Social and Structural Determinants of Lower Extremity Amputations in Diabetes

Lower extremity amputations (LEAs) are among the most severe complications of diabetes, with approximately 1.5 million procedures performed globally each year. This review explores the impact of social and structural determinants of health on amputation rates in diabetic patients, highlighting disparities driven by systemic factors.

Structural determinants such as healthcare policies and economic systems intersect with social factors, including access to care, racial disparities, and socioeconomic status, influencing amputation risk. Black patients with diabetes face up to a fourfold increased risk of major amputation compared to non-Hispanic white patients. Lower socioeconomic status is also strongly linked to higher amputation rates. Geographic and environmental factors, like food deserts and limited access to specialized care, further exacerbate these disparities. Emerging prevention strategies, such as telemedicine and mobile health units, demonstrate promise in improving access to care. Addressing disparities in LEAs requires comprehensive policy changes and targeted interventions. Future directions include leveraging artificial intelligence and precision medicine alongside community-based programs to reduce amputation rates in high-risk diabetic populations.