Foluso Fakorede, MD: Racial Disparities in PAD Amputation Rates

Amputation rates among Black Americans with peripheral arterial disease (PAD) are alarmingly higher than in their White counterparts. According to recent data, these rates are 3 times greater, especially in communities with lower socioeconomic status, Foluso A. Fakorede, MD, CEO and owner of Cardiovascular Solutions of Central Mississippi, told Patient Care at ACP Internal Medicine Meeting 2025. This disturbing trend reflects a complex interplay of risk factors, including higher rates of diabetes and hypertension, as well as significant barriers to accessing timely and effective treatment. In the video above, Dr Fakorede addresses the contributing factors to these disparities, from under-prescribed medications to limited access to specialists, and explores how multi-society efforts aim to improve early intervention and tackle the social determinants of health driving these inequalities.

The following transcript has been edited for clarity, style, and length.

Patient Care: Some of the statistics you presented on amputation rates among Black Americans with PAD were concerning. Could you review those numbers?

Dr Fakorede: The rate of amputation in the Black community is three times higher than in their white counterparts, particularly when we examine the geographical distribution. If you look at what I call the “Black census scope” of America—areas with predominantly Black populations—and overlay that with low socioeconomic status, you’ll find a concerning pattern. Across all regions in the US, including both urban and rural areas, those with lower socioeconomic status in predominantly Black communities are at the highest risk of amputations. This trend is evident in both the Medicare and Medicaid populations.

Why is this happening? There are several contributing factors. While the prevalence of risk factors such as diabetes, chronic kidney disease, and hypertension is higher among Black patients, access to limb-preserving procedures and medications is a major issue. Medications like statins and antiplatelet therapies are often under-prescribed or under-recommended for these patients. Additionally, many do not have access to specialists—like myself—who can perform procedures to save limbs. By the time these patients present for care, it’s often at later stages of the disease. Instead of being offered limb-preserving procedures, they are frequently offered amputation as the only option.

This is a disturbing trend, and it's something we are actively working to address through a multi-society effort. The goal is not only to prevent patients from reaching the point of needing amputation by addressing these issues earlier, but also to tackle the broader social determinants of health—economic, financial, educational, transportation, and housing challenges—that contribute to health disparities. These factors historically have played a significant role in limiting healthcare access and exacerbating the health outcomes of these communities.