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Racial differences in primary and repeat lower extremity amputation : results from a multihospital study . OBJECTIVE African Americans have a much higher risk of major ( above- or below-knee ) lower extremity amputation and a lower rate of limb-preserving vascular surgery or angioplasty than white patients . This article analyzes two potential pathways for racial disparities : primary amputation , defined as a major amputation performed without any prior attempt at revascularization , and repeat amputation , defined as a major amputation subsequent to a previous through-foot or major amputation . METHODS Randomly selected medical records were reviewed for 248 African American , 30 Hispanic , and 235 white or other-race patients undergoing above- or below-knee amputation between 1995 and 2003 at three Chicago teaching hospitals . Chronic disease prevalence and severity , preadmission functional status , clinical presentation , and vascular history were used to test the risk-adjusted effect of race and ethnicity on rates of primary and repeat amputation . RESULTS Controlling for demographic , functional , chronic disease , and clinical characteristics , African American patients were 1.7 times more likely to have undergone both primary ( P = .01 ) and repeat ( P = .03 ) amputation than white or other-race amputees . Race remained a significant independent risk factor even after controlling for the higher severity of illness , greater disability , and more complex presentation of African American amputees . CONCLUSIONS Higher rates of primary and repeat amputation for African American patients at study hospitals , which all have significant vascular surgery capacity and an aggressive policy of limb salvage , suggest that these rates may be even higher at less well equipped institutions . Improving access to primary and preventive care for lower-income patients could reduce amputation rates among African Americans .
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Intervention_Surgical
Racial differences in primary and repeat lower extremity amputation :
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Intervention_Surgical
( above- or below-knee ) lower extremity amputation
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Intervention_Other
amputation
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Intervention_Other
amputation
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Intervention_Educational
amputation
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Intervention_Surgical
above- or below-knee amputation
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Intervention_Surgical
primary
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Intervention_Surgical
repeat amputation
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Intervention_Educational
amputation
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Intervention_Surgical
primary
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Intervention_Surgical
repeat amputation
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Outcome_Physical
risk of major ( above- or below-knee ) lower extremity amputation
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Outcome_Physical
rate of limb-preserving vascular surgery
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Outcome_Physical
rates of primary and repeat amputation .
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Outcome_Physical
primary and repeat amputation
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Outcome_Physical
amputation rates
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Participant_Condition
primary and repeat lower extremity amputation :
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Participant_Sample-size
248 African American
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Participant_Sample-size
30 Hispanic
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Participant_Sample-size
235 white or other-race patients
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Participant_Condition
undergoing above- or below-knee amputation