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Blacks
More Likely to Lose Leg to Diabetes
 Blacks
undergo leg amputations as a complication of diabetes at a far higher
rate than whites, according to a study out today that also found blacks
lag behind whites in breast cancer screening and diabetic tests. "There
are remarkable disparities between blacks and whites and between
communities," says Dartmouth Medical School professor and study lead
author Elliott Fisher, who says health systems, economics, lifestyle,
education and community resources all play a role in the differences.
The study, paid for
by the non-profit Robert Wood Johnson Foundation, used data from
Medicare to look at amputations, screening rates and other measures of
quality care among the 50 states and the District of Columbia. The
foundation is one of the nation's largest philanthropies and backs
efforts to change the health care system.
Researchers studied amputation because it can indicate that diabetes patients have received inadequate preventive care.
The study found:
• Across the USA, the rate of leg amputation is four times greater among black Medicare recipients than white.
• Black residents of Louisiana, Mississippi and South Carolina had
6 amputations per 1,000 Medicare enrollees, while black residents of
Colorado and Nevada had fewer than 2 per 1,000.
• Overall amputation rates for both blacks and whites vary among
states. Utah has the lowest rate at .5 amputations per 1,000 Medicare
members, and Louisiana has the highest at 1.7 amputations per 1,000.
Fisher says patients undergo leg amputations partly because of the care
they get and partly because of difficulties they may face in getting
treatment. Other factors ? such as whether patients smoke or exercise,
or if they can afford the special shoes some diabetics need ? also play
a role, he says.
Blacks also were less likely than whites to get mammograms to check for
breast cancer, although the size of the gap varied widely among states.
In Illinois, for example, 63% of white female Medicare beneficiaries
were screened for cancer, while only 51% of blacks were. In
Massachusetts, the gap was narrow: 71.9% of whites were screened, 71.5%
of blacks.
With the exception of Arizona and Kentucky, black diabetic patients
were less likely to get a recommended annual blood test than whites.
The biggest gap was in Colorado, where 84% of whites were tested, 66%
of blacks.
Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson
Foundation, says it will spend $300 million over three years to fund
programs nationwide and targeted in 14 regions to improve medical care
and reduce racial and ethnic disparities.
Changes could include getting patients to regular doctor visits and
stocking fresh produce at grocery stores, says John Buse, president for
Medicine and Science at the American Diabetes Association, who did not
work on the study.
Often, he says, patients who have leg amputations live in poorer
communities and are either uninsured or have limited coverage. By the
time they qualify for Medicare, they may be in bad shape.
"Once someone with modest resources and no health insurance becomes
acutely ill or disabled, they can generally get Medicare or Medicaid,"
Buse says. "But often the price of admission for a patient with
diabetes is a serious complication like blindness, kidney failure,
amputation or stroke."
USA Today
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