Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA.
Semin Vasc Surg. 2023 Mar;36(1):19-32. doi: 10.1053/j.semvascsurg.2023.01.002. Epub 2023 Jan 20.
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
最近,美国经历了 20 多年来首次主要截肢手术的反弹。造成这种上升的原因是长期存在的差异。非西班牙裔黑人患者截肢的可能性是西班牙裔白人患者的两倍,而拉丁裔患者的截肢风险则增加了 30%。农村患者也更有可能接受主要截肢手术,而且城乡差距正在扩大。我们使用了国家少数民族健康和健康差异研究所的框架来更好地了解这些差异,并确定导致这些差异的共同因素。共同因素很多,包括糖尿病的发病率增加,足部自我护理的可能性降低,就医的交通障碍,居住在贫困社区,以及缺乏保险。需要在医疗保健领域内外寻找解决方案。在社区内嵌入预防和门诊护理服务的医疗保健特定干预措施可能特别有效。