A study of lower extremity amputation rates in older diabetic South Carolinians.

Several studies have shown that lower extremity non-traumatic amputations for diabetic patients disproportionately affect senior minorities. Our study uses population and Medicare data from the year 2000 to profile the magnitude of this disparity by county in South Carolina and its relation to race, gender, per capita income, and the number of primary care physicians. Data from 1998-2001 is used to investigate trends in amputation rates for the state as a whole and for individual counties. Lower extremity non-traumatic amputation (LEA) rates in black diabetic Medicare patients are more than twice that of White diabetic Medicare patients. In 2000, the three counties with the highest LEA rates for black males were Barnwell (5.06%), Allendale (4.87%), and Florence (4.50%). LEA rates are not related to the number of primary care physicians per 10,000 county residents or per capita income. All gender/race groups saw declines in LEA rates. Although our study could not explain the socioeconomic factors involved, it does mirror other prior studies that show a racial disparity in LEAs. Similarly, men have a greater risk of diabetic non-traumatic LEAs. Interestingly however, having more primary care physicians per 10,000 county residents does not decrease the rate of amputations. Policy makers and insurance brokers may utilize our findings to target the areas of most need for intervention and further studies. Improved adherence to guidelines by primary care physicians, decreasing barriers to health care access, educating patients about the severity of diabetes and its complications, and providing more culturally competent care may lessen the burden of this disability for our minority patients. In the era of "pay for performance", the rate of LEAs as a proxy of poor diabetic care management must clearly improve. Fortunately, the decrease in LEA rates over time as shown in our study is a step in the right direction. However, the decrease is not consistent across all counties in South Carolina.