Regional variations in amputation rates: are regional diabetic foot services the reason?

Lazzarini, Peter A; Fitridge, Robert

doi:10.1111/ans.15161

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…Interestingly, we found no marked differences between Indigenous and non-Indigenous people for these risk factors, in contrast to a previous systematic review [40]. This may be explained by our tighter inclusion criteria that included only population-based publications and in turn only identified studies from urban settings [32], while the previous review predominantly identified single site clinic-based studies from remote settings [40], with geographical remoteness known to increase DFD rates [41].…”

Section: Risk Factorscontrasting

confidence: 64%

Diabetes‐related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations

Zhang

Netten

Baba

et al. 2021

Journal of Foot and Ankle Research

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Background Diabetes-related foot disease (DFD) is a leading cause of global hospitalisation, amputation and disability burdens; yet, the epidemiology of the DFD burden is unclear in Australia. We aimed to systematically review the literature reporting the prevalence and incidence of risk factors for DFD (e.g. neuropathy, peripheral artery disease), of DFD (ulcers and infection), and of diabetes-related amputation (total, minor and major amputation) in Australian populations. Methods We systematically searched PubMed and EMBASE databases for peer-reviewed articles published until December 31, 2019. We used search strings combining key terms for prevalence or incidence, DFD or amputation, and Australia. Search results were independently screened for eligibility by two investigators. Publications that reported prevalence or incidence of outcomes of interest in geographically defined Australian populations were eligible for inclusion. Included studies were independently assessed for methodological quality and key data were extracted by two investigators. Results Twenty publications met eligibility and were included. There was high heterogeneity for populations investigated and methods used to identify outcomes. We found within diabetes populations, the prevalence of risk factors ranged from 10.0–58.8%, of DFD from 1.2–1.5%, and the incidence of diabetes-related amputation ranged from 5.2–7.2 per 1000 person-years. Additionally, the incidence of DFD-related hospitalisation ranged from 5.2–36.6 per 1000 person-years within diabetes populations. Furthermore, within inpatients with diabetes, we found the prevalence of risk factors ranged from 35.3–43.3%, DFD from 7.0–15.1% and amputation during hospitalisation from 1.4–5.8%. Conclusions Our review suggests a similar risk factor prevalence, low but uncertain DFD prevalence, and high DFD-related hospitalisation and amputation incidence in Australia compared to international populations. These findings may suggest that a low proportion of people with risk factors develop DFD, however, it is also possible that there is an underestimation of DFD prevalence in Australia in the few limited studies, given the high incidence of hospitalisation and amputation because of DFD. Either way, studies of nationally representative populations using valid outcome measures are needed to verify these DFD-related findings and interpretations.

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Section: Risk Factorscontrasting

confidence: 64%

Diabetes‐related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations

Zhang

Netten

Baba

et al. 2021

Journal of Foot and Ankle Research

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“…The adjusted probability shows that with all covariates being equal, for every 100 patients treated over six months in different geographical areas, 65 would become ulcerfree in a major city, 55 in regional area, and only 40 in remote area (Figure 4; eTable 4). We hypothesise, like we did in our previous letter [24] and others have for amputation [42,43], that geographical remoteness may be indicative of infrequent access to care, reduced socioeconomic status or poorer health literacy [42][43][44][45]. Whilst we didn't collect socio-economic status or health literacy, in unpublished post-hoc analyses, we did find statistically larger mean number of Diabetic Foot Service visits in those from major cities, which supports infrequent access to care being implicated.…”

Section: Discussionsupporting

confidence: 62%

Multiple factors predict longer and shorter time-to-ulcer-free in people with diabetes-related foot ulcers: Survival analyses of a large prospective cohort followed-up for 24-months

Zhang

Cramb

McPhail

et al. 2022

Diabetes Research and Clinical Practice

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“…34 In addition to this, recent data (adjusted for socioeconomic status) from New Zealand suggests that the considerable fourfold variation in LEA incidence seen within regions of the same country may be in part caused by variation in quality and availability of diabetic foot management services. 35…”

Section: Discussionmentioning

confidence: 99%

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

Hughes

Goodall

Salciccioli

et al. 2020

European Journal of Vascular and Endovascular Surgery

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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.

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Regional variations in amputation rates: are regional diabetic foot services the reason?

Cited by 8 publications

References 12 publications

Diabetes‐related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations

Diabetes‐related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations

Multiple factors predict longer and shorter time-to-ulcer-free in people with diabetes-related foot ulcers: Survival analyses of a large prospective cohort followed-up for 24-months

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

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