Equity analysis identifies populations at greatest risk for diabetes-related amputations
In Canada, more than 3,000 leg amputations are performed on people living with diabetes annually. Up to 85% of these amputations are avoidable through prevention efforts and access to appropriate clinical care and interventions.
AV’s recent Equity in diabetes care report dove deeper into these amputations statistics by using socio-demographic data to apply an equity lens. The report determined that leg amputations related to diabetes complications are
- 3 times higher for those living in the lowest-income neighbourhoods
- 4 times higher for those living in neighbourhoods with the lowest rates of high school completion
The data in the report reflects what clinicians in Canada are seeing when caring for patients with diabetes. There are glaring inequities that currently play a substantial role in determining who is likely to lose a leg from diabetes complications and who is not.
This leads to the question: How can health systems leverage data to better direct resources and target interventions to higher-risk communities and population groups?
Using socio-demographic data to tailor health system improvement efforts
Clinicians working with diabetes patients have emphasized that data that’s typically reported, such as total counts or overall rates, is only one piece of the puzzle. Using segmented data to identify differences in care and outcomes for different socio-demographic groups — such as groups defined by income level, gender and other factors — can identify patients who need access to better care. This type of equity analysis can inform how to tailor programs and services so that they have the greatest impact.
“Amputations are one of the complications of diabetes with the largest degree of inequities. We might see affluent people with diabetes having a heart attack, but it’s rarer to see them coming in for an amputation,” said Dr. Baiju Shah, Endocrinologist, Sunnybrook Health Sciences Centre. “It is the type of complication where we can see the impact of the social determinants of health most dramatically.”
When it comes to providing medical interventions for things like foot ulcers and gangrene that can lead to the need for amputation, “time is tissue.” It is critical that patients receive timely preventative and proactive care at the first sign of a foot problem.
Navigating a fragmented health system
Clinicians have indicated that the fragmented continuum of care is a barrier for patients trying to navigate access to timely and appropriate wound care. It’s especially challenging for those living in less-affluent areas whose circumstances may accentuate barriers to accessing primary care or other services. Clinicians identify this as a contributing factor related to the increased rates of amputation in these communities that are reflected in AV’s report.
“When you’re talking about a diabetic foot problem, no single profession has all the skills, knowledge, and capabilities required,” said Tom Weisz, a retired chiropodist/podiatrist. He emphasized that it is difficult for patients to navigate the health care systems period, and that this is further complicated by the fact that some integral clinicians in wound care and wound prevention, such as podiatrists, are mainly found outside of publicly funded health systems in Canada.
According to Weisz, in terms of access, patients don’t always know about this type of specialty care and as a result end up seeking care in places like the emergency department. With respect to cost, many patients don’t have the financial means to pay privately out of pocket for wound care; this causes a ripple effect whereby the health system ends up spending millions of dollars on surgery and aftercare for a problem that theoretically could and should have been preventable.
Timely access to foot ulcer care a priority
According to Dr. Shah, health system leaders have identified timely and appropriate access to foot ulcer care as a priority, and steps are being made to provide more coordinated and accessible care. While there is yet to be a standardized model implemented to help prevent people from falling through the cracks, things are improving.
“For example, clinicians at Sunnybrook who are passionate about preventing amputations due to diabetes complications have created a wound care clinic for patients that have foot ulcers,” explains Dr. Shah. “These patients have access to a care coordinator and multidisciplinary care team.”
Dr. Shah sees potential for more hospitals to create similar clinics and to integrate them into health team models, which will better capture hospital, community and primary care services and ultimately provide better, patient-centred care to more patients.
About AV’s Equity in diabetes care report
By analyzing data from an equity perspective, AV’s Equity in diabetes care report gleans stronger insights into how specific populations are impacted by diabetes than would be understood by overall data alone. This type of data analysis leveraging socio-demographic data is an important tool that policy-makers can harness when seeking solutions to improve patients’ quality of life, while also creating efficiencies in health systems.
Thank you to , Endocrinologist, Sunnybrook Health Sciences Centre, and , Patient Partner, Diabetes Action Canada, retired chiropodist/podiatrist and former social services worker, for their time and contributions to this article and AV’s Equity in diabetes care report.
How to cite:
Canadian Institute for Health Information. Equity analysis identifies populations at greatest risk for diabetes-related amputations. Accessed October 21, 2024.
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