Racial Disparities in Non-Traumatic Lower Extremity Amputation Rates in Illinois, 2013-2016
Background. Racial disparities in amputation rates have been widely recognized, including studies of higher rates in the Chicago metropolitan area among predominantly non-Hispanic black as compared to predominantly non-Hispanic white zip code areas. These disparities persisted into the 2000s despite a declining overall amputation rate after 1996. This study compares racial and ethnic amputation rates from more recent years for all residents of Illinois.Methods. Illinois hospital discharge data from 154 non-federal Illinois hospitals were used to calculate lower extremity amputation rates for the years 2013-2016 by race and ethnicity. ACS 5-year Census data were utilized to create race and ethnicity population denominators for patients 35 years of age or older in the state of Illinois, as well as for the populations of 3 different groups being compared (non-Hispanic white, non-Hispanic black, and Hispanic or Latino). The study assessed statewide amputation procedure trends as well as trends in population-based differences in through foot, below knee, and above knee amputation rates per 100,000.Results. Between 2010 and 2014, there was an apparent 14.7% increase in total lower extremity amputations in National Inpatient Sample estimates. In Illinois, statewide amputation procedure rates at all levels increased steadily from 2013 to 2016, increasing to 38.29 per 100,000 in 2016. However, there were very apparent ICD-9 to ICD-10 coding effects, with a 13% jump in through foot amputations and a 10% decline in above knee procedures between quarters when coding transitioned in 2015. Though only representing approximately 13% of the Illinois population, 26.9% of all lower extremity procedures were performed for non-Hispanic blacks, with the disparity in overall rates averaging 48.5 per 100,000, twice the non-Hispanic white rate.Conclusions. There was an increase nationally in the number of amputation procedures preceding the change to ICD-10 coded procedures in 2015. These data from Illinois hospitals indicate an apparent continuing increase in amputations driven by a large 2016 increase in through foot procedures, that is to some extent an IVC-10 coding change artifact. While ICD-10 coded above knee amputations appear to have declined in 2016, we cannot determine whether this was a real or a coding-related decline. Racial disparities in lower extremity amputation rates in Illinois continue to exist. Compared to a prior study looking at amputation rates in Northern Illinois, it possible that the racial gap has narrowed since the early 2000s, suggesting that public health interventions involving education and addressing social determinants of health may be promising to continue to reduce the gap.
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2018When the item was originally created.