Limb Amputation and Limb Deficiency: Epidemiology and Recent Trends in the United States

Background. The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States. Methods. Data from the Healthcare Cost and Utilization Project from 1988 through 1996 were used to calculate rates of congenital deficiency, trauma-related, cancer-related, and dysvascular amputations in the United States. Trends over time in adjusted rates were then examined using linear regression techniques. Results. Dysvascular amputations accounted for 82% of limb loss discharges and increased over the period studied. Over all years, the estimated increase in the rate of dysvascular amputations was 27%. Rates of trauma-related and cancer-related amputations both declined by approximately half. The incidence of congenital deficiencies remained stable. Conclusions. The risk of amputations increased with age for all causes and was highest among blacks having dysvascular amputations. Increasing risk of dysvascular amputations, particularly among elderly and minority populations, is of concern and warrants further investigation.

[1]  P. Banişter Congenital malformations: preliminary report of an investigation of reduction deformities of the limbs, triggered by a pilot surveillance system. , 1970, Canadian Medical Association journal.

[2]  E. S. Smith,et al.  An epidemiological study of congenital reduction deformities of the limbs. , 1977, British journal of preventive & social medicine.

[3]  L. Saxén,et al.  Incidence and secular trends of congenital limb defects in Finland. , 1982, International journal of epidemiology.

[4]  Traumatic amputations and the need for a replantation service in Finland. , 1982, Annales chirurgiae et gynaecologiae.

[5]  P Sinnock,et al.  The Epidemiology of Lower Extremity Amputations in Diabetic Individuals , 1983, Diabetes Care.

[6]  F. Lithner,et al.  Amputations in diabetics and nondiabetics in Umeå county 1971-1977. , 2009, Acta medica Scandinavica. Supplementum.

[7]  B. Källén,et al.  Infants with congenital limb reduction registered in the Swedish Register of Congenital Malformations. , 1984, Teratology.

[8]  E. Miller,et al.  Diabetes-related lower extremity amputations in New Jersey, 1979 to 1981. , 1985, The Journal of the Medical Society of New Jersey.

[9]  H. Alaranta,et al.  Lower limb amputations in Southern Finland 1984-1985 , 1988, Prosthetics and orthotics international.

[10]  P A Baird,et al.  Limb reduction defects in over one million consecutive livebirths. , 1989, Teratology.

[11]  W. Gray,et al.  Are Osha Health Inspections Effective? a Longitudinal Study in the Manufacturing Sector , 1990 .

[12]  L. Jones Lower limb amputation in three Australian states. , 1990, International disability studies.

[13]  L. Ebskov Lower limb amputations for vascular insufficiency , 1991, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[14]  R. Kotz,et al.  The management of IIB osteosarcoma. Experience from 1976 to 1985. , 1991, Clinical orthopaedics and related research.

[15]  F. Osterman The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease. , 1992, The New England journal of medicine.

[16]  U. Froster,et al.  Upper limb deficiencies and associated malformations: a population-based study. , 1992, American journal of medical genetics.

[17]  L. Ebskov Level of lower limb amputation in relation to etiology: An epidemiological study , 1992, Prosthetics and orthotics international.

[18]  A. Csima,et al.  Diabetes-related lower extremity amputations in Ontario: 1987-88 experience. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[19]  Jennifer S. Lee,et al.  Lower-Extremity Amputation: Incidence, Risk Factors, and Mortality in the Oklahoma Indian Diabetes Study , 1993, Diabetes.

[20]  U. Froster,et al.  Congenital defects of lower limbs and associated malformations: a population based study. , 1993, American journal of medical genetics.

[21]  L. Ebskov Major amputation for malignant melanoma: An epidemiological study , 1993, Journal of surgical oncology.

[22]  J. Gujral,et al.  Ethnic Differences in the Incidence of Lower Extremity Amputation Secondary to Diabetes Mellitus , 1993, Diabetic medicine : a journal of the British Diabetic Association.

[23]  H. Alaranta,et al.  Lower-limb amputations. , 1993, Annales chirurgiae et gynaecologiae.

[24]  Diabetes in a Northern Minnesota Chippewa Tribe: Prevalence and incidence of diabetes and incidence of major complications, 1986–1988 , 1993, Diabetes Care.

[25]  E. Bass,et al.  Variation in utilization of procedures for treatment of peripheral arterial disease. A look at patient characteristics. , 1993, Archives of internal medicine.

[26]  L. Al-falahi,et al.  Amputee population in the Kingdom of Saudi Arabia , 1993, Prosthetics and orthotics international.

[27]  A. Lanier,et al.  Diabetes Prevalence, Incidence, and Complications Among Alaska Natives, 1987 , 1993, Diabetes Care.

[28]  Lower extremity amputations in New Jersey. , 1994, New Jersey medicine : the journal of the Medical Society of New Jersey.

[29]  P. Choong,et al.  Soft‐tissue sarcoma of the extremity: experience with limb‐sparing surgery , 1994, The Medical journal of Australia.

[30]  L. Ebskov,et al.  Trauma-related major lower limb amputations: an epidemiologic study. , 1994, The Journal of trauma.

[31]  H. Alaranta,et al.  Lower limb amputees in Southern Finland , 1995, Prosthetics and orthotics international.

[32]  M. McGrail,et al.  A Comprehensive Initiative to Manage the Incidence and Cost of Occupational Injury and Illness: Report of an Outcomes Analysis , 1995, Journal of occupational and environmental medicine.

[33]  L. Lavery,et al.  Variation in the Incidence and Proportion of Diabetes-Related Amputations in Minorities , 1996, Diabetes Care.

[34]  L. Ebskov,et al.  Major lower limb amputation in diabetic patients: development during 1982 to 1993 , 1996, Diabetologia.

[35]  J. Groothoff,et al.  Epidemiology of lower limb amputees in the north of the Netherlands: Aetiology, discharge destination and prosthetic use , 1997, Prosthetics and orthotics international.

[36]  E J MacKenzie,et al.  Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study. , 1998, Archives of physical medicine and rehabilitation.

[37]  S. Blair,et al.  Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. , 1999, Medicine and science in sports and exercise.

[38]  H. Alaranta,et al.  Epidemiology of lower limb amputees in Southern Finland in 1995 and trends since 1984 , 1999, Prosthetics and orthotics international.

[39]  D. Armstrong,et al.  Diabetes-Related Lower-Extremity Amputations Disproportionately Affect Blacks and Mexican Americans , 1999 .

[40]  J. Feinglass,et al.  Rates of lower-extremity amputation and arterial reconstruction in the United States, 1979 to 1996. , 1999, American journal of public health.

[41]  D. Holtzman,et al.  State-specific prevalence of selected health behaviors, by race and ethnicity--Behavioral Risk Factor Surveillance System, 1997. , 2000, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[42]  J. A. Martin,et al.  Births: final data for 1998. , 2000, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[43]  A. Czeizel,et al.  Incidence at birth of different types of limb reduction abnormalities in Hungary 1975–1977 , 2004, Human Genetics.