A shocking new report shows more diabetic African Americans have their legs amputated as a result of the disease compared with diabetics among all other races across the United States. What’s more, according to the study, conducted by the Dartmouth Institute for Health Policy and Clinical Practice, this health disparity plays out worst in the South, Bloomberg Businessweek reports.

When combined with artery blockages that reduce blood circulation to the lower limbs, diabetes can turn otherwise benign wounds into dangerous infections. Indeed, health officials confirmed that more than half of the 100,000 leg amputations paid for by Medicare in 2013 occurred as a direct result of diabetes.

After studying 306 state Medicare markets, health researchers said the distribution of these amputations shows a troubling disparity in the system. For example, they found that diabetes sufferers are much less likely to face leg amputation in a mostly white town in Michigan (Royal Oaks, where the amputation rate is 1.2 per 1,000) than patients in largely black areas, such as Tupelo, Mississippi. (In that city, the rate is 6.2 per 1,000.)

“We currently as a system don’t do a great job of addressing the social determinants of health,” said Marshall Chin, MD, a doctor at the University of Chicago, about the report.

Chin and other researchers suggested that since the diabetes patients had Medicare coverage, the disparities can’t be explained by a simple lack of access to health insurance. Instead, scientists said, it’s patients’ lack of access to healthy foods or safe neighborhoods where they could walk for exercise that contributes to the troubling trend.

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