A few weeks ago, we launched The ZIP Code Lottery — a data narrative showing how amputation rates in Los Angeles County track almost perfectly with poverty, not clinical severity. It struck a nerve. The response told us something important: people want to see the data, and they want it to be impossible to look away from.
So we built another one.
The Amputation Heat Map takes the national view. Built around data from the American Heart Association’s PAD Collaborative Heat Map, CMS Medicare geographic variation files, and the published evidence base, it tells a story that should make every policymaker in the country uncomfortable.
Here are the numbers:
150,000 Americans lose a limb every year. Ten to twelve million are living with peripheral artery disease. And amputation rates vary up to five-fold between congressional districts. Not between countries. Between districts — sometimes neighboring ones.
The South, Appalachia, and the Midwest shoulder a wildly disproportionate burden. And the drivers are not mysterious: screening gaps, provider shortages, insurance barriers, and chronic underinvestment in community health infrastructure. This is a systems failure, not a clinical one.
We Know What Works. We’re Not Doing It.
The interventions that prevent amputation are well-established — screening, antiplatelet therapy, statins, supervised exercise, timely vascular consultation. The evidence base is decades deep. And yet: 32% of Medicare patients who underwent amputation received zero diagnostic arterial testing in the 12 months before losing their limb. 67% of PAD patients were not on a statin. 64% were not on an antiplatelet. And just 2% were referred for supervised exercise therapy.
This is not a knowledge problem. It is an implementation catastrophe.
Worse Than Cancer
Five-year mortality after major lower extremity amputation is 56.6%. That exceeds the five-year mortality of breast cancer, prostate cancer, and colorectal cancer. Diabetic foot complications cost the US healthcare system $80 billion a year. And research funding for diabetic foot disease lags cancer funding by orders of magnitude.
Every 20 seconds, somewhere in the world, a limb is lost to diabetes. Most of those amputations are preventable.
A Question for Your Representative
Every congressional district has an amputation rate. Every representative votes on Medicare coverage, community screening programs, and health equity funding. The AHA’s heat map gives them their number. Our visualization makes it visceral.
Where interdisciplinary limb preservation teams have been deployed, amputations have been cut in half. The evidence is clear. The tools exist. What’s missing is awareness, political will, and resources directed to the communities that need them most.
Use these maps. Share them. Show them to your representative. Ask the question:
“Do you know where we are on the amputation heat map — and what are you doing about it?”
Explore the Amputation Heat Map →
AHA PAD Collaborative Heat Map →
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