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According to researchers from the University of Arizona, hospitalizations and serious amputations among adults with racial and ethnic minorities with diabetic foot ulcers have declined in states that have adopted the Medicaid extension under the Affordable Care Act (ACA).

Diabetic foot ulcers and amputations have serious health and funding implications, and the disproportionate frequency with which it occurs among patients from lower socioeconomic groups is a widely recognized problem in medicine and vascular surgery. Research is one of the few to study health policy and explore patient outcomes due to the expansion of access to insurance coverageaccording to lead author Jie-woi Tang, MBBS, MPH, FACS, associate professor of surgery at Arizona Medical College in Tucson.

“There are many reasons that lead to increased amputations among vulnerable and underserved populations, one of which is health insurance“said Dr. Tang, a vascular and endovascular surgeon in the surgery department.” Our data suggests that if you extend insurance coverage to those in need, they will be able to receive better care and have better results. ”

The paper “Percentage of serious amputations related to diabetes among adults from racial and ethnic minorities following the expansion of Medicaid under the Patient Protection and Affordable Care Act” was published in JAMA open network.

The study looked at 115,071 hospitalizations for diabetic foot ulcers among adult racial and ethnic minorities between the ages of 20 and 64 – African Americans, Asian and Pacific Islanders, Native Americans or Alaska Natives, Hispanic and Hispanic . Researchers compared amputation rates in selected areas that were early adopted, where Medicaid was expanded until 2014 – 12 states and Washington, DC – with amputation rates in seven states that did not expand Medicaid at the time.

They found that from January 2013 to September 2015, hospitalizations among adult minorities increased by 3% in states that adopted early and by 8% in states that did not adopt. For adult minorities without insurance, the hospitalization rate decreased by 35% after expanding in pre-adoption states and increased by 26% in non-adoption states.

There was no increase in amputation rates among adult minorities after enlargement in pre-adoption states, while non-adoption states recorded a 9% increase in amputations. The amputation rate for adult minorities who have Medicaid or do not have insurance decreased by 33% in states that adopted early, with no change in states that did not adopt.

“The paper suggests that the early introduction of the ACA was due to a reduction in diabetes-related leg amputations among adult minorities who are not served,” Dr. Tan said.

Diabetic foot ulcers and concomitant amputations are the leading cause of death in patients with diabetes and carry a heavy financial burden on patients and the health care system.

In 2017, the five-year mortality rate from ulcers and small and large amputations was 30.5%, 46.2% and 56.6%, respectively, according to previous research by senior author David G. Armstrong, professor of surgery at Keck Medical School in 2017. USC and pediatric surgeon with Keck Medicine of USC. By comparison, the five-year overall cancer mortality rate was 31%.

Up to one-third of people with diabetes at some point in their lives develop a foot ulcer. More than half of them heal in more than nine months, turning into chronic diabetic ulcers, which account for 80% of amputations among people with diabetes, Dr Tang said.

In addition, racial and ethnic minorities with diabetes more often than white adults postpone care until they have more advanced foot infections and extensive comorbidities. Ulceration and amputation of the diabetic foot lead to decreased physical function, reduced quality of life, reduced mobility, and increased hospitalization and mortality.

“There is a window into which we can intervene earlier amputation“And so we need to focus on treating patients before they reach an advanced state,” Dr. Tan said. “Our results suggest that expanding access to insurance coverage is accompanied by an overall improvement in limb rescue assistance.”


Obamacare is associated with fewer leg amputations for minorities


Additional information:
Tze-Woei Tan et al., Part of serious diabetes-related amputations among adults from racial and ethnic minorities following the expansion of Medicaid under the Patient Protection and Affordable Care Act, JAMA open network (2022). DOI: 10.1001 / jamanetworkopen.2022.3991

Citation: A study shows that the number of amputations, hospitalizations decreased among minorities after the expansion of Medicaid (2022, May 5), obtained May 5, 2022 from https://medicalxpress.com/news/2022-05-amputation-hospitalization-fell -minorities-medicaid.html

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