Industry Voices—Too many minorities are experiencing unnecessary leg amputations

Across the U.S., the drug overdose epidemic took the lives of more than 70,000 Americans last year and remains a highly visible killer. Meanwhile, infectious diseases such as measles, which was declared eradicated from the U.S. in 2000, are on the rise again—reaching a 27-year high in 2019

These epidemics rightly receive a lot of attention from policymakers and the media, but there’s another epidemic plaguing our communities—especially our communities of color—that is too often overlooked: peripheral artery disease (PAD).  

PAD is a dangerous and expensive complication of diabetes, which afflicts over 30 million Americans. If a patient does not manage their diabetes well, he or she is at serious risk of developing PAD, which causes plaque to build up in blood vessels and reduces blood flow to the legs. This puts patients at a dramatically higher risk of suffering a stroke, heart attack or limb amputation.

While many of the roughly 200,000 non-traumatic amputations (PDF) occurring in the U.S. each year could be avoided with timely, appropriate care for PAD, the disease is largely unrecognized. Sadly, too many Americans have never heard of PAD until the disease has progressed so far that they are forced to have their limbs surgically amputated.     

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Racial minorities are at the highest risk of losing their legs to PAD.

Research shows that African Americans with diabetes are three times more likely than white patients to have their limbs amputated as a result of PAD. Other communities of color face similar disparities. For example, Hispanics are 75% more likely to have their limbs surgically removed, while Native Americans are more than twice as likely to face non-traumatic amputations.  

For racial minorities in Mississippi, where I work as a limb salvage specialist, the rates are even higher. Here at the epicenter of the PAD epidemic, nine out of 10 of amputees that I’ve encountered or evaluated have never had a diagnostic test for PAD or an appropriate vascular evaluation to salvage their limbs.

Though studies suggest the probability of requiring a PAD-related amputation can be decreased by up to 90% through regular screenings and follow-ups, too many patients in Mississippi go undiagnosed and untreated. Unfortunately, this troubling trend is echoed across the country, putting communities of color and diabetic patients at tremendous risk. 

Amputations are not inevitable. More doctors should make PAD a priority by routinely screening Americans for signs of reduced blood flow to their legs and increasing access to angiograms that could help prevent unnecessary amputations.

Since many people with diabetes live in low-income communities and may experience significant barriers to accessing care, healthcare providers should meet patients where they are. At my practice, our team met with Mississippians directly in the community to raise awareness about how to prevent and treat PAD. In addition to education, patients also need the tools to manage their diabetes to prevent or delay the onset of PAD.

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A recent survey by the Centers for Disease Control and Prevention (CDC) showed that roughly 1 in 7 American adults with diabetes skipped a dose of insulin or took less of it because the medicine was too expensive—suggesting policy change is needed to make medications like insulin much more affordable.  

Luckily, lawmakers are paying attention.

Congressman Donald Payne Jr. of New Jersey and Congressman Gus Bilirakis of Florida recently joined forces and launched the first-ever Congressional PAD Caucus—an exciting step toward advancing policies to improve access to PAD screening and interdisciplinary care for patients. I personally look forward to working with the caucus on legislative solutions to improve PAD research, education and treatment, with the goal of preventing non-traumatic amputations. 

We can—and must—do better as a country. It is critical that physicians, policymakers and patients all confront the danger head on.

Like other health crises, the first step to ensuring community health is awareness and determination to act.  

Foluso Fakorede, M.D., is a practicing cardiologist and CEO of Cardiovascular Solutions of Central Mississippi as well as co-chair of the PAD Initiative for the Association of Black Cardiologists.