J. Cao1, S. Sharath1, N. Zamani1, N. R. Barshes1 1Baylor College Of Medicine,Division Of Vascular Surgery And Endovascular Therapy,Houston, TX, USA
Introduction: Amputation rates in Texas are high, and racial disparities continue to affect leg amputation rates. Targeted interventions aimed at reducing health disparities may benefit patients in high-need, low-resource areas, and reduce gaps in care.
Methods: We collated 2005-2009 data on 254 Texas counties from three sources: Texas Inpatient Public Use Data File, Health Resources and Services Administration, and the County Health Rankings and Roadmaps. The primary outcome measure was the number of non-traumatic, lower-extremity amputations. Counties with greater than 11 leg amputations per 100,000 patients per year were designated as “hotspot” counties. Population-adjusted linear and logistic regressions identified factors that could explain increasing amputations among Texas counties.
Results: We identified 33 counties in Texas as “hotspot” counties. Hotspot counties had fewer healthcare resources and lower healthcare utilization. Dual Medicare/Medicaid enrollment and ER visits for foot complications are each associated with more amputations. In the presence of more ER visits, greater dual enrollment decreases total associated amputations (coefficients = -1.21*10-06, P<0.001). In counties with more than 70% rural communities, additional primary care providers decreased the total associated amputations (coefficients = -0.004, P=0.022). Populations in hotspot counties consisted of more people with diabetes (OR = 1.49, P<0.001) and more people categorized as black (OR = 1.09, P=0.007).
Conclusion: Healthcare availability plays a critical role in decreasing PAD-related amputations. Insurance enrollment and improved access to primary care providers may help reduce PAD-associated leg amputations. Strategic resource allocation may promote the reduction in PAD-associated amputations.
