title: Temporal trends in initial and recurrent lower extremity amputations in people with and without diabetes in Western Australia from 2000 to 2010.
abstract: OBJECTIVE
  To examine temporal trends in lower extremity amputations in people with type 1 diabetes, type 2 diabetes and cardiovascular disease (CVD) without diabetes in Western Australia (WA) from 2000 to 2010.
  
  
  METHODS
  We used linked health data to identify all non-traumatic lower extremity amputations in adults aged ≥20 years with diabetes and/or CVD from 2000 to 2010 in WA. Annual age- and sex-standardised rates of total, initial and recurrent amputations, stratified by major and minor status, were calculated for type 1 and type 2 diabetes, and CVD without diabetes, from the at-risk population for each group. Age- and sex-adjusted trends were estimated from Poisson regression models.
  
  
  RESULTS
  5891 lower extremity amputations were identified. Peripheral vascular disease (71%), hypertension (70%) and chronic kidney disease (60%) were highly prevalent. Average annual rates of total amputations were 724, 564 and 66 per 100,000 person-years in type 1, type 2 diabetes and CVD without diabetes respectively. Rates of initial amputations fell significantly by 2.4%/year (95% CI -3.5, -1.4) in type 2 diabetes, with similar declines for type 1 diabetes and CVD without diabetes (interaction p=0.96), driven by large falls in major amputations. There was limited improvement in recurrence rates overall, with recurrent minor amputations increasing significantly in type 2 diabetes (+3.5%/year, 95% CI +1.3%, +5.7%).
  
  
  CONCLUSIONS
  Lower extremity amputation rates have declined at a population level in people with diabetes and CVD without diabetes, suggesting improvements in prevention and management for this high-risk patient group, however limited declines in recurrent amputations requires further investigation.
authors.affiliation: Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia.
authors.forename: Julia R
authors.initials: JR
authors.lastname: Kurowski
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia. Electronic address: lee.nedkoff@uwa.edu.au.
authors.forename: Lee
authors.initials: L
authors.lastname: Nedkoff
authors.affiliation: Western Australian Centre for Rural Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia.
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Schoen
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.affiliation: School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Norman
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000639:trends*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D014904:Western Australia / Q000453:epidemiology
keywords: Amputation; Cardiovascular disease; Diabetes; Epidemiology; Trends