title: Geographic clustering of diabetic lower-extremity amputations in low-income regions of California.
abstract: For patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases. Using statewide facility discharge data for California in 2009, we identified 7,973 lower-extremity amputations in 6,828 adults with diabetes. We mapped amputations based on residential ZIP codes and used data from the Census Bureau to produce corresponding maps of poverty rates. Comparisons of the maps show amputation "hot spots" in lower-income urban and rural regions of California. Prevalence-adjusted amputation rates varied tenfold between high-income and low-income regions. Our analysis does not support detailed causal inferences. However, our method for mapping complication hot spots using public data sources may help target interventions to the communities most in need.
authors.affiliation: Carl D. Stevens (carlstevens@mednet.ucla.edu) is a clinical professor in health sciences, David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
authors.forename: Carl D
authors.initials: CD
authors.lastname: Stevens
authors.affiliation: David L. Schriger is a professor at the Center for Emergency Medicine, UCLA.
authors.forename: David L
authors.initials: DL
authors.lastname: Schriger
authors.affiliation: Brian Raffetto is a physician resident in the Department of Emergency Medicine, Keck School of Medicine, University of Southern California, in Los Angeles.
authors.forename: Brian
authors.initials: B
authors.lastname: Raffetto
authors.affiliation: Anna C. Davis is a PhD student in the Department of Health Policy and Management, Fielding School of Public Health, UCLA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Davis
authors.affiliation: David Zingmond is an associate professor of medicine in the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: David
authors.initials: D
authors.lastname: Zingmond
authors.affiliation: Dylan H. Roby is an assistant professor in the Department of Health Policy and Management, Fielding School of Public Health, and director of health economics and evaluation research, UCLA Center for Health Policy Research.
authors.forename: Dylan H
authors.initials: DH
authors.lastname: Roby
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D019352:Censuses; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D062306:Geography, Medical; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D015995:Prevalence; D012424:Rural Population; D017062:Small-Area Analysis
keywords: Chronic Care; Disparities; Health Promotion/Disease Prevention; Public Health; Safety-Net Systems
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