National Minority Health Month: End Racial Disparities in Limb Loss


It’s often said that serious illnesses don’t discriminate. Health crises are the great equalizer – striking men, women, the elderly and even children with terrifying unpredictability.

Yet, some of the most life-threatening and life changing health conditions are anything but random. Far from it – they disproportionately affect certain communities and populations often times despite (or in spite of) our best efforts.  History has shown that collective knowledge and awareness as well as considerable energy aimed at prevention are our best weapons at combating these often devastating diseases.

For African Americans in the United States, limb amputation has become a distressingly common, although often preventable, health crisis. Largely attributable to increased rates of high blood pressure and diabetes, which are key risk factors for the development of Peripheral Artery Disease (PAD), African Americans are four times more likely to undergo an amputation than white Americans.

The statistics are grim: an estimated one in four African Americans between the ages of 65 and 74 has diabetes. Likewise, high blood pressure affects more than 40 percent of African Americans, develops earlier in life, and is usually more severe than with white Americans.

Twelve million African Americans – twice as often as their white counterparts – have developed PAD, which causes narrowing or blockage of the vessels that carry blood from the heart to the legs.  Poor circulation not only causes excruciating pain, but can lead to tissue death and complex, untreatable ulcers. Today, one out of every three diabetics over the age of 50 has PAD, and vascular disease is now responsible for 80 percent of all amputations.

And while it’s an unfortunate but well-known fact that societal, social and genetic factors contribute to higher rates of PAD among African Americans, what’s more egregious is our lack of progress in slowing their rate of life-changing amputations.

Despite the wide availability of technologies that help patients avoid amputations, African American patients are less likely to have access to them. Outpatient interventions like angiography, revascularization (which restores critical blood flow to affected limbs), and atherectomy (a minimally invasive endovascular technique that removes plaque from blood vessels), have helped decrease the incidence of major amputations by 75 percent. Still, studies show that African American patients hospitalized for complications of peripheral arterial disease (PAD) have significantly lower rates of potentially limb-saving lower extremity angioplasty.

Lack of access to these technologies is a nationwide problem. Data indicate that of the more than 18 million Americans currently suffering from PAD, only two million will receive a diagnosis that will help to save their limb. It’s a problem that robs patients of their mobility, quality of life, and leads to lifelong physical and emotional burdens – not to mention expense.

It’s estimated that amputations cost the U.S. healthcare system an estimated at $10.6 billion annually. The largest payer of major amputations in America, Medicare, covered 66 percent of all amputations in 2010.

Avoiding amputations through revascularization procedures will not only help avoid the expense of amputation, it also allows patients to thrive: research shows that 80 percent of revascularization patients are walking again after two years, whereas 60 to 80 percent of amputation patients will never walk again. Fewer than 20 percent of patients require discharge to a skilled nursing facility after revascularization, compared to 70 percent of amputation patients who require either SNF or rehab care. Most notably, 2-year mortality for revascularization patients falls between 16 to 24 percent, while amputees face mortality rates of up to 50 percent.

The racial and ethnic disparities in amputation rates, especially with the existence of technology that could prevent them, deserve increased attention and action by our lawmakers – particularly as we observe National Minority Health Month in April.  Ongoing initiatives to reduce amputation rates, like those supported by the CardioVascular Coalition, seek to make limb preservation practices and the standard of care.  By doing so, we know that healthcare costs will decrease, but more importantly lives will be saved.

Bryan T. Fisher Sr., MD is the co-director of Limb Preservation at Centennial Medical Center and is an endovascular surgeon at the The Surgical Clinic in Nashville, Tennessee.

Morning Consult