Limits...
Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008.

Vamos EP, Bottle A, Edmonds ME, Valabhji J, Majeed A, Millett C - Diabetes Care (2010)

Bottom Line: To test for time trend, we fitted Poisson regression models.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK. e.vamos@imperial.ac.uk

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.

Show MeSH

Related in: MedlinePlus

Changes in minor and major amputation incidence rates in (A) individuals with diabetes expressed per 10,000 people with diabetes and (B) individuals without diabetes expressed per 100,000 people without diabetes.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2992196&req=5

Figure 1: Changes in minor and major amputation incidence rates in (A) individuals with diabetes expressed per 10,000 people with diabetes and (B) individuals without diabetes expressed per 100,000 people without diabetes.

Mentions: Between 2004 and 2008, the number of patients who underwent an amputation and the number of amputations performed increased significantly among individuals with diabetes in England (Table 1). Overall amputation incidence rates (minor and major combined) decreased by 9.1%, from 27.5 per 10,000 people with diabetes in 2004 to 25.0 per 10,000 people with diabetes in 2008. During the study period, the incidence of minor LEAs (15.7 to 14.9 per 10,000 people with diabetes; P = 0.66) and major LEA rates (11.8 to 10.2 per 10,000 people with diabetes; P = 0.29) decreased slightly, but this decrease did not reach statistical significance (Fig. 1A). Incidence of LEAs was significantly higher among men than among women with diabetes (P < 0.001). However, changes in overall LEA rates did not significantly differ between men and women (19.9 to 18.3 vs. 7.6 to 6.7 per 10,000 people with diabetes; P = 0.81) (Fig. 2). When stratified by age, the incidence was the highest among individuals aged >65 years in both men and women (Fig. 2). Poisson regression analysis showed no significant decrease in incidence of amputations after adjustment for age, sex, year, and level of amputation (0.98 decrease per year [95% CI 0.93–1.02]; P = 0.12).


Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008.

Vamos EP, Bottle A, Edmonds ME, Valabhji J, Majeed A, Millett C - Diabetes Care (2010)

Changes in minor and major amputation incidence rates in (A) individuals with diabetes expressed per 10,000 people with diabetes and (B) individuals without diabetes expressed per 100,000 people without diabetes.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992196&req=5

Figure 1: Changes in minor and major amputation incidence rates in (A) individuals with diabetes expressed per 10,000 people with diabetes and (B) individuals without diabetes expressed per 100,000 people without diabetes.
Mentions: Between 2004 and 2008, the number of patients who underwent an amputation and the number of amputations performed increased significantly among individuals with diabetes in England (Table 1). Overall amputation incidence rates (minor and major combined) decreased by 9.1%, from 27.5 per 10,000 people with diabetes in 2004 to 25.0 per 10,000 people with diabetes in 2008. During the study period, the incidence of minor LEAs (15.7 to 14.9 per 10,000 people with diabetes; P = 0.66) and major LEA rates (11.8 to 10.2 per 10,000 people with diabetes; P = 0.29) decreased slightly, but this decrease did not reach statistical significance (Fig. 1A). Incidence of LEAs was significantly higher among men than among women with diabetes (P < 0.001). However, changes in overall LEA rates did not significantly differ between men and women (19.9 to 18.3 vs. 7.6 to 6.7 per 10,000 people with diabetes; P = 0.81) (Fig. 2). When stratified by age, the incidence was the highest among individuals aged >65 years in both men and women (Fig. 2). Poisson regression analysis showed no significant decrease in incidence of amputations after adjustment for age, sex, year, and level of amputation (0.98 decrease per year [95% CI 0.93–1.02]; P = 0.12).

Bottom Line: To test for time trend, we fitted Poisson regression models.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK. e.vamos@imperial.ac.uk

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.

Show MeSH
Related in: MedlinePlus