Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 Sep;72(3):1011-1017.
doi: 10.1016/j.jvs.2019.10.090. Epub 2020 Jan 19.

The effect of rurality on the risk of primary amputation is amplified by race

Samantha Danielle Minc  1 , Philip P Goodney  2 , Ranjita Misra  3 , Dylan Thibault  4 , Gordon Stephen Smith  5 , Luke Marone  4
Affiliations
Comparative Study

The effect of rurality on the risk of primary amputation is amplified by race

Samantha Danielle Minc et al. J Vasc Surg. 2020 Sep.

Abstract

Objective: Primary amputation (ie, without attempted revascularization) is a devastating complication of peripheral artery disease. Racial disparities in primary amputation have been described; however, rural disparities have not been well investigated. The purpose of this study was to examine the impact of rurality on risk of primary amputation and to explore the effect of race on this relationship.

Methods: The national Vascular Quality Initiative amputation data set was used for analyses (N = 6795). The outcome of interest was primary amputation. Independent variables were race/ethnicity (non-Latinx whites vs nonwhites) and rural residence. Multivariable logistic regression examined impact of rurality and race/ethnicity on primary amputation after adjustment for relevant covariates and included an interaction for race/ethnicity by rural status.

Results: Primary amputation occurred in 49% of patients overall (n = 3332), in 47% of rural vs 49% of urban patients (P = .322), and in 46% of whites vs 53% of nonwhites (P < .001). On multivariable analysis, nonwhites had a 21% higher odds of undergoing primary amputation overall (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.05-1.39). On subgroup analysis, rural nonwhites had two times higher odds of undergoing primary amputation than rural whites (AOR, 2.06; 95% CI, 1.53-2.78) and a 52% higher odds of undergoing primary amputation than urban nonwhites (AOR, 1.52; 95% CI, 1.19-1.94). In the urban setting, nonwhites had a 21% higher odds of undergoing primary amputation than urban whites (AOR, 1.21; 95% CI, 1.05-1.39).

Conclusions: In these analyses, rurality was associated with greater odds for primary amputation in nonwhite patients but not in white patients. The effect of race on primary amputation was significant in both urban and rural settings; however, the effect was significantly stronger in rural settings. These findings suggest that race/ethnicity has a compounding effect on rural health disparities and that strategies to improve health of rural communities need to consider the particular needs of nonwhite residents to reduce disparities.

Keywords: Amputation; Amputation disparities; Peripheral artery disease; Racial disparities; Rural disparities; Rural health.

PubMed Disclaimer

Conflict of interest statement

Author conflict of interest: none.

Figures

Fig.
Fig.
Observed rates of primary amputation.
See this image and copyright information in PMC

References

    1. Amputee Coalition: Limb Loss Task Force. Roadmap for stimulating limb loss research and improving care: recommendations from the 2015 Limb Loss Task Force. Amputee Coalition Website; 2015. Available at: http://www.amputee-coalition.org/wp-content/uploads/2016/01/roadmap-for-.... Accessed October 13,2017.
    1. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990;13: 513–21. - PubMed
    1. Feinglass J, Abadin S, Thompson J, Pearce WH. A census-based analysis of racial disparities in lower extremity amputation rates in Northern Illinois, 1987–2004. J Vasc Surg 2008;47:1001–7. - PubMed
    1. Tseng CL, Helmer D, Rajan M, Tiwari A, Miller D, Crystal S, et al. Evaluation of regional variation in total, major, and minor amputation rates in a national health-care system. Int J Qual Health Care 2007;19:368–76. - PubMed
    1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020. Available at: https://www.healthypeople.gov/node/4121/data_details. Accessed November 27,2018. - PubMed

Publication types