Geographic clustering of diabetic lower-extremity amputations in low-income regions of California

• Published in: Health Affairs Vol. 33; no. 8; pp. 1383 - 1390
• Main Authors: Stevens, Carl D, Schriger, David L, Raffetto, Brian, Davis, Anna C, Zingmond, David, Roby, Dylan H
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01-08-2014
• Subjects: Adults; Aged; Amputation; Amputation - statistics & numerical data; California; California - epidemiology; Census; Censuses; Chronic illnesses; Comparative analysis; Diabetes; Diabetes Complications - epidemiology; Diseases; Female; Geography, Medical; Health care access; Health Problems; Healthcare Disparities - economics; Households; Humans; Income; Information systems; Intervention; Low Income Groups; Lower Extremity - surgery; Male; Middle Aged; Patients; Poverty; Poverty Areas; Prevalence; Preventive medicine; Rural Areas; Rural Population; Small-Area Analysis; Socioeconomic factors; Studies; Suffering; California; United States > US; Chronic Care; Health Promotion/Disease Prevention; Public Health; Disparities; Safety-Net Systems
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2014.0148

For patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases. Using statewide facility discharge data for California in 2009, we identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. We mapped amputations based on residential ZIP codes and used data from the Census Bureau to produce corresponding maps of poverty rates. Comparisons of the maps show amputation "hot spots" in lower-income urban and rural regions of California. Prevalence-adjusted amputation rates varied tenfold between high-income and low-income regions. Our analysis does not support detailed causal inferences. However, our method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.