{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T12:22:36Z","timestamp":1779020556895,"version":"3.51.4"},"reference-count":34,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T00:00:00Z","timestamp":1702339200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health","award":["R01DK113295"],"award-info":[{"award-number":["R01DK113295"]}]},{"name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health","award":["R01DK132569-01"],"award-info":[{"award-number":["R01DK132569-01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2023,11,2]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>While rates for non-traumatic lower extremity amputations (LEA) have been declining, concerns exist over disparities. Our objectives are to track major LEA (MLEA) rates over time among Medicare beneficiaries residing in a high diabetes prevalence region in the southeastern USA (the diabetes belt) and surrounding areas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used Medicare claims files for ~900\u2009000 fee-for-service beneficiaries aged \u226565 years in 2006\u20132015 to track MLEA rates per 1000 patients with diabetes. We additionally conducted a cross-sectional analysis of data for 2015 to compare regional and racial disparities in major amputation risks after adjusting for demographic, socioeconomic, access-to-care and foot complications and other health factors. The Centers for Disease Control and Prevention defined the diabetes belt as 644 counties across Appalachian and southeastern US counties with high prevalence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>MLEA rates were 3.9 per 1000 in the Belt compared with 2.8 in the surrounding counties in 2006 and decreased to 2.3 and 1.6 in 2015. Non-Hispanic black patients had 8.5 and 6.9 MLEAs per 1000 in 2006 and 4.8 and 3.5 in 2015 in the Belt and surrounding counties, respectively, while the rates were similar for non-Hispanic white patients in the two areas. Although amputation rates declined rapidly in both areas, non-Hispanic black patients in the Belt consistently had &gt;3 times higher rates than non-Hispanic whites in the Belt. After adjusting for patient demographics, foot complications and healthcare access, non-Hispanic blacks in the Belt had about twice higher odds of MLEAs compared with non-Hispanic whites in the surrounding areas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Our data show persistent disparities in major amputation rates between the diabetes belt and surrounding counties. Racial disparities were much larger in the Belt. Targeted policies to prevent MLEAs among non-Hispanic black patients are needed to reduce persistent disparities in the Belt.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2023-000206","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T23:20:55Z","timestamp":1702423255000},"page":"e000206","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Regional and racial disparities in major amputation rates among medicare beneficiaries with diabetes: a retrospective study in the southeastern USA"],"prefix":"10.1136","volume":"1","author":[{"given":"Jennifer Mason","family":"Lobo","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyojung","family":"Kang","sequence":"additional","affiliation":[{"name":"University of Illinois, Urbana, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan B","family":"Brennan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soyoun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA"},{"name":"Department of Social Welfare, Ewha Womans University, Seoul, Korea (the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy L","family":"McMurry","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Balkrishnan","sequence":"additional","affiliation":[{"name":"Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Anderson","sequence":"additional","affiliation":[{"name":"Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"McCall","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9474-2907","authenticated-orcid":false,"given":"Min-Woong","family":"Sohn","sequence":"additional","affiliation":[{"name":"Health Management and Policy, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"2025083110082329000_1.1.e000206.1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S011"},{"key":"2025083110082329000_1.1.e000206.2","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1377\/hlthaff.2021.01827","article-title":"Disparities in diabetes-related lower extremity amputations in the United States: a systematic review","volume":"41","author":"Gasoyan","year":"2022","journal-title":"Health Affairs"},{"key":"2025083110082329000_1.1.e000206.3","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.007425","article-title":"Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease","volume":"7","author":"Arya","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025083110082329000_1.1.e000206.4","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/ATVBAHA.120.314595","article-title":"Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery disease","volume":"40","author":"Barnes","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2025083110082329000_1.1.e000206.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjdrc-2020-001328","article-title":"Association between race\/Ethnicity and the risk of amputation of lower extremities among Medicare beneficiaries with diabetic foot ulcers and diabetic foot infections","volume":"8","author":"Tan","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2025083110082329000_1.1.e000206.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.05.100"},{"key":"2025083110082329000_1.1.e000206.7","unstructured":"Fisher ES , Goodman DC , Chandra A . 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