People living in poorer areas of California have up to ten times the risk of suffering amputation as people living in more affluent areas.

Researchers from UCLA (The University of California, Los Angeles) reviewed nearly 8,000 (7,973) incidences of amputation occurring in 6,828 people with diabetes in California. The number of amputations was then mapped against ZIP codes of the patients. Evaluation of poverty rates of different areas were assessed using Census Bureau data.

When the results were mapped, clear ‘hot spots’ of high amputation rates emerged within lower-income urban regions as well as within rural areas. When analysed, the difference in amputation prevalence was a ten-fold difference between poorer and wealthy areas. Further analysis showed that patients most at risk of amputation were from non-English speaking minorities, males and over 65 year olds.

Amputations affecting the lower leg are much more common in people with diabetes than in the rest of the population. Poor blood circulation, neuropathy and slow wound healing, can each be a consequence of diabetes and can each increase the risk of wound infections occurring. If foot infections are not noticed and therefore not treated early, amputation becomes a strong likelihood.

Carl Stevens, the lead author of the study, noted: “Patients that don’t have adequate care will put off seeking care until their foot is red, swollen and obviously infected. They’ll go to the emergency room, where they find the infection is too far and often need amputation beginning at the toe to further up the leg.”