Racial, rural, and regional disparities in diabetes-related lower-extremity amputation rates, 2009–2017

Marvellous A. Akinlotan, Kristin Primm, Jane N. Bolin, Abdelle L.Ferdinand Cheres, Ju Sung Lee, Timothy Callaghan, Alva O. Ferdinand

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


OBJECTIVE To examine the racial/ethnic, rural-urban, and regional variations in the trends of diabetes-related lower-extremity amputations (LEAs) among hospitalized U.S. adults from 2009 to 2017. RESEARCH DESIGN AND METHODS We used the National Inpatient Sample (NIS) (2009–2017) to identify trends in LEA rates among those primarily hospitalized for diabetes in the U.S. We conducted multivariable logistic regressions to identify individuals at risk for LEA based on race/ethnicity, census region location (North, Midwest, South, and West), and rurality of residence. RESULTS From 2009 to 2017, the rates of minor LEAs increased across all racial/ethnic, rural/urban, and census region categories. The increase in minor LEAs was driven by Native Americans (annual percent change [APC] 7.1%, P < 0.001) and Asians/Pacific Islanders (APC 7.8%, P < 0.001). Residents of non-core (APC 5.4%, P < 0.001) and large central metropolitan areas (APC 5.5%, P < 0.001) experienced the highest increases over time in minor LEA rates. Among Whites and residents of the Midwest and non-core and small metropolitan areas there was a significant increase in major LEAs. Regression findings showed that Native Americans and Hispanics were more likely to have a minor or major LEA compared with Whites. The odds of a major LEA increased with rurality and was also higher among residents of the South than among those of the Northeast. A steep decline in major–to–minor amputation ratios was observed, especially among Native Americans. CONCLUSIONS Despite increased risk of diabetes-related lower-limb amputations in underserved groups, our findings are promising when the major–to–minor amputation ratio is considered.

Original languageEnglish (US)
Pages (from-to)2053-2060
Number of pages8
JournalDiabetes care
Issue number9
StatePublished - Jul 1 2021

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


Dive into the research topics of 'Racial, rural, and regional disparities in diabetes-related lower-extremity amputation rates, 2009–2017'. Together they form a unique fingerprint.

Cite this