Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland

Abstract

Aims: To describe trends in the incidence of non-traumatic amputations among people with and without diabetes and estimate the relative risk of an individual with diabetes undergoing a lower extremity amputation compared to an individual without diabetes in the Republic of Ireland.

Methods: All adults who underwent a nontraumatic amputation during 2005 to 2009 were identified using HIPE (Hospital In-patient Enquiry) data. Participants were classified as having diabetes or not having diabetes. Incidence rates were calculated using the number of discharges for diabetes and non-diabetes related lower extremity amputations as the numerator and estimates of the resident population with and without diabetes as the denominator. Age-adjusted incidence rates were used for trend analysis.

Results: Total diabetes-related amputation rates increased non-significantly during the study period; 144.2 in 2005 to 175.7 in 2009 per 100,000 people with diabetes (p = 0.11). Total non-diabetes related amputation rates dropped non-significantly from 12.0 in 2005 to 9.2 in 2009 per 100,000 people without diabetes (p = 0.16). An individual with diabetes was 22.3 (95% CI 19.1-26.1) times more likely to undergo a nontraumatic amputation than an individual without diabetes in 2005 and this did not change significantly by 2009.

Discussion: This study provides the first national estimate of lower extremity amputation rates in the Republic of Ireland. Diabetes-related amputation rates have remained steady despite an increase in people with diabetes. These estimates provide a base-line and will allow follow-up over time.

Figure 1. Hospital Discharge rates.

Direct age standardised rate of hospital discharges of patients with diabetes for any cause, per 100,000 total population.

Figure 2. LEA Incidence rates.

Changes in total, major and minor LEA incidence rates in A) people with diabetes expressed per 100,000 people with diabetes and B) people without diabetes expressed per 100,000 people without diabetes.

Figure 3. LEA Incidence rates.

Changes in total LEA incidence rates in A) people with diabetes expressed per 100,000 people with diabetes and B) people without diabetes expressed per 100,000 people without diabetes, by age: 20–29 years, 30–59 years, 60+ years.