Clark L. Issues in minority health: atherosclerosis and coronary heart disease in African Americans. Med Clin North Am. 2005;89:977–1001.PubMedCrossRefGoogle Scholar
  9. 9.
    Collins N. Diabetes, nutrition and wound healing. Advances in Skin and Wound Care. 2003;16:291–294.PubMedCrossRefGoogle Scholar
  10. 10.
    Collins TC, Johnson M, Henderson W, Khuri SF, Daley J. Lower extremity non traumatic amputation among veterans with peripheral arterial disease: is race an independent factor? Med Care. 2002;40:1106–1116.Google Scholar
  11. 11.
    Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J. 2002; 95:875–883.PubMedGoogle Scholar
  12. 12.
    Dillingham TR, Pezzin LE, Mackenzie EJ. Racial differences in the incidence of limb loss secondary to peripheral vascular disease: a population-based study. Arch Phys Med Rehabil. 2005;83:1252–1257.CrossRefGoogle Scholar
  13. 13.
    Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–1163.PubMedCrossRefGoogle Scholar
  14. 14.
    Eggers PW, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney Int. 1999;56:1524–1533.PubMedCrossRefGoogle Scholar
  15. 15.
    Ephraim PL, Dillingham TR, Sector M, Pezzin LE, Mackenzie EJ. Epidemiology of limb loss and congenital limb deficiency: a review of the literature. Arch Phys Med Rehabil. 2003;84:747–761.PubMedGoogle Scholar
  16. 16.
    Eslami MH, Zayaruzny M, Fitzgerald GA. The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia. J Vasc Surg. 2007;45:55–59.PubMedCrossRefGoogle Scholar
  17. 17.
    Feinglass J, Abadin S, Thompson J, Pearce WH. A census based analysis of racial disparities in lower extremity amputation rates in Northern Illinois, 1987–2004. J Vasc Surg. 2008;47:1001–1007.PubMedCrossRefGoogle Scholar
  18. 18.
    Feinglass J, Rucker-Whitaker C, Lindquist L, McCarthy WJ, Pearce WH. Racial differences in primary and repeat lower extremity amputation: results from a multihospital study. J Vasc Surg. 2005;41:823–829.PubMedCrossRefGoogle Scholar
  19. 19.
    Fletcher DD, Andrews KL, Butters MA, Jacobsen SJ, Rowland CM, Hallett JW Jr. Rehabilitation of the geriatric vascular amputee patient: a population-based study. Arch Phys Med Rehabil. 2001;82:776–779.PubMedCrossRefGoogle Scholar
  20. 20.
    Gadegbeku CA, Lea JP, Jamerson KA. Update on disparities in pathophysiology and management of hypertension: focus on African Americans. Med Clin N Am. 2005;89:921–933.PubMedCrossRefGoogle Scholar
  21. 21.
    Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK, Kucken LE, Vladeck BC. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–799.PubMedCrossRefGoogle Scholar
  22. 22.
    Guadagnoli E, Ayanian JZ, Gibbons G. The influence of race on the use of surgical procedures for treatment of peripheral arterial disease of the lower extremities. Arch Surg. 1995;130:381–386.PubMedGoogle Scholar
  23. 23.
    Halpern CT, Hallfors D, Bauer DJ, Iritani B, Waller MW, Cho H. Implications of racial and gender differences in patterns of adolescent risk behavior for HIV and other sexually transmitted diseases. Perspect Sex Repro H. 2004;36:239–247.CrossRefGoogle Scholar
  24. 24.
    Huang CT, Jackson JR, Moore NB, Fine PR, Kuhlemeier KV, Traugh GH, Saunders P. Amputation: energy cost of ambulation. Arch Phys Med Rehabil. 1979;60:18–24.PubMedGoogle Scholar
  25. 25.
    Huber TS, Wang JG, Wheeler KG, Cuddeback JK, Dame DA, Ozaki CK, Flynn TC, Seeger JM. Impact of race on the treatment for peripheral arterial occlusive disease. J Vasc Surg. 1999;30:417–425.PubMedCrossRefGoogle Scholar
  26. 26.
    Iribarren C, Sidney S, Sternfeld B, Browner WS. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke and peripheral vascular disease. JAMA. 2000;283:2810–2815.PubMedCrossRefGoogle Scholar
  27. 27.
    Jaegers SM, Arendzen JH, de Jongh HJ. Prosthetic gait of unilateral transfemoral amputees: a kinematic study. Arch Phys Med Rehabil. 1995;76:736–743.PubMedCrossRefGoogle Scholar
  28. 28.
    Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287:2519–2527.PubMedCrossRefGoogle Scholar
  29. 29.
    Keil JE, Sutherland SE, Knapp RG, Lackland DT, Gazes PC, Tyroler HA. Mortality rates and risk factors for coronary disease in black as compared with white men and women. N Engl J Med. 1993;329:73–78.PubMedCrossRefGoogle Scholar
  30. 30.
    Lantz PM, Lynch JW, House JS, Lepkowski JM, Mero RP, Musick MA, Williams DR. Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors. Soc Sci Med. 2001;53:29–40.PubMedCrossRefGoogle Scholar
  31. 31.
    LaVeist TA, Thorpe RJ Jr, Galarraga JE. Environmental and socioeconomic factors as contributors to racial disparities in diabetes prevalence. J Gen Intern Med. 2009;24:1144–1148.PubMedCrossRefGoogle Scholar
  32. 32.
    Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S. Variation in the incidence and proportion of diabetes related amputations in minorities. Diabet Care. 1996;19:4854.Google Scholar
  33. 33.
    Lefebvre KM, Metraux S. Disparities in level of amputation: implications for improved preventative care. J Natl Med Assoc. 2009;101:649–655.PubMedGoogle Scholar
  34. 34.
    Link B, Pelan J. McKeown and the idea that social conditions are fundamental causes of disease. Am J Public Health. 2002;92:730–733.PubMedCrossRefGoogle Scholar
  35. 35.
    McBean AM, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev. 1994;15:77–90.PubMedGoogle Scholar
  36. 36.
    McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002;136:873–883.PubMedGoogle Scholar
  37. 37.
    Miller WC, Speechley M, Deathe AB. Balance confidence among people with lower-limb amputations. Phys Ther. 2002;82:856–865.PubMedGoogle Scholar
  38. 38.
    Millstein S, Bain D, Hunter GA. A review of employment patterns of industrial amputees—factors influencing rehabilitation. Prosthet Orthot Int. 1985;9:69–78.PubMedGoogle Scholar
  39. 39.
    Mitka M. Diabetes group warns vascular complication is underdiagnosed and undertreated. JAMA. 2004;291:809–810.PubMedCrossRefGoogle Scholar
  40. 40.
    Moore TJ, Barron J, Hutchinson F 3rd, Golden C, Ellis C, Humphries D. Prosthetic usage following major lower extremity amputation. Clin Orthop Relat Res. 1989;238:219–224.PubMedGoogle Scholar
  41. 41.
    Mort EA, Weissman JS, Epstein AM. Physician discretion and racial variation in the use of surgical procedures. Arch Intern Med. 1994;154:761–767.PubMedCrossRefGoogle Scholar
  42. 42.
    Nissen SJ, Newman WP. Factors influencing reintegration to normal living after amputation. Arch Phys Med Rehabil. 1992;73:548–551.PubMedGoogle Scholar
  43. 43.
    Oddone EZ, Petersen LA, Weinberger M, Freedman J, Kressin NR. Contribution of the Veterans Health Administration in understanding racial disparities in access and utilization of health care: a spirit of inquiry. Med Care. 2002;40(Suppl):I3–13.PubMedCrossRefGoogle Scholar
  44. 44.
    Ollendorf DA, Kotsanos JG, Wishner WJ, Friedman M, Cooper T, Bittoni M, Oster G, Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. Diabetes Care. 1998;21:1240–1245.PubMedCrossRefGoogle Scholar
  45. 45.
    Oster NV, Welch V, Schild L, Gazmararian JA, Rask K, Spettell C. Differences in self management behaviors and use of preventative services among diabetes management enrollees by race and ethnicity. Dis Manage. 2006;9:167–175.CrossRefGoogle Scholar
  46. 46.
    Patout CA Jr, Birke JA, Horswell R, Williams D, Cerise FP. Effectiveness of a comprehensive diabetes lower extremity amputation prevention program in a predominantly low income African American population. Diabetes Care. 2000;23:1339–1342.PubMedCrossRefGoogle Scholar
  47. 47.
    Resnick HE, Valsania P, Phillips CL. Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, 1971–1992. Arch Intern Med. 1999;159:2470–2475.PubMedCrossRefGoogle Scholar
  48. 48.
    Rith-Najarian SJ, Reiber G. Prevention of foot problems in persons with diabetes. J Fam Pract. 2000;49:S30–39.PubMedGoogle Scholar
  49. 49.
    Rucker-Whitaker C, Feinglass J, Pearce WH. Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital. Arch Surg. 2003;138:1347–1351.PubMedCrossRefGoogle Scholar
  50. 50.
    Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LN, Eisma WH. Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands. Arch Phys Med Rehabil. 2001;82:239–245.PubMedCrossRefGoogle Scholar
  51. 51.
    Selby JV, Fireman BH, Lundstrom RJ, Swain BE, Truman AF, Wong CC, Froelicher ES, Barron HV, Hlatky MA. Variation among hospitals in coronary-angiography practices and outcomes after myocardial infarction in a large health maintenance organization. N Engl J Med. 1996;335:1888–1896.PubMedCrossRefGoogle Scholar
  52. 52.
    Selvin P, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation. 2004;110:738–743.PubMedCrossRefGoogle Scholar
  53. 53.
    Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Diabetes Care. 2004;27:1598–1604.PubMedCrossRefGoogle Scholar
  54. 54.
    Tunis SR, Bass EB, Klag MJ, Steinberg EP. Variation in utilization of procedures for treatment of peripheral arterial disease: a look at patient characteristics. Arch Intern Med. 1993;153:991–998.PubMedCrossRefGoogle Scholar
  55. 55.
    Van Houtum WH, Lavery LA, Armstrong DG. Risk factors for above-knee amputations in diabetes mellitus. South Med J. 1998;91:643–649.PubMedCrossRefGoogle Scholar
  56. 56.
    van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(Suppl):I140–151.PubMedGoogle Scholar
  57. 57.
    Whyte AS, Carroll LJ. A preliminary examination of the relationship between employment, pain and disability in an amputee population. Disabil Rehabil. 2002;24:462–470.PubMedCrossRefGoogle Scholar
  58. 58.
    Young BA, Maynard C, Reiber G, Boyko EJ. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes Care. 2003;26:495–501.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Institute for Physical Therapy Education, One University PlaceWidener UniversityChesterUSA
  2. 2.Department of Plastic Surgery and Department of Orthopaedic SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA

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