Does Geographic Disadvantage Increase Lower Extremity Amputation Risk in the State of Georgia?

Introduction Over 100,000 lower extremity amputations are performed annually in the United States, with most related to peripheral arterial disease and diabetes. Rural populations experience greater socioeconomic disparities and higher rates of chronic disease. This study examined socioeconomic differences, prevalence of amputation risk factors, and lower extremity amputation rates between rural and urban residents of Georgia. Methods County-level lower extremity amputation data for 2020 were obtained from the Georgia Department of Public Health. Demographic and socioeconomic data were retrieved from the US Census Bureau, and the prevalence of hypertension, diabetes, peripheral arterial disease, and smoking from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Rural counties were defined as those with populations <50,000. Bivariate analyses compared rural and urban medians. Nonparametric data were log-transformed to meet assumptions of normality. Significance was set at P < 0.05 with 80% power. Results Rural counties had higher proportions of males and individuals greater than 65 y. Rural populations had greater socioeconomic disadvantages: higher poverty and lower median income. Risk factors were more prevalent in rural areas: diabetes, hypertension, smoking, and peripheral arterial disease. The incidence of lower extremity amputations per 100,000 residents was higher in rural versus urban counties. Conclusions Rural Georgians undergo higher amputations of the lower extremities occurring in the context of greater prevalence of chronic disease and socioeconomic disadvantage.