Over two million Americans live with limb loss and limb difference.1 But the risk is not the same for everyone. People of color are more likely to have limb loss as a result of unequal access and treatment in our society and health systems. They are also more likely to have diabetes and vascular disease,1,2 which are among the leading causes of limb loss. If you think you may be at risk, especially if you have diabetes, peripheral artery disease (PAD), or chronic limb ischemia (CLI), talk with your health care provider about what you can do to avoid limb loss. The Amputee Coalition is committed to increasing data on the race and ethnicity disparities in limb loss to better serve the needs of all our community members. Stay updated with the latest findings by visiting amputee-coalition.org.
Racial Disparities in Limb Loss
Black Americans are much less likely than White Americans to undergo procedures that can prevent amputation, known as limb salvage.3 They are FOUR TIMES more likely to experience amputation for any reason than White Americans, and nearly TWO TIMES more likely to experience diabetes-related amputations.2,4
Latino Americans are ONE-and-a-HALF times more likely to experience amputation for any reason than White Americans, and 30% more likely to experience a major amputation related to a diabetic foot infection than White Americans.5
Indigenous Americans are up to 70% more likely to experience amputation for any reason than insured, non-Indigenous adult Americans.9 Indigenous Americans are TWO TO THREE times more likely to experience a major amputation related to a diabetic foot infection than White Americans.7,10
Racial Disparities in Predisposing Conditions
Diabetes often leads to Peripheral Artery Disease (PAD), which restricts blood flow to the limbs. Black Americans experience PAD at three times the rate of White Americans.11,12 PAD is a type of vascular disease, and nearly half of people who lose a limb because of vascular disease will die within five years. This is a higher five-year mortality rate than breast, colon, or prostate cancer.13,14
Income Disparity in Limb Loss
Lower household income correlates with higher rates of amputation, particularly due to diabetes.15 People living with limb loss who have a household income at or near the poverty line were up to three-and-a-half times more likely to experience barriers to participation in work and community life.15,16
(1) Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. “Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050.” Archives of Physical Medicine and Rehabilitation, 2008;89(3):422-429. doi.org/10.1016/j.apmr.2007.11.005
(2) Fisher ES, Goodman DC, Chandra A. “Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project.” Robert Wood Johnson Foundation, 2008.
(3) Holman KH, Henke PK, Dimick JB, Birkmeyer JD. Racial disparities in the use of revascularization before leg amputation in Medicare patients. Journal of vascular surgery. 2011 Aug 1;54(2):420-6. doi.org/10.1016/j.jvs.2011.02.035
(4) Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. “Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008.” Diabetes Care February 1, 2012;35(2):273-7. doi.org/10.2337/dc11-1360
(5) Bancks MP, Kershaw K, Carson AP, Gordon-Larsen P, Schreiner PJ & Carnethon MR. (2017). Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood. Jama, 318(24), 2457-2465. doi:10.1001/jama.2017.19546
(6) Rizzo JA, Chen J, Kotlarz H, Ryan MP & Gunnarsson C. (2016). Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease Using the Health Care Cost and Utilization Project Database. Value in Health, 19(3), A55-A56. doi:https://doi.org/10.1016/j.jval.2016.03.142
(7) Tan TW, Shih CD, Concha-Moore KC, Diri MM, Hu B, Marrero D, … & Armstrong, DG (2019). Disparities in outcomes of patients admitted with diabetic foot infections. PLoS One, 14(2), e0211481. https://doi.org/10.1371/journal.pone.0215532
(8) Centers for Disease Control. Hispanic/Latino Americans and Type 2 Diabetes. September 2019. Access March 2021. https://www.cdc.gov/diabetes/library/features/hispanic-diabetes.html
9. O’Connel J, Yi R, Wilson C, Manson SM & Acton KJ. (2010). Racial disparities in health status: a comparison of the morbidity among American Indian and US adults with diabetes. Diabetes Care, 33(7), 1463-1470. https://doi.org/10.2337/dc09-1652
10. Young BA, Maynard C, Reiber G & Boyko EJ. (2003). Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes care, 26(2), 495-501. https://doi.org/10.2337/diacare.26.2.495
11. Lavery LA, Houtum WHV, Ashry HR, Armstrong DG, Pugh JA. “Diabetes-Related Lower-Extremity Amputations Disproportionately Affect Black and Mexican Americans.” Southern Medical Journal (online) 1999,92(5):593. doi:10.1097/00007611-199906000-00008
12. Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. “Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008.” Diabetes Care February 1, 2012;35(2):273-7. https://doi.org/10.2337/dc11-1360
13. Pandian G, Hamid F, Hammond M. Rehabilitation of the Patient with Peripheral Vascular Disease and Diabetic Foot Problems. In: DeLisa JA, Gans BM, editors. Philadelphia: Lippincott -Raven; 1998.
14. Selvin E, 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(6):73843. https://doi.org/10.1161/01. CIR.0000137913.26087.F0
15. Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation. Amin L, Shah BR, Bierman AS, Lipscombe LL, Wu CF, Feig DS, Booth GL. Diabet Med. 2014;31:1410–1417/. https://doi.org/10.1111/dme.12507
16. Ephraim PL, MacKenzie EJ, Wegener ST, Dillingham TR, Pezzin LE. “Environmental Barriers Experienced by Amputees: The Craig Hospital Inventory of Environmental Factors – Short Form.” Archive of Physical Medicine and Rehabilitation 2006,87(3):328-333. https://doi.org/10.1016/j.apmr.2005.11.010