VESS09 - Lower Extremity Amputation Risk by Hispanic Ethnicity and Immigration Status

Objectives: Diabetic foot ulcers are a leading cause of lower extremity amputation in safety-net health systems. Although racial and ethnic differences are well described, immigration-related factors remain poorly studied. This study examines the association between immigration status and primary language are associated with variation in amputation risk.

Methods: We analyzed linked electronic medical records, demographic, and claims data (2016-2024) from the Los Angeles Department of Health Services (LADHS). Adults over 18 years with DFUs were included. Patients were categorized by place of birth ( US vs. non-US), Hispanic ethnicity, and primary language. The primary outcome was any lower extremity amputation. Multivariable logistic regression was used to estimate associations between sociodemographic factors and amputation risk.

Results: Among 39,508 patients with DFUs, 3.52% (n=1,392) underwent lower extremity amputation. Overall, 44% were non-US-born (n=17,429). US-born patients had a 40% lower odd of amputation (OR 0.60; 95% CI 0.49-0.72) compared to non-US-born patients. By nativity and ethnicity, 17.2% were US-born Hispanic, 26.9% US-born non-Hispanic, 48.0% non-US-born Hispanic, and 7.9% non-US-born non-Hispanic. Compared with US-born Hispanic patients, non-US-born Hispanic patients had 82% higher odds of amputation (OR 1.82, 95% CI 1.43,2.32), whereas US-born non-Hispanic patients had 26% lower add of amputation (OR 0.77, 95% CI 0.61,0.97). Spanish-speaking patients had higher odds of amputation compared with English-speaking patients (OR 1.49; 95% CI 1.22-1.82).

Conclusions: In a large safety-net health system, immigration status and language were independently associated with amputation risk among patients with DFUs. These findings suggest barriers related to nativity and language which may contribute to preventable limb loss and represent targets for equity-focused interventions in diabetic foot care.