Researchers from Northwestern University’s Feinberg School of Medicine have found people in black communities on Chicago’s South and West Sides have a five times higher rate of lower limb amputations than people in the predominantly white suburbs and exurbs.
“Amputations are the canary in the coal mine for quality of care,” Joe Feinglass, lead author and research professor of medicine at the Feinberg School, said in a press release. “Many amputations are preventable. This means the primary care for minority people may not be good.”
Feinglass said the high rate of amputations means people are not being closely monitored. “They come in with gangrene or a skin ulcer that comes to the attention of a doctor late and nothing can be done,” he said.
This is the first longitudinal study as most studies of amputation rates look at one point in time. The study was published in the Journal of Vascular Surgery.
The high amputation rate for minorities in Chicago likely reflects other racial disparities in health care, Feinglass said. “Diabetes is a condition that is highly susceptible to quality of care. Amputation rates give you a basic idea of how the system is performing.”
The study examined hospital discharge data from the Illinois Department of Public Health for nine counties in northern Illinois encompassing more than eight million people. Feinglass then broke the statistics into three rings of the metropolitan area based on their zip codes.
He found that amputations in the suburban and exurban areas with a primarily white population dropped to 12 per 100,000 in 2004 from 14 in 1987. The largely black area on the South and West Sides actually increased to 63 amputations from 60. The inner suburbs and other areas of Chicago, with a black population between 10% and 50%, as well as a large Hispanic population, held steady at 20 amputations per 100,000.
The high amputation rate was linked to lack of access to primary care and specialty care for diabetic patients and patients with vascular disease. In addition, patients without diabetes may not have received screening for peripheral arterial disease.
To address these problems, Feinglass said communities need diabetes management programs with nurses to help people control their blood sugar.
“Those are the kinds of programs we know would pay off in the inner city. When blood sugar is lower, there is a lower amputation rate,” he said.
