Editor's Choice – Trends in Lower Extremity Amputation Incidence in European Union 15+ Countries 1990–2017

Abstract

This is an observational analysis of lower limb amputation incidence in European Union (EU) 15þ countries between 1990 and 2017, using data obtained from the Global Burden of Disease (GBD) Study 2017. The hypothesis was that reducing incidence trends would be identified, given previous work from the present study group using the GBD Study, which identified reducing incidence of peripheral arterial disease over the same time period in EU15þ countries. However, the present study identifies variable trends in lower limb amputation incidence across EU15þ countries between 1990 and 2017. The potential contributors to the observed results are discussed. Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity, and health economic burden. In the Western world, it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. The incidence of PAOD has declined in Europe, the United States, and parts of Australasia. The present study aimed to assess trends in LEA incidence in European Union (EU15þ) countries for the years 1990e2017. Methods: This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15þ countries for each of the years 1990e2017. Trends were analysed using Joinpoint regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15þ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients À22.93%, male patients À29.76%; toe amputation: female patients À29.93%, male patients À32.67%). The greatest overall increase in incidence was observed in Australia. Conclusion: Variable trends in LEA incidence were observed across EU15þ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.

Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality

“…It should be emphasized, that generally, the incidence of lower extremity amputation for all reasons in European countries is variable [ 17 ]. Even in Poland, the geographic variability of the numbers of major nontraumatic lower limb amputations in diabetics was observed [ 18 ].…”

Progress in aorta and peripheral cardiovascular disease research

“…The lack of improvement in CV prognosis of LEAD patients extends also to limb prognosis, as demonstrated by a new analysis from the 2017 Global Burden of Disease study. 15 Data from 16 European countries, Canada, Australia, and the USA between 1990 and 2017 showed wide time trend variability among countries and between sexes regarding amputation proximal to toes, in the absence of uniform improvements. New data on the impact of revascularization on limb prognosis in claudicants were reported in a retrospective analysis of 11 887 elective endovascular procedures.…”

Associations between partial foot amputation level, gait parameters, and minimum impairment criteria in para-sport: A research study protocol

“…Lower extremity amputation is a condition associated with a significant impact on quality of life, morbidity, and mortality. 1 Chronic degenerative disease complications, including vascular disease due to Type I and Type II diabetes, peripheral vascular disease, and infection, are the most frequent indication for lower-extremity amputation, 2 with diabetes and associated comorbidities accounting for more than 50% of all lower-limb amputations globally. 3 In children and young adults, the most common causes include trauma (75%), malignancy (5%), and congenital limb deficiency (5%).…”

“…Less common levels are ankle disarticulations (Syme), through-knee amputations, hip disarticulation, and hemipelvectomy (combined 1.5%). 1 , 4 …”