A research team set out to determine if lower median household income (MHI) and Medicaid/no insurance status are associated with a higher risk for amputation, and if it occurs in a progressively linear fashion, such that poorer individuals are at progressively greater risk for amputation. The results of the study indicated that lower MHI, Medicaid insurance, and uninsured status were associated with a greater likelihood of amputation and a lower likelihood of undergoing limb-saving revascularization. The disparities were exacerbated in stepwise fashion, such that lower income quartiles are at progressively greater risk for amputation, according to the study.
The researchers used the National (Nationwide) Inpatient Sample Database to identify patients who were admitted with a diagnosis of critical limb ischemia from 2005 to 2014 and underwent either a major amputation or a revascularization procedure during that admission. Patients were placed into one of four income quartiles according to their insurance status and MHI. Multivariate logistic regression was performed to determine the effect of income and insurance status on the odds of undergoing amputation versus leg revascularization.
According to the study, there was a significant decrease in the odds ratios for amputation as one progressed from one MHI quartile to a higher one.
The study was published online March 7 in the Journal of Vascular Surgery.