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Variation in the recorded incidence of amputation of the lower limb in England
Open accessAbstract
Aims/hypothesis The study aimed to explore the variation in recorded incidence of lower limb amputation in England.Methods The incidences of amputations in adults with and without diabetes were determined from hospital episode statistics over 3 years to 31 March 2010 and compared between the 151 Primary Care Trusts (PCTs) in England.Results There were 34,109 amputations, including 16,693 (48.9%) in people with diabetes. The incidence was 2.51 per 1,000 person-years in people with diabetes and 0.11 per 1,000 person-years in people without (relative diabetes risk 23.3). Incidence varied eightfold across PCTs in people both with diabetes (range 0.64-5.25 per 1,000 person-years) and without (0.03-0.24 per 1,000 person-years). Amputations in people with diabetes varied tenfold--both major (range 0.22-2.20 per 1,000 person-years) and minor (range 0.30-3.25 per 1,000 person-years). The incidences of minor and major amputations were positively correlated both in those with (r = 0.537, p < 0.0005) and without (r = 0.611, p < 0.0005) diabetes. Incidences of amputations were also correlated between people with and without diabetes (total amputations r = 0.433, p < 0.0005; major amputations r = 0.528, p < 0.0005). There was a negative correlation between the incidence of amputation and estimated prevalence of ethnic Asians. No association was found between the PCT incidence of either total amputations and general population prevalence of social deprivation (r = -0.138, p = 0.092) or smoking (r = 0.137, p = 0.096).Conclusions/interpretation Variation in amputation incidence occurs across England. Because of the similarity in amputation variation between people with and without diabetes the variation may reflect generic differences in local healthcare delivery, although racial factors may also contribute.
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“One study in the UK found that 48.9% of amputations from 2007 to 2010 were carried out on people with diabetes and diabetes conferred a 23.3x risk for amputations.41”
From A review of current trends with type 2 diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives (2021) · cites this paper as [41]
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Metadata
- Authors
- Holman, N., Young, R. J., & Jeffcoate, W. J.
- Affiliations
- Salford Royal NHS Foundation Trust (GB)
- Nottingham University Hospitals NHS Trust (GB)
- Corresponding author
- Jeffcoate, W. J.
- Venue
- Diabetologia
- Published
- 2012-03-08
- Volume
- 55
- Issue
- 7
- Pages
- 1919-1925
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2115626618
- Cited by
- 226
- References
- 18
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 11 · 2023: 13 · 2022: 12 · 2021: 15 · 2020: 27 · 2019: 20 · 2018: 17 · 2017: 16 · 2016: 19 · 2015: 15 · 2014: 19 · 2013: 20 · 2012: 11
- FWCI
- 16.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- lower limb amputation, amputation incidence, diabetes mellitus, regional variation, primary care trusts, social deprivation, smoking, health care delivery
- MeSH terms
- Adolescent, Adult, Aged, Amputation, Surgical, Analysis of Variance, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, England, Ethnicity, Female, Health Services Accessibility, Humans, Male, Middle Aged, Risk Factors, Incidence, Prevalence, Diabetic Foot, Lower Extremity, Healthcare Disparities, Young Adult
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