title: Incidence and characteristics of lower limb amputations in people with diabetes.
abstract: OBJECTIVE
  To estimate the incidence, characteristics and potential causes of lower limb amputations in France.
  
  
  METHODS
  Admissions with lower limb amputations were extracted from the 2003 French national hospital discharge database, which includes major diagnoses and procedures performed during hospital admissions. For each patient, diabetes was defined by its record in at least one admission with or without lower limb amputation in the 2002-2003 databases.
  
  
  RESULTS
  In 2003, 17 551 admissions with lower limb amputation were recorded, involving 15 353 persons, which included 7955 people with diabetes. The crude incidence of lower limb amputation in people with diabetes was 378/100 000 (349/100 000 when excluding traumatic lower limb amputation). The sex and age standardized incidence was 12 times higher in people with than without diabetes (158 vs. 13/100 000). Renal complications and peripheral arterial disease and/or neuropathy were reported in, respectively, 30% and 95% of people with diabetes with lower limb amputation. Traumatic causes (excluding foot contusion) and bone diseases (excluding foot osteomyelitis) were reported in, respectively, 3% and 6% of people with diabetes and lower limb amputation, and were 5 and 13 times more frequent than in people without diabetes.
  
  
  CONCLUSIONS
  We provide a first national estimate of lower limb amputation in France. We highlight its major impact on people with diabetes and its close relationship with peripheral arterial disease/neuropathy and renal complications in the national hospital discharge database. We do not suggest the exclusion of traumatic causes when studying the epidemiology of lower limb amputation related to diabetes, as diabetes may contribute to amputation even when the first cause appears to be traumatic.
authors.affiliation: Institute for Public Health Surveillance, 12 rue du Val d'Osne, 94 415 Saint Maurice Cedex, France. s.fosse@invs.sante.fr
authors.forename: S
authors.initials: S
authors.lastname: Fosse
authors.forename: A
authors.initials: A
authors.lastname: Hartemann-Heurtier
authors.forename: S
authors.initials: S
authors.lastname: Jacqueminet
authors.forename: G
authors.initials: G
authors.lastname: Ha Van
authors.forename: A
authors.initials: A
authors.lastname: Grimaldi
authors.forename: A
authors.initials: A
authors.lastname: Fagot-Campagna
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged