The Amputation Reduction and Compassion Act (H.R. 2631) would ensure that Medicare and Medicaid both cover peripheral artery disease screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care.
As our health care system works to address the many disparities and inequities that Americans of color—particularly Black, Hispanic, and Native Americans—continue to face, there remains too little understanding of our nation’s amputation epidemic. Over the past 2 years, the pandemic has brought attention to the health disparities that continue to affect people from racial and ethnic minority groups. Although some policymakers encourage action through health education, early detection, and control of disease complication, the systematic inequities that result in unnecessary and senseless amputations must be addressed.
Each year, surgeons perform some 200,000 nontraumatic amputations, due primarily to peripheral artery disease (PAD), an all-too-common complication of diabetes, kidney disease, and chronic hypertension. For the 20 million Americans living with PAD, it will become increasingly difficult for oxygen to reach the legs and feet due to plaque building up in a person’s arteries—unless the chronic condition is diagnosed and treated early. Without medical intervention, amputation will become the only option for a high number of individuals, many of whom don’t even find out they have PAD until it’s too late to save their limbs.
PAD-related amputation is a major crisis in communities of color. According to a landmark report by the Dartmouth Institute, Americans who identify as Black are up to 3 times more likely to have their limbs surgically removed than the national average. Take a ride with me through the South to my community in the Mississippi Delta and you’ll likely see a substantial number of people who have lost their legs to this chronic disease.
As you can imagine, amputations have a tremendous impact on patients’ lives. Not only does the loss of a leg or foot mean permanent disability, but it also makes it more difficult for individuals to work, get around, and do what they love. It is no surprise then that amputations can lead to high rates of chronic pain and depression. Sadly, between 52% and 80% of patients with diabetes-related amputations die within 5 years of their operation.
Considering that 85% of amputations could be prevented with access to timely care, amputation is a racial justice issue. Unfortunately, many patients don’t even know they have PAD until amputation became their only option. Even in metropolitan areas where access is theoretically better due to a higher number of providers, research shows that being Black is associated with higher rates of major lower limb amputations.
Not only is amputation a racial justice issue, but amputation is also a gender issue. Black females are the the group most likely to undergo amputation, and they have a higher risk for amputation compared with other women and with Black males. More Black females undergo amputation for PAD than males. Gender disparities reflect the combination of higher PAD prevalence and lower socioeconomic status, as well as the higher prevalence and differing impact of diabetes, chronic kidney disease, hypertension, and metabolic syndrome.
With too few patients being screened for PAD until it’s too late, Washington must act to correct the amputation epidemic.
Fortunately, Representative Donald Payne, Jr. (D-New Jersey) is spearheading a bipartisan effort to do just that. If passed, the Amputation Reduction and Compassion Act (H.R. 2631) would ensure Medicare and Medicaid both cover PAD screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care. It would also establish a PAD education program to better empower patients and providers with accurate information about the disease, as well as how they can get timely care before amputation becomes the only option.
Facing such a dire situation, communities of color need national healthcare solutions to ensure better healthcare access and outcomes—especially when it comes to the amputation epidemic. The time to highlight this issue is now. To help advance racial justice in medicine and reduce preventable amputations, it is time for Congress to pass the ARC Act.
Foluso Fakorede, MD, is CEO of Cardiovascular Solutions of Central Mississippi. He is a co-chair of the Association of Black Cardiologists’ PAD Task Force and an advocate for persons of color at risk of limb loss.