As of October of 2022, more than one million people have died from COVID-19 (coronavirus disease 2019, SARS-CoV-2) across the United States. (1) In addition to the significant morbidity and mortality associated with acute illness from COVID-19, the indirect impact has been far-reaching, with significant disruptions in chronic disease care, including diabetes and peripheral artery disease. Racial and ethnic minority communities have been underserved by our healthcare systems and experience higher prevalence and severity of chronic disease, with greater associated morbidity. (2, 3) The COVID-19 pandemic has intensified these existing racial disparities as evidenced by higher rates of infection, hospitalization, and death rates among non-White individuals. (4) According to early United States reports during the pandemic, COVID-19 disproportionately affected Black populations with higher mortality rates, a concerning pattern seen across the country. (5)

Peripheral artery disease (PAD) is a common complex chronic condition with a broad spectrum of severity for which the management has suffered in the wake of COVID-19 with resultant increases in amputation rates and mortality. Chronic limb-threatening ischemia (CLTI) describes PAD with lower limb rest pain, gangrene, or a lower limb ulcer that has been present for more than 2 weeks. (6) Diabetes is prevalent in the United States, affecting over 10% of the Unites States population. (7) The presence of diabetes is independently associated with mortality from cardiovascular disease. (8) Additionally, patients with poorly controlled diabetes (DM) are more likely to suffer from ischemic vascular changes, which accelerates the disease process and increases risk of amputation.(9) Despite efforts to lower the number of amputations in the United States, rates have remained stable in patients with DM and PAD. (10)

A well-described example of disparate health outcomes is the disproportionately higher rate of lower extremity amputation experienced by Black, Hispanic/Latino, American Indian/Alaskan Natives, and indigenous communities with peripheral artery disease as well as diabetes, despite accounting for confounding factors like socioeconomic status, co-morbidities, and advanced disease. (3, 9, 11, 12) Additionally, American Indian/Alaskan Native populations have a lower rate of revascularization procedures despite their increased risk of amputation compared to other minority groups. (12) Despite efforts to lower the number of amputations in the United States, rates have remained stable in patients with DM and PAD. (10)

To date, there are few published reports on the impact of COVID-19 on PAD and diabetes management and resultant amputation rates among vulnerable communities. In this review, we seek to better understand contributing factors leading to the increase in overall amputation rates and describe possible approaches to mitigate the uneven burden of disease experienced by these populations.