Lower extremity amputation rates in people with diabetes as an indicator of health systems performance. A critical appraisal of the data collection 2000–2011 by the Organization for Economic Cooperation and Development (OECD)

Abstract

AimsCritical appraisal of secondary data made available by the OECD for the time frame 2000–2011.MethodsComparison of trends and variation of amputations in people with diabetes across OECD countries. Generalized estimating equations to test the statistical significance of the annual change adjusting for major potential confounders.ResultsA total of 26 OECD countries contributed to the OECD data collection for at least 1 year in the reference time frame, showing a decline in rates of over 40 %, from a mean of 13.2 (median 9.4, range 5.1–28.1) to 7.8 amputations per 100,000 in the general population (9.9, 1.0–18.4). The multivariate model showed an average decrease equal to −0.27 per 100,000 per year (p = 0.015), adjusted by structural characteristics of health systems, showing lower amputation rates for health systems financed by public taxation (−4.55 per 100,000 compared to insurance based, p = 0.002) and non-ICD coding mechanisms (−7.04 per 100,000 compared to ICD-derived, p = 0.001). Twelve-year decrease was stronger among insurance-based financing systems (tax based: −0.16 per 100,000, p = 0.064; insurance based: −0.36 per 100,000; p = 0.046).ConclusionsIn OECD countries, amputation rates in diabetes continuously decreased over 12 years. Still, in 2011, one amputation every 7 min could be directly attributed to diabetes. Although interesting, these results should be taken with extreme caution, until common definitions are improved and data quality issues, e.g., a different ability in capturing diabetes diagnoses, are fully resolved.

Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

“…Data from national audits in many countries and the Organization for Economic Cooperation and Development (OECD) have demonstrated a signi cant reduction in the incidence of diabetes-related major LEA over years owing to diabetic foot ulcer prevention and care programs [9][10][11][12]. Nevertheless, studies have reported up to a 20-fold variation in the rate of major LEA among countries [13,14]. Furthermore, as per OECD estimates of 2017, Austria had a high agesex standardized rate of major LEA (13.20 per 100,000 population) in individuals with diabetes amongst European Countries [10].…”

Limb- and Person-Level Risk Factors for Lower-Limb Amputation in the Prospective Seattle Diabetic Foot Study

“…infrequency of this event. A recent study of 26 Organization for Economic Cooperation and Development countries found a median rate of 7.8 events/100,000 people with diabetes (2). A review of global variation in incidence that mainly included European countries and the U.S. found annual incidence ranging from 4.6 to 960/10,000 people with diabetes, but 85% of countries/states examined had an annual incidence ,100/10,000 (3).…”

Trends in the epidemiology of diabetic foot and lower limb amputations in Russian Federation according to the Federal Diabetes Register (2013–2016)

“…населения по сравнению с данными Венгрии, где этот показатель составил 1,1 на 100 тыс. населения [10]. Данная вариабельность может объясняться рядом при-чин, в том числе различными способами кодирования медицинских услуг, существенными различиями в распро-страненности СД, различным уровнем оказания специа-лизированной медицинской помощи, а также качеством сбора информации.…”