Over two million Americans live with limb loss and limb difference.1 But the risk is not the same for everyone. People of color are more likely to have limb loss as a result of unequal access and treatment in our society and health systems. They are also more likely to have diabetes and vascular disease,1,2 which are among the leading causes of limb loss. If think you may be at risk based on the information below, especially if you have diabetes, peripheral artery disease (PAD), or chronic limb ischemia (CLI), talk with your health care provider about what you can do to avoid limb loss.
Racial Disparities in Limb Loss
Black Americans are much less likely than white Americans to undergo procedures that can prevent amputation, known as limb salvage.3 They are FOUR TIMES more likely to experience amputation for any reason than white Americans, and nearly TWO TIMES more likely to experience diabetes-related amputations.2,4
Latino Americans are ONE-and-a-HALF times more likely to experience amputation for any reason than white Americans, and 30% more likely to experience a major amputation related to a diabetic foot infection than white Americans.5
Racial Disparities in Predisposing Conditions
Diabetes often leads to Peripheral Artery Disease (PAD), which restricts blood flow to the limbs. Black Americans experience PAD at three times the rate of white Americans.11,12
PAD is a type of vascular disease, and nearly half of people who lose a limb because of vascular disease will die within five years. This is a higher five-year mortality rate than breast, colon, or prostate cancer.13,14
Income Disparity in Limb Loss
Lower household income correlates with higher rates of amputation, particularly due to diabetes.15
People living with limb loss who have a household income at or near the poverty line were up to three-and-a-half times more likely to experience barriers to participation in work and community life.15,16
- Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. “Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050.” Archives of Physical Medicine and Rehabilitation, 2008;89(3):422-429. doi.org/10.1016/j.apmr.2007.11.005
- Fisher ES, Goodman DC, Chandra A. “Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project.” Robert Wood Johnson Foundation, 2008.
- Holman KH, Henke PK, Dimick JB, Birkmeyer JD. Racial disparities in the use of revascularization before leg amputation in Medicare patients. Journal of vascular surgery. 2011 Aug 1;54(2):420-6. doi.org/10.1016/j.jvs.2011.02.035
- Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. “Declining Rates of Hospitalization for Nontraumatic Lower‐Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008.” Diabetes Care February 1, 2012;35(2):273‐7. doi.org/10.2337/dc11- 1360
- Bancks MP, Kershaw K, Carson AP, Gordon-Larsen P, Schreiner PJ & Carnethon MR. (2017). Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood. Jama, 318(24), 2457-2465. doi:10.1001/jama.2017.19546
- Rizzo JA, Chen J, Kotlarz H, Ryan MP & Gunnarsson C. (2016). Racial Disparities in Amputation Rates for the Treatment of Peripheral Artery Disease Using the Health Care Cost and Utilization Project Database. Value in Health, 19(3), A55-A56. doi:https://doi.org/10.1016/j.jval.2016.03.142
- Tan TW, Shih CD, Concha-Moore KC, Diri MM, Hu B, Marrero D, … & Armstrong, DG (2019). Disparities in outcomes of patients admitted with diabetic foot infections. PLoS One, 14(2), e0211481. https://doi.org/10.1371/journal.pone.0215532
- Centers for Disease Control. Hispanic/Latino Americans and Type 2 Diabetes. September 2019. Access March 2021. https://www.cdc.gov/diabetes/library/features/hispanic-diabetes.html
- O’Connel J, Yi R, Wilson C, Manson SM & Acton KJ. (2010). Racial disparities in health status: a comparison of the morbidity among American Indian and US adults with diabetes. Diabetes Care, 33(7), 1463-1470. https://doi.org/10.2337/dc09-1652
- Young BA, Maynard C, Reiber G & Boyko EJ. (2003). Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes care, 26(2), 495-501. https://doi.org/10.2337/diacare.26.2.495
- Lavery LA, Houtum WHV, Ashry HR, Armstrong DG, Pugh JA. “Diabetes-Related Lower-Extremity Amputations Disproportionately Affect Black and Mexican Americans.” Southern Medical Journal (online) 1999,92(5):593. doi: 10.1097/00007611-199906000-00008
- Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. “Declining Rates of Hospitalization for Nontraumatic Lower‐Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988–2008.” Diabetes Care February 1, 2012;35(2):273‐7. https://doi.org/10.2337/dc11-1360
- Pandian G, Hamid F, Hammond M. Rehabilitation of the Patient with Peripheral Vascular Disease and Diabetic Foot Problems. In: DeLisa JA, Gans BM, editors. Philadelphia: Lippincott‐Raven; 1998.
- Selvin E, Erlinger TP. “Prevalence of and risk factors for peripheral arterial disease in the United States: Results from the National Health and Nutrition Examination Survey, 1999‐2000.” Circulation 2004;110(6):738‐43.https://doi.org/10.1161/01.CIR.0000137913.26087.F0
- Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation. Amin L, Shah BR, Bierman AS, Lipscombe LL, Wu CF, Feig DS, Booth GL. Diabet Med. 2014;31:1410–1417/. https://doi.org/10.1111/dme.12507
- Ephraim PL, MacKenzie EJ, Wegener ST, Dillingham TR, Pezzin LE. “Environmental Barriers Experienced by Amputees: The Craig Hospital Inventory of Environmental Factors – Short Form.” Archive of Physical Medicine and Rehabilitation 2006,87(3):328-333. https://doi.org/10.1016/j.apmr.2005.11.010
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Authors and Contributors
The Amputee Coalition is grateful to the many organizational members and individuals that have contributed to this work. The Amputee Coalition Scientific and Medical Advisory Committee (SciMAC) conducts expert peer view for the Amputee Coalition-commissioned patient education materials. SciMAC contributes clinical and scientific expertise in developing, implementing, and evaluating the Amputee Coalition program and policy initiatives.
Suggested AMA format citation for this material:
Amputee Coalition. Race and Ethnicity Disparities in Limb Loss Fact Sheet. https://www.amputee-coalition.org. Published March 2021. Accessed [date].
It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.
This project was supported, in part, by grant number 90LLRC0001-01-00, from the Administration for Community Living, U.S. Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
© Amputee Coalition. Local reproduction for use by Amputee Coalition constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other World Wide Web sites must contact the Amputee Coalition for permission to do so.