It should really come as no surprise that the poorest in the nation have a higher risk of getting diabetes. But moreover, a new study finds that their risk of getting a foot, toe, or a complete leg amputated because of diabetes is up to 10 times higher than their wealthier counterparts. Now, the University of California, Los Angeles (UCLA) researchers who conducted the study are calling for policymakers and health care providers alike to focus on breaking down the barriers that lead to these unfortunate surgeries.

“I’ve stood at the bedsides of diabetic patients and listened to the surgical residents say, ‘We have to cut your foot off to save your life,’” said lead author of the study Dr. Carl Stevens, clinical professor of medicine at UCLA’s David Geffen School of Medicine, in a press release. “These patients are often the family breadwinners and parents of young children — people with many productive years ahead of them.”

But living in poverty is obviously not easy. Not only do the stresses of daily life, such as being a single parent or working two jobs, affect a person’s risk of diabetes, but a lack of access to healthy foods does, too. Food insecurity affected 50.1 million Americans in 2011, limiting their access to fresh fruits, vegetables, and whole grains, according to the Food Research and Action Center. Many of these people just don’t have access to a full-service grocery stores, and instead rely on their local convenience or corner store, where fresh produce is rarely available but sugary, fatty foods are plentiful.

These living conditions — in addition to more sedentary lifestyles — create the perfect storm for developing obesity, and eventually diabetes. The researchers of the current study are concerned that people living in poverty aren’t doing enough to prevent the onset of diabetes, and those who already have the disease aren’t doing enough to control it. It’s true, unfortunately. A study from earlier this year found that price hikes on healthier foods forced poor diabetics to eat foods that increased their blood sugar levels.

Knowing these things about poverty may help policymakers to enact legislation that helps poor people access healthier foods. The new information provides a map of the greater Los Angeles area, showing how diabetics in poorer neighborhoods are the ones most likely to be affected by diabetes, thus leading to their amputations. The researchers found that areas like San Fernando, where the estimated median household income was $51,000 in 2012, were nearly 10 times as likely to get at least one amputation, when compared to an area like Hermosa Beach, where the estimated median household income was $95,000 in 2012.

“When you have diabetes, where you live directly relates to whether you’ll lose a limb to the disease,” Stevens said. “Millions of Californians have undergone preventable amputations due to poorly managed diabetes.”

For the study, the researchers looked at data from the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated diabetes rates in low-income populations based on zip codes. To form a complete picture of diabetes amputations and poverty, they combined these statistics with those from Census Bureau household-income figures and diabetes-related amputation rates logged by the Office of Statewide Health Planning and Development. Their final result was the map showing amputation rates by neighborhood among patients aged 45 and older — the age range most at risk of amputations.

According to the press release, there were nearly 8,000 legs, feet, and toes amputated from 6,800 people in 2009. About 1,000 of these people got two or more amputations. The researchers’ next steps will be to identify the most pressing issues that contribute to diabetes-related amputations. Surely, they’ll consider food insecurity and lack of physical activity, but they’re also concerned about health care costs.

“The U.S. spends more health care dollars per person than any country in the world,” said co-author Dr. David Schriger, a professor of emergency medicine, in the release. “Yet, we still can’t organize our health care system in a way that gives everyone adequate treatment. Should we tolerate a tenfold disparity for the loss of a limb and a patient’s ability to walk when we can prevent amputations with proper care?”

Answering that simply: No, we shouldn’t.

Source: Stevens C, Schriger D, et al. Health Affairs. 2014.