Poor Californians with diabetes are up to 10 more likely to lose a limb over it than folks living in nicer zip codes.

A study by UCLA researchers, lurking behind a paywall at the online Health Affairs journal, went a step beyond other studies, which established poor people have lousier access to preventive care, and showed that, perhaps not surprisingly, the medical outcomes are much worse, too.

“Millions of Californians have undergone preventable amputations due to poorly managed diabetes,” said Dr. Carl Stevens, the study’s lead author and a clinical professor of medicine at the David Geffen School of Medicine at UCLA.

The study found that, on average, 20 Californians a day had amputations in 2009. Around 1,000 of those 6,828 patients had more than one amputation. Patients in poor San Fernando had 10 times as many amputations as upscale Hermosa Beach.

In general, the amputation rate for diabetics in neighborhoods where 40% of residents had incomes below 200% of the poverty was double that of neighborhoods where only 10% were below the line.

The most likely amputation patient was male, over 65 and black or non-English speaking. Although only 6% of diabetic patients are black, they account for almost 13% of the amputees. On the other hand, Asians, which make up 12% of the diabetic population account for just 5% of the amputation population.

Stevens and his five co-authors used data from the U.S. Census Bureau, the Office of Statewide Health Planning and Development (OSHPD) and the UCLA Center for Health Policy Research's California Health Interview Survey to map diabetic amputations by neighborhood for patients 45 and older. That’s the age of people at greatest risk of amputation.

“Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level,” said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health.

A big part of the problem is related to the compromised immune system that often accompanies diabetes. Patients with better managed medical care don’t lose a limb when blisters or other injuries progress to much more serious stages through infection of the blood and gangrene.

Stevens told the Los Angeles Times that the good news was the Affordable Care Act has changed the landscape for medical care of low-income patients since the 2009 data was gathered. But he added the caveat that it would depend to some extent on whether the increase in insured residents under Obamacare translates into better care.

–Ken Broder

To Learn More:

Study: Poor People with Diabetes 10 Times More Likely to Lose Limb (by Eryn Brown, Los Angeles Times)

Poor People with Diabetes Up to 10 Times Likelier to Lose a Limb Than Wealthier Patients (by Elaine Schmidt, UCLA Newsroom)

Geographic Clustering of Diabetic Lower-Extremity Amputations in Low-Income Regions of California (by Carl D. Stevens, David L. Schriger, Brian Raffetto, Anna C. Davis, David Zingmond and Dylan H. Roby, UCLA)