Changes in the Incidence of Lower Extremity Amputations in Individuals With and Without Diabetes in England Between 2004 and 2008
Open Access
- 10 September 2010
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 33 (12), 2592-2597
- https://doi.org/10.2337/dc10-0989
Abstract
OBJECTIVE To describe recent trends in the incidence of nontraumatic amputations among individuals with and without diabetes and estimate the relative risk of amputations among individuals with diabetes in England. RESEARCH DESIGN AND METHODS We identified all patients aged >16 years who underwent any nontraumatic amputation in England between 2004 and 2008 using national hospital activity data from all National Health Service hospitals. Age- and sex-specific incidence rates were calculated using the total diabetes population in England every year. To test for time trend, we fitted Poisson regression models. RESULTS The absolute number of diabetes-related amputations increased by 14.7%, and the incidence decreased by 9.1%, from 27.5 to 25.0 per 10,000 people with diabetes, during the study period (P > 0.2 for both). The incidence of minor and major amputations did not significantly change (15.7–14.9 and 11.8–10.2 per 10,000 people with diabetes; P = 0.66 and P = 0.29, respectively). Poisson regression analysis showed no statistically significant change in diabetes-related amputation incidence over time (0.98 decrease per year [95% CI 0.93–1.02]; P = 0.12). Nondiabetes-related amputation incidence decreased from 13.6 to 11.9 per 100,000 people without diabetes (0.97 decrease by year [0.93–1.00]; P = 0.059). The relative risk of an individual with diabetes undergoing a lower extremity amputation was 20.3 in 2004 and 21.2 in 2008, compared with that of individuals without diabetes. CONCLUSIONS This national study suggests that the overall population burden of amputations increased in people with diabetes at a time when the number and incidence of amputations decreased in the aging nondiabetic population.Keywords
This publication has 23 references indexed in Scilit:
- Decreasing amputation rates in patients with diabetes—a population‐based studyDiabetic Medicine, 2009
- Incidence of Lower-limb Amputations in the Diabetic Compared to the Non-diabetic Population. Findings from Nationwide Insurance Data, Germany, 2005–2007Experimental and Clinical Endocrinology & Diabetes, 2009
- Secular Trends in Diabetes-Related Preventable Hospitalizations in the United States, 1998–2006Diabetes Care, 2009
- Diabetes- and Nondiabetes-Related Lower Extremity Amputation Incidence Before and After the Introduction of Better Organized Diabetes Foot CareDiabetes Care, 2008
- Reduction in Diabetic Amputations Over 11 Years in a Defined U.K. PopulationDiabetes Care, 2008
- Lower-limb revascularization and major amputation rates in EnglandBritish Journal of Surgery, 2007
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)The Lancet, 1998
- The Use of Angioplasty, Bypass Surgery, and Amputation in the Management of Peripheral Vascular DiseaseThe New England Journal of Medicine, 1991
- Robust Tests for the Equality of VariancesJournal of the American Statistical Association, 1974
- Robust Tests for the Equality of VariancesJournal of the American Statistical Association, 1974