Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018

Hayes, J; Rafferty, Jim; Cheung, WY; Akbari, Ashley; Thomas, R; Bain, Steve; Topliss, C; Stephens, Jeffrey

doi:10.1016/j.deman.2023.100144

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Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018

J Hayes

, Jim Rafferty

, WY Cheung, Ashley Akbari

, R Thomas, Steve Bain

, C Topliss, Jeffrey Stephens

Diabetes Epidemiology and Management, Volume: 11, Start page: 100144

Swansea University Authors: Jim Rafferty , Ashley Akbari , Steve Bain , Jeffrey Stephens

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DOI (Published version): 10.1016/j.deman.2023.100144

Abstract

Background: There is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotl...

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Published in:	Diabetes Epidemiology and Management
ISSN:	2666-9706
Published:	Elsevier BV 2023
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URI:	https://cronfa.swan.ac.uk/Record/cronfa63611
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National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation. Materials and Methods: All first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time. Results: Over the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period. Conclusion: This study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population.</abstract><type>Journal Article</type><journal>Diabetes Epidemiology and Management</journal><volume>11</volume><journalNumber/><paginationStart>100144</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2666-9706</issnPrint><issnElectronic/><keywords>Diabetes, amputation, Wales</keywords><publishedDay>1</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-07-01</publishedDate><doi>10.1016/j.deman.2023.100144</doi><url>http://dx.doi.org/10.1016/j.deman.2023.100144</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Not Required</apcterm><funders>This study makes use of anonymised data held in the SAIL databank, which is part of the national e-health records research infrastructure for Wales. 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spelling	v2 63611 2023-06-08 Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018 52effe759a718bd36eb12cdd10fe1a09 0000-0002-1667-7265 Jim Rafferty Jim Rafferty true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 5399f4c6e6a70f3608a084ddb938511a 0000-0001-8519-4964 Steve Bain Steve Bain true false 5219d126f97f8f884bdb622099bd41de 0000-0003-2228-086X Jeffrey Stephens Jeffrey Stephens true false 2023-06-08 HDAT Background: There is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation. Materials and Methods: All first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time. Results: Over the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period. Conclusion: This study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population. Journal Article Diabetes Epidemiology and Management 11 100144 Elsevier BV 2666-9706 Diabetes, amputation, Wales 1 7 2023 2023-07-01 10.1016/j.deman.2023.100144 http://dx.doi.org/10.1016/j.deman.2023.100144 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Not Required This study makes use of anonymised data held in the SAIL databank, which is part of the national e-health records research infrastructure for Wales. We would like to acknowledge all the data providers who make anonymised data available for research. 2023-06-21T15:03:53.0293986 2023-06-08T14:20:14.8792575 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science J Hayes 0000-0002-3130-7254 1 Jim Rafferty 0000-0002-1667-7265 2 WY Cheung 3 Ashley Akbari 0000-0003-0814-0801 4 R Thomas 5 Steve Bain 0000-0001-8519-4964 6 C Topliss 7 Jeffrey Stephens 0000-0003-2228-086X 8 63611__27803__3401102af06c4487a8d81b5656429f0d.pdf 63611.pdf 2023-06-12T10:41:19.8310134 Output 605872 application/pdf Version of Record true Distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). true eng http://creativecommons.org/licenses/by-nc-nd/4.0
title	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
spellingShingle	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018 Jim Rafferty Ashley Akbari Steve Bain Jeffrey Stephens
title_short	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
title_full	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
title_fullStr	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
title_full_unstemmed	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
title_sort	Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018
author_id_str_mv	52effe759a718bd36eb12cdd10fe1a09 aa1b025ec0243f708bb5eb0a93d6fb52 5399f4c6e6a70f3608a084ddb938511a 5219d126f97f8f884bdb622099bd41de
author_id_fullname_str_mv	52effe759a718bd36eb12cdd10fe1a09_*_Jim Rafferty aa1b025ec0243f708bb5eb0a93d6fb52__Ashley Akbari 5399f4c6e6a70f3608a084ddb938511a__Steve Bain 5219d126f97f8f884bdb622099bd41de_*_Jeffrey Stephens
author	Jim Rafferty Ashley Akbari Steve Bain Jeffrey Stephens
author2	J Hayes Jim Rafferty WY Cheung Ashley Akbari R Thomas Steve Bain C Topliss Jeffrey Stephens
format	Journal article
container_title	Diabetes Epidemiology and Management
container_volume	11
container_start_page	100144
publishDate	2023
institution	Swansea University
issn	2666-9706
doi_str_mv	10.1016/j.deman.2023.100144
publisher	Elsevier BV
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url	http://dx.doi.org/10.1016/j.deman.2023.100144
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description	Background: There is variance in the incidence of lower extremity amputation across and within countries including within the UK. National data shows up to a fourfold variance in the amputation rate throughout the regions of England and differences in amputation incidence have been reported in Scotland and Ireland. Lower extremity amputation rate has yet to be documented within Wales. The aim of this cohort study was to examine trends in diabetes and non-diabetes related lower extremity amputation incidence within the Welsh population and to examine the influence of diabetes on the relative risk of amputation. Materials and Methods: All first-time amputations between 2008-2018 were extracted from SAIL, a repository of all routine medical data of residents of Wales. People with diabetes were identified using an algorithm utilising data from several clinical and non-clinical sources. Crude and direct age and sex adjusted incidences were estimated over time. Results: Over the period 3505 major amputations and 4335 minor amputations occurred. The diabetes population greater than 17 years of age increased by 29.4% from 143,595 in 2008 to 206,818 in 2018. There was a statistically significant rate reduction in major amputation in both populations. In the diabetes population the number of major amputations reduced from 6.9 [5.5–8.5]/10 000 person years (PY) in 2008 to 4.9 [5.4–6.2]/10 000 PY in 2018. However, for major amputation, the risk of incident amputation in people with diabetes was 7.3 fold higher [7.1–7.5] than those without diabetes. The relative risk of minor amputation for those with diabetes was higher at 11.9 [11.8 –1.01]. There was no reduction in this risk over the period. Conclusion: This study found that rates of major amputation decreased over the study period but the risk of amputation for persons with diabetes remained substantial. As the population with diabetes increases so do crude rates of amputation, providing a substantial financial and societal cost to the Welsh Population.
published_date	2023-07-01T15:03:53Z
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Quantifying the incidence of lower limb amputation in people with and without diabetes in Wales between 2008–2018

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