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J Natl Med Assoc. 2009 Jul;101(7):649-55.

Disparities in level of amputation among minorities: implications for improved preventative care.

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Widener University, Institute for Physical Therapy Education, 1 University Place, Chester, PA 19013, USA.



The purpose of this study was to evaluate the relationship between race and level of amputation and to discuss the implications if a disparity was found.


From the 2003 Healthcare Cost and Utilization Nationwide Inpatient Sample, 80845 (weighted) discharges with a diagnosis of vascular disease and black or white race were evaluated for a disparity in level of amputation. Level of amputation was categorized using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes into above-knee and below-knee amputation. SPSS 15.0 complex samples software (SPSS Inc, Chicago, Illinois) was used for univariate and multivariate statistical analysis.


Bivariate (p < .001) and logistic regression (p < .001; OR, 1.51; 95% CI, 1.4-1.7) analyses revealed a significant association between race and level of amputation. Other covariates were also significant for influencing level of amputation and include age (p < .001; OR, 1.03; 95% CI, 1.02-1.03), female gender (p < .001; OR, 1.33; 95% CI, 1.2-1.5), Charlson Comorbidity Index (p < .001; OR, 1.12; 95% CI, 1.1-1.2), Medicare (p < .017; OR 1.34; 95% CI, 1.1-1.9), Medicaid (p < .003; OR, 1.63; 95% CI, 1.2-2.2, peripheral arterial disease (p < .001; OR, 1.22. CI, 1.1-1.4) and cerebrovascular disease (p < .001; OR, 1.80; 95% CI, 1.5-2.1).


Black race is significantly more associated with above-knee amputation when compared to white race. The consequences of higher-level evaluation could lend to disparities in overall health between the black and white races.

[Indexed for MEDLINE]

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