One of the most feared bad outcomes of diabetes is the need for amputation (cutting off a leg) due to nerve and blood vessel harm in the leg, foot, and toes. Many people with diabetes fear losing a leg more than death. About 5% of adults with a foot ulcer (open wound) due to diabetes need an above-ankle amputation. For people with diabetes, the risk of amputation is disproportionate in the U.S.. Black patients are twice as likely than White patients to have an amputation, and rural patients have about a 35% higher risk of having a leg amputation than people living in cities. Other important socio-economic factors also lead to unequal risk of major amputation.

Where you live matters as well as your race

New Medicare data in the U.S. included almost 125,000 patients hospitalized due to a diabetic foot ulcer. Overall, 17.6% needed major (above-ankle) leg amputation or died within a month after being hospitalized. However, t18.3% of rural patients, 21.9% of Black patients, and 28% of patients who were both Black and rural had these outcomes. Racial, rural, and neighborhood disadvantages are well known risk factors for poor outcomes from diabetes. However, it remains unclear how these risk factors interact to affect the outcomes of diabetic foot ulcer.

Diabetes and intersectionality

This study shows that racial and rural disparities interact, increasing leg amputation risk. These findings support using an intersectionality lens to find and face disparities in major leg amputation and mortality for patients with diabetic foot ulcers.


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