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Home > Press Center > Racial Disparity Evident in Amputation Rate in Northern Illinois

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Emily Kalata
Assistant Director, Communications
312.334.2309

An 18-year study in northern Illinois has revealed that African-American neighborhoods have an incidence rate of lower amputations more than five times higher per capita than residents in primarily “white” zip codes.         

In particular, in the South and West sides of Chicago, African-Americans comprised less than 15 percent of that area’s population, but accounted for 27 percent of all amputation discharges for 33,775 patients at 171 hospitals during the study period between 1987 and 2004. Details of this research were published in the May 2008 issue of the Journal of Vascular Surgery by lead author Joseph M. Feinglass, PhD, research professor, division of general internal medicine at Northwestern University Feinberg School of Medicine in Chicago.  

Co-author William H. Pearce, chief of vascular surgery, Northwestern University Feinberg School of Medicine, noted that statistics for the 8 million residents in northern Illinois indicate that major (above and below knee) amputation rates declined to 17 per 100,000 residents in the last decade. He added that inpatient mortality and length of stay also was reduced during that time period.  

Better diabetes management, introduction of statin drugs (that benefit patients with peripheral arterial disease) and improved vascular surgery and angioplasty procedures (including increased lower extremity stent replacement which contributes to improved arterial patency and amputation–free survival times for re-vascularized patients) are the most likely reasons for the reduction of overall amputations.  

“However, lack of access to educational opportunities or medical care in both the Hispanic and African-American communities creates racial disparities which have remained constant, despite progress in reducing the overall major amputation rate,” said Dr. Pearce.      

Researchers noted that a compounding factor in the magnitude of racial disparity is the more frequent re-amputations experienced by African-American patients; the numbers for re-amputations were equally as great as primary amputations. Medicare data indicated that 26 percent of all amputees in 1996 underwent a second amputation and one-third of the patients died within a year. This data also reflects potentially important rehabilitation, home health, as well as end of life and palliative care issues for amputees.

According to Dr. Pearce, the African-American community also has more childhood and adolescent weight gain which can cause diabetes prevalence, as well as a higher smoking rate than white areas (39 vs. 18 percent), and both of these socioeconomic factors can lead to peripheral artery disease and often amputation.    

He added that amputation disparities can only be explained by differences in social determinants of health and reflect the disease burden often associated with the effects of low socioeconomic status, segregation and concentrated neighborhood poverty.

“These disparities will require that low income, medically complex patients at risk for limb loss, receive timelier and high performance care; these should be combined with community-based public health and preventive medicine interventions that address the socioeconomic issues that impact these patients’ access to care,” added Dr. Pearce.  

Researchers noted that this study reflected the specific socioeconomic conditions of Chicago, where low income or poor whites are uncommon and racial disparities exist across many aspects of health. “It is likely that rather than race itself, socioeconomic inequality (including differential access to and quality of care), underlies most of the difference in amputation rates described in our study,” said Dr. Pearce.