Diabetes-Related Lower Limb Amputations in the Rio Grande Valley of Texas: A Focused Look at a Historical Health Disparity.

Abstract

Background: There are established regional and racial/ethnic disparities in lower limb amputation due to diabetes; risk is higher in people of African American and Hispanic origin, particularly those in South Texas. The studies exposing these disparities in the Lower Rio Grande Valley are not current and are limited in number.

Methods: We collected data from 2011 to 2016 from the United States Census Bureau, Texas Department of State Health Services (DSHS), and Robert Wood Johnson Foundation (RWJF) databases. Demographic information related to gender, race, and Hispanic ethnicity was extracted from the Census Bureau, counts of minor and major amputations from DSHS, and socioeconomic data such as percent of unemployed, uninsured, and college education attainment from RWJF. Using multivariate Poisson regression, current rates of lower limb amputation secondary to diabetes in the Rio Grande Valley were analyzed, and the role of Hispanic ethnicity in county-level amputation rates was explored.

Results: The Valley population living with diabetes had a significantly increased risk (1.334; CI 1.291, 1.378) of diabetes-related lower limb amputation compared to the rest of Texas when adjusting for the year. Similarly, Hispanic ethnicity was associated with an increased risk of amputation by a factor of 2.172 (CI 2.097, 2.248) compared to non-Hispanic ethnicity. However, when adjusting for Hispanic ethnicity, residing in the Valley is a protective factor for amputation, decreasing risk by a factor of 0.827 (CI 0.795, 0.86) compared to the rest of Texas.

Conclusion: While Hispanic ethnicity is associated with an increased individual risk of diabetes-related lower limb amputation in the Rio Grande Valley, residence in the Valley is simultaneously a protective factor from amputation.