title: Regional variation in the incidence of diabetes-related amputations in The Netherlands.
abstract: The purpose of this study is to identify the incidence of diabetes-related lower extremity amputations in 27 health regions in the Netherlands. A secondary database was used that contains all hospitalizations for a lower extremity amputation in the Netherlands in 1991 and 1992, recorded separately for 27 health regions. The age-adjusted incidence lower extremity amputations per 10,000 diabetic patients in the Netherlands was 25.05, and among the regions it ranged from 10.15 to 44.64. In the non-diabetic population, the age-adjusted incidence in the Netherlands was 1.24 and ranged by region from 0.77 to 1.77. Overall, diabetic males had higher age-adjusted incidence rates than diabetic females, although in four health regions the situation was reversed. In the Netherlands, there was an increasing incidence of diabetes-related lower extremity amputation as age increased: < 45 years, 11.15; 45-64 years, 33.84; 65-74 years, 61.22; and 75 + years, 107.92 (P < 0.001). This continued to be a significant phenomenon for every health region (P < 0.001). This study found a wide range in the incidence of diabetes related lower extremity amputations in the 27 health regions in the Netherlands. A possible explanation could be differences in the severity of diabetes, in local treatment philosophies or the availability of subspecialties.
authors.affiliation: Mexican-American Medical Treatment Effectiveness Research Center, San Antonio, TX, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: van Houtum
authors.forename: L A
authors.initials: LA
authors.lastname: Lavery
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003710:Demography; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007256:Information Systems; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors; D012737:Sex Factors