Penn study finds higher amputation rates in low income and majority-Black communities

A recent Penn study found that amputation rates in cities are correlated with poverty and living in a majority Black neighborhood. 

The study, led by assistant professor of medicine at the Hospital of the University of Pennsylvania Alexander Fanaroff, examined amputation rates for patients with peripheral artery disease. The researchers studied the relationship between amputation rates, ZIP codes, and their racial and socioeconomic disparities, WHYY reported. The study concluded that even in cities with close access to health professionals, poorer and primarily Black communities have higher amputation rates. 

“The genesis for this study was [seeing whether] risk factors for amputation and inadequate medical care act at a smaller level than the county,” Fanaroff told WHYY. “Living in Philadelphia, [you see] neighborhood-to-neighborhood variation in resources available to the people that are living in these communities."

Once the team of researchers determined the relationship between amputations and ZIP codes, they cross-referenced the data with racial compositions and poverty within those areas, WHYY reported. They found that ZIP codes with high amputation rates, majority Black ZIP codes, and low median income ZIP codes overlapped. In cities, 76% of majority Black ZIP codes were in the top quartile of amputation rates.

The study used data from 188,995 patients who underwent a total of 222,956 amputations from 2010 to 2018, WHYY reported. More than 75% of patients lived in metropolitan areas, and more than half the ZIP codes with highest amputation rates were located in cities. 

The study builds upon medical literature that addresses the relationship between residential racial segregation and health outcomes. Previous research has shown that living in high-poverty neighborhoods or rural counties makes it harder for people to access specialized healthcare due to disparities in socioeconomic status. 

“We know, in our backyard of the University of Pennsylvania Health System, in our own ZIP code, amputation rates are high despite the availability of dozens of folks that specialize in treating that condition,” Fanaroff told WHYY. “An amputation is a failure at multiple levels.” 

There are currently no standardized guidelines for the disease that affects over 8.5 million Americans, according to WHYY, but efforts are being made to educate patients and providers on symptoms, diagnosis, and treatment. Fanaroff told WHYY that racial and socioeconomic disparities in amputation rates are not only about how much access to a doctor an individual may have, but also about maintaining a healthy lifestyle. 

Healthcare professionals can aim to slow or stop the progression of PAD before amputation is necessary. Strategies such as diet and exercise, monitoring and treating other health conditions — like high blood pressure and cholesterol — that are risk factors, and reducing smoking can moderate the effects of the disease, WHYY reported. Other treatments and medicines – such as limb salvage, antiplatelet therapy, and aspirin — can also be used to avoid amputation. 

"It takes a lot more than geographic proximity to see a doctor to maintain health,” Fanaroff told WHYY.