Congress: Eliminate disparities in health care
Despite the turmoil of recent months, I am hopeful that 2020 will lead to lasting change —especially when it comes to our health care options and outcomes for communities of color. The COVID-19 pandemic has laid bare the lingering and unjust disparities between racial and ethnic groups. Now, the calls to close that gap have grown louder.
As a Black cardiologist in the Mississippi Delta, I have long been aware of these troubling trends. That is why I have worked tirelessly to save lives — and, literally, limbs — from the devastating impacts of peripheral artery disease (PAD), a circulatory condition that affects nearly 20 million Americans including a disproportionate number of minorities.
If left untreated, PAD can lead to dangerous complications such as lower-limb amputation. Unfortunately, this is too often the case for people of color. Research shows that African Americans, Hispanics and Native Americans are two to four times more likely than white Americans to develop PAD and require an amputation as the disease progresses. Despite a tendency for racial minorities to exhibit higher risk factors for PAD including a history of smoking, hypertension and diabetes, too many physicians fail to screen for the disease until it is too late. For some, their condition is only diagnosed once their limb function is so deteriorated, that amputation is the only option.
Diabetics make up 130,000 out of the 200,000 PAD-related amputations each year, predominantly in low-income and underinsured neighborhoods. In the U.S., Black adults are nearly twice as likely as white adults to develop type 2 diabetes. This racial disparity has been rising over the last 30 years.
Even more frustrating, is that far too many minorities suffer amputation without ever receiving arterial testing to indicate whether their limb is salvageable, or not. The reality is, limbs are being removed when they should have been saved. Many of these amputations could have been prevented with simple screenings.
However, many insurers don’t cover these simple tests and the U.S. Preventative Services Task Force has failed to recommend PAD screening to at-risk populations yet again in its latest review.
As a result, patients suffer worse health outcomes and the health care system bears even greater financial burdens because the lifetime costs for a patient who undergoes amputation are much higher than the costs of saving a limb. Further, mortality among amputees show a 48 percent death rate in the first year following amputation, which increases to 71 percent in year two.
It doesn’t have to be this way.
With access to screening and early detection, PAD can be treated at an earlier stage, giving many patients the option for treatments that save limbs and prevent amputation. After moving to Mississippi — the epicenter of the nation’s PAD epidemic — I started the Amputation Prevention Institute in order to address the shocking racial disparities I saw. While African Americans have a lower life expectancy and tend to develop chronic illnesses like PAD a full decade earlier than white people, I am proud to say our clinic has made great strides.
In my first three years, by reaching out directly to at-risk people in the community, educating our local providers and advocating on behalf of our patients at the hospital to get quality comprehensive care. The treatment spectrum consisted of implementing guideline recommended therapies and performing more than 500 diagnostic tests for at-risk patients, resulting in nearly 90 percent reduction in amputation rates. Our technical and interpersonal competence has led to engendering the trust of our community which has facilitated care seeking behavior and improved quality of life in an underserved community!
We must build on these successes to address disparities in health care across the whole country. The Congressional PAD Caucus, chaired by Reps. Donald Payne, Jr. (D-N.J.) and Gus Bilirakis (R-Fla.), supports policies to establish Medicare coverage for PAD screening for at-risk beneficiaries, while disallowing payment for non-emergent amputations unless diagnostic screening has been done in the three months prior to amputation. In addition, they are calling for the creation of a peripheral artery disease education program through the U.S. Department of Health and Human Services.
All Americans deserve the opportunity to keep their legs. This must be made clear among communities of color who have long faced higher incidence of PAD, its risk factors, and its most severe outcomes including amputation. Enough is enough.
Recognizing PAD Awareness Month this September, there is no better time to advance policies to improve education, screening and access.
Dr. Foluso Fakorede is a cardiologist operating in the Mississippi Delta. Fakorede has been working with congressional members in the Peripheral Artery Disease (PAD) Caucus to develop legislative solutions to end disparities in health care and prevent amputations among at-risk populations nationwide.