Amputation Rate – A Racial Issue?

Is it possible that race could be a factor in the decision to amputate a leg? Chris Kaiser, cardiology editor of MedPage Today, writes that a recent study found data which indicates that African American patients have greater odds of undergoing amputation than do white patients despite access to high rated hospitals or above average incomes patient income. Tyler S. Durazzo, M.D. and colleagues at the Yale University School of Medicine conducted the study and published it online in the journal Jama Surgery.

Kaiser noted that in hospitals with the greatest capacity to perform revascularizations, African American patients had a 98% higher probability of undergoing amputation for critical lower limb ischemia than did white patients, independent of all other variables. Income seemed to make no difference. While both African American patients and white patients with higher incomes had a better chance of revascularization, even African American patients from the wealthiest ZIP codes were disproportionately more likely to undergo an amputation.

They found that African American and Hispanic patients both had greater odds of undergoing an amputation compared with whites, but Hispanics were less likely to undergo amputation compared with African Americans (34% Whites versus 48% Hispanics versus 56% African Americans). Kaiser reported that the only two variables with more odds of leading to an amputation, than being African American, were having gangrene and needing repair of a previously revascularized artery. “Race independently influenced the treatment decision more than insurance or socioeconomic status, ” the researchers said.

The study included 774, 399 patients with a primary diagnosis of critical lower extremity ischemia from 2002 to 2008. A total of 38% underwent amputation, and 62% had revascularization. The mean age was about 70, and there were more African American women compared with white or Hispanic women.

Commenting on the study Karl Illig, M.D., the University of South Florida, Tampa, said that while provider bias could not be excluded, he suggested that genetic differences between races could be an explanation Kaiser quotes him as saying, “It is politically dangerous to raise the issue of consistent biologic variability between groups, but such variability unequivocally exists for certain genetically determined entities.”

Illig added that if this possibility is ignored, the result may be inferior care because the “true problem” is not fully understood or recognized. The cause of disparity may be provider bias, but the possibility of genetic differences must be investigated “to provide the best possible care for all our patients.”