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Diabetic foot ulcers cost the government almost $9 billion each year, and those in rural areas have a higher risk of amputation or death, according to new research.

The study, published online in PLOS ONE, used hospital data from 2006 to 2010 to evaluate the impact of diabetic foot ulcers on the healthcare industry. 

Researchers found diabetic foot complications made up 1.9% of the 54.2 million total diabetes cases presented to emergency departments over the four years. These cases, including those admitted to inpatient care, added up to $8.78 billion in costs each year. 

Patients living in rural areas had a 51.3% higher risk of major amputation, and 41.4% higher risk of inpatient death, than those diabetes patients living in urban areas, researchers found. Patients in regions with the lowest incomes also experienced a 38.5% higher risk of major amputation.

Researchers at the University of Arizona suggest screening and prevention programs may reduce costs and improve outcomes for those living in poor or rural areas.

Earlier coordinated care should be a “major” point of emphasis, one leading researcher said.