After publishing a research study in late March showing that blacks in Chicago are five times more likely than suburban whites to have their legs amputated, Feinberg School of Medicine’s Chief of Vascular Surgery Dr. William Pearce submitted a three-part proposal Monday to Northwestern Memorial Hospital to create programs to bridge that gap.
“The issue is the socioeconomics,” Pearce said. “You can make a great impact by raising awareness in disadvantaged communities in providing relatively low-cost interventions to prevent these high-cost procedures later.”
Pearce collaborated with Joe Feinglass, a Northwestern Research Professor of Medicine in the Institute for Health Care Studies, to analyze the amputation rates between 1987 and 2004 in different zip codes in the Chicago metropolitan area. In the paper, published in this month’s Journal of Vascular Surgery, the scientists looked at non-traumatic leg amputations, which result from unchecked diabetes or blood vessel diseases, not accidents. They found that today, between 60 and 65 of every 100,000 blacks in the inner city underwent amputations, about five times the amount of amputations in primarily white suburban regions.
The two scientists already knew of a connection between race and large numbers of amputations and further investigated the correlation. Their findings can apply across the nation, particularly in large urban areas, said Feinglass, the lead author of the study.
“Chicago may be different only in the sense that we have a very high level of segregation in our housing here that allowed us to do this and to project these rates relatively easily,” he said.
Two-thirds of amputees have diabetes, which predisposes them to circulatory system problems. Amputations must occur when they let their condition get “out of control” and wait too long before seeking care, Feinglass said.
The increasing number of blacks with diabetes has led to the elevated rate of amputations. In 2005, statistics from the American Diabetes Association cited that 3.2 million blacks aged 20 or older in the U.S. had diabetes, the second-highest prevalence of the disease among racial groups.
In that same year, 20.8 million people in the U.S., or 7 percent of the population, had diabetes, the organization reported.
Amputations are a way to treat atherosclerosis, or the hardening of blood vessels, which restricts circulation. It’s similar to what happens to the heart during a heart attack, Feinglass said.
In more affluent communities, patients can choose more advanced and pricier alternatives to amputation; this has helped decrease amputation rates in suburban areas, he said. But many at inner-city hospitals can’t offer other options.
“For the inner-city populations, there’s been very little, if no, progress,” he said, referring to areas like the South and West sides of Chicago. The number of amputations in these parts of the city, which are between 80 and 90 percent black, actually recorded a total increase over the years, Feinglass said.
Even if health care systems improve, the benefits don’t always “trickle down” to lower-income populations, he said.
“The findings that we have reflect that our health care system has the greatest resources for the population that has the fewest needs and the least resources for the population that has the greatest need,” Feinglass said.
It’s this socioeconomic divide that Pearce said he hopes to address with his latest proposal. The three-pronged approach includes a research component to examine new treatment methods that use stem cells or nanofibers, he said. Pearce also suggested a clinic for limb preservation at Northwestern Memorial Hospital, and the final segment of his plan involves local activism and outreach.
Even though his proposal has yet to be reviewed by the hospital, Pearce said he expects the clinic to start this year and the other two programs to begin within two years, “with or without their funding.”
The patient disparity with amputations is so “missed and overlooked” that it needs to be addressed, he said.
“(Doctors) in big medical centers strive to find new ways to treat people to prevent amputations,” Pearce said. “I think we miss the real point, which is you can make a great impact by raising awareness in disadvantaged communities in providing relatively low-cost interventions to prevent these high-cost procedures later.”
