title: Variation in the incidence and proportion of diabetes-related amputations in minorities.
abstract: OBJECTIVE
  To identify the age-adjusted and level-specific incidence of amputations associated with diabetes in Hispanics, African-Americans, and non-Hispanic whites.
  
  
  METHODS
  We used a database from the Office of Statewide Planning and Development in California that identified all hospitalizations for lower-extremity amputations in the state in 1991. Amputation level was defined by ICD-9-CM codes 84.11-84.18 and were categorized as toe, foot, leg, and thigh amputations.
  
  
  RESULTS
  The age-adjusted incidence of diabetes-related amputation per 10,000 persons with diabetes in 1991 was 95.25 in African-Americans, 55.98 in non-Hispanic whites, and 44.43 in Hispanics. Hispanics had a higher proportion of amputations (82.7%) associated with diabetes than did African-Americans (61.6%) or non-Hispanic whites (56.8%) (P < 0.001). African-Americans had the highest age-adjusted incidence rate for each level in people with and without diabetes. African-Americans underwent more proximal amputations compared with non-Hispanic whites and Hispanics (P < 0.001). Diabetes-related amputations were 1.72 and 2.17 times more likely in African-Americans compared with non-Hispanic whites and Hispanics, respectively.
  
  
  CONCLUSIONS
  Hispanics had proportionally more amputations associated with diabetes than did African-Americans or non-Hispanic whites. A significant excess incidence of both diabetes- and non-diabetes-related amputations and proportionally more proximal amputations were identified in African-Americans compared with Hispanics and non-Hispanic whites. A possible explanation could be the higher prevalence of peripheral vascular disease in African-Americans. Public health initiatives, which have been demonstrated to reduce the incidence of diabetes-related lower-extremity amputations, should be implemented, and additional work should focus on minority groups.
authors.affiliation: Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78284-7776, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
authors.forename: H R
authors.initials: HR
authors.lastname: Ashry
authors.forename: W
authors.initials: W
authors.lastname: van Houtum
authors.forename: J A
authors.initials: JA
authors.lastname: Pugh
authors.forename: L B
authors.initials: LB
authors.lastname: Harkless
authors.forename: S
authors.initials: S
authors.lastname: Basu
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002140:California; D003920:Diabetes Mellitus / Q000453:epidemiology; D005528:Foot; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D007866:Leg; D008875:Middle Aged; D008913:Minority Groups; D011336:Probability; D012307:Risk Factors; D013848:Thigh; D014034:Toes; D044465:White People