Health disparities in diabetes-related lower extremity amputations in the Texas-Mexico border region

Background: Disability and mortality from diabetes-related lower extremity amputations (LEA) have significant social and economic costs. Study purpose: (1) To identify any differences across ethnicity, age, gender, or insurance status among individuals undergoing LEA and residing in the Lower Rio Grande Valley (Valley) in the Texas-Mexico border area; and (2) to determine if LEA prevalence is higher in the Valley than in Texas. Methods: Data used for this study(n=204,776)was drawn from the 2003 Texas Impatient Hospital Discharge Data, which includes information for all hospital discharges from state-licensed hospitals in Texas . The main focus of the study was border residents in the Valley, where the majority is Spanish-speaking Hispanic, very poor, uninsured, and with lower education levels. Descriptive, univariate, and multivariate logistic regression analyses were used. Results: Hispanics (OR:1.51, CI: 1.43-1.60) are more likely to undergo LEA than non-Hispanic whites and other minority groups in Texas. Being 65 and older, being male, and having a moderate level of diabetes severity had also a significant association to LEA. Diabetes-related LEA prevalence rates were higher in the Valley (OR=1.35, CI: 1.24-1.48) compared to the State. Conclusions: This study shows ethnic and geographic disparities related to diabetes-related lower extremity amputations. Public health policies and diabetes education interventions in the Texas-Mexico border should include effective strategies to reduce such health disparities affecting Hispanics, particularly focusing on the older and male border groups. This research was supported, in part, by Cooperative Agreement number 5U48 DP000045 from the Centers for Disease Control and Prevention.