Income, race are risk factors for leg amputation

By Megan Rauscher

NEW YORK (Reuters Health) - Minorities from low-income areas are at increased risk for having a leg amputated as a result of severe peripheral artery disease (PAD), a type of atherosclerosis, or hardening of the arteries, of the legs, new research indicates.

In PAD, plaque builds up in the arteries that supply the legs with blood, which causes them to narrow. This causes reduced blood flow and oxygen delivery to the legs (ischemia) and subsequent pain in the calves, legs and buttocks, leading to difficulty walking, painful foot ulcers, infections and even gangrene.

"Advanced PAD could lead to amputation," Dr. Mohammad Hamed Eslami, a vascular surgeon at the University of Massachusetts Medical School in Worcester, told Reuters Health.

Eslami and colleagues analyzed hospital data on 691,833 adults diagnosed with leg ischemia and found that roughly two thirds required vascular grafts to treat their condition while roughly one third had the affected leg amputated.

Patients from poor neighborhoods in the low-income bracket, non-white patients, and patients without commercial insurance, and those on Medicare or Medicaid, had significantly higher rates of amputation than those who were more affluent, the team reports in the Journal of Vascular Surgery.

"Of particular interest is the Medicaid patients who were on average younger than private and Medicare insurance recipients," Eslami noted. "This group still had a very high amputation rate."

In addition to low-income level and lack of private insurance, co-existing illnesses, including diabetes, chronic kidney failure, and gangrene, were also significantly associated with amputation.

Eslami notes that although some PAD patients will undergo amputation in spite of excellent and timely care, amputation may be related to a delayed diagnosis and delayed referral to a vascular surgeon.

Overall, this study points to a "disparity of care provided to patients with PAD on the basis of race, income, and insurance status," the authors conclude.

Eliminating barriers to appropriate medical care, along with better education about the signs, symptoms and causes of PAD, may lead to earlier care and help reduce the amputation rate in low-income, minority groups and in the population as a whole, the researchers suggest.

Risk factors for PAD include age older than 40 years, high blood pressure, diabetes, high cholesterol, smoking, obesity, family history of vascular disease and the presence of atherosclerosis in other arteries such as the heart and brain.

SOURCE: Journal of Vascular Surgery, January 2007.