title: Trends in initial lower extremity amputation rates among Veterans Health Administration health care System users from 2000 to 2004.
abstract: OBJECTIVE
  To evaluate temporal trends in rates of initial lower extremity amputation (ILEA) among patients with diabetes in the Veterans Health Administration (VHA).
  
  
  METHODS
  Retrospective administrative data analysis of VHA clinic users with diabetes in fiscal years (FY) 2000 to 2004 (1 October 1999-30 September 2004). We calculated annual age- and sex-standardized rates of initial major, minor, and total amputations for the overall population and for various racial/ethnic groups (African Americans, Hispanics, and whites). Trends in ILEA risk were evaluated with and without adjustment for demographic characteristics and other potential risk factors, including presence of microvascular and macrovascular diseases, and antiglycemic treatment.
  
  
  RESULTS
  Study populations of VHA patients with diabetes and without prior amputations ranged from 405,580 in FY 2000 to 739,377 in FY 2004. Age- and sex-standardized ILEA rates decreased by 34% (7.08/1,000 patients in FY 2000 to 4.65/1,000 patients in FY 2005) during the 5-year period. Minor and major amputation rates decreased by 33% (4.59 to 3.06/1,000) and 36% (2.49 to 1.59/1,000), respectively. Of major amputations, below-knee rates decreased from 1.08 to 0.87/1,000 (-19%), and above-knee decreased from 1.41 to 0.72/1,000 (-49%). Similar trends were seen for all racial groups. ILEA risk decreased by 28% (odds ratio 0.72 [95% CI 0.68-0.75]) when FY 2004 was compared with FY 2000 in the model, adjusting for demographic characteristics. This risk decrease was 22% in the model adjusting for all independent variables (odds ratio 0.78 [95% CI 0.74-0.82]).
  
  
  CONCLUSIONS
  Downward 5-year trends in ILEA rates were observed for all amputation levels and among all racial groups, even after adjustment for risk differences over time.
authors.affiliation: Department of Veterans Affairs New Jersey Healthcare System–Center for Healthcare Knowledge Management, East Orange, New Jersey, USA. chin-lin.tseng@va.gov
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Tseng
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lafrance
authors.forename: Leonard
authors.initials: L
authors.lastname: Pogach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D058014:Veterans Health / Q000706:statistics & numerical data