Geographic Variation in Amputations for Medicare Patients With Diabetic Lower-Extremity Wounds

Area of Science:

• Medical research
• Public health
• Health services research

Background:

• Diabetic lower-extremity (DLE) wounds have substantial geographic variation in amputation rates.
• Understanding sociodemographic and healthcare factors is crucial for policy development to reduce amputations.

Purpose of the Study:

• To investigate the associations between regional patient characteristics, healthcare system factors, and major amputations in DLE wounds.
• To identify key determinants influencing amputation disparities in DLE wound patients.

Main Methods:

• Cross-sectional study of Medicare fee-for-service beneficiaries (aged 66+) with DLE wounds (2017-2019).
• Data aggregated at the hospital referral region (HRR) level, analyzing sociodemographic factors, economic deprivation, clinician supply, and wound care programs.
• Spatial-temporal Bayesian models used to estimate associations between HRR-level factors and major amputations.

Main Results:

• A total of 707,971 DLE wounds were analyzed across 306 HRRs.
• Higher percentages of Black and Hispanic beneficiaries and increased economic deprivation were associated with higher amputation rates.
• Increased podiatrist supply per 10,000 Medicare beneficiaries showed a significant negative association with major amputations.

Conclusions:

• Beyond social determinants, higher podiatrist supply is associated with reduced major amputations in DLE wounds.
• Findings suggest that enhancing access to podiatry services may be an effective strategy to decrease amputations among patients with DLE wounds.