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Geographic Clustering of Diabetic Lower-Extremity Amputations in Low-Income Regions of California (Health Affairs)

August 4, 2014

CHIS Journal Article

Authors: Carl D. Stevens, David Schriger, Brian Raffetto, Anna C. Davis, David Zingmond, M.D., Ph.D., Dylan H. Roby, PhD

​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, this study identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. Amputations were mapped 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. The analysis does not support detailed causal inferences. However, the method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.

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