A Lack of Decline in Major Nontraumatic Amputations in Texas: Contemporary Trends, Risk Factor Associations, and Impact of Revascularization

Author:

Garcia Marlene1,Hernandez Brian2,Ellington Tyler G.1,Kapadia Anupama1,Michalek Joel2,Fisher-Hoch Susan3,McCormick Joseph B.3,Prasad Anand1ORCID

Affiliation:

1. Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX

2. Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX

3. Division of Epidemiology, The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX

Abstract

OBJECTIVE Nontraumatic major lower extremity amputations (LEAs) have been reported to be declining nationally; however, trends in Texas have been less well described. We evaluated demographic and clinical risk factors and revascularization associations for LEAs by using inpatient hospital discharge data in Texas from 2005 to 2014. RESEARCH DESIGN AND METHODS Inpatient hospital discharge data were obtained from the Texas Center for Health Statistics. Multivariate logistic regression analyses were performed to evaluate clinical, ethnic, and socioeconomic risk factors associated with LEA. The impact of revascularization (surgical and/or endovascular) on LEA was analyzed. RESULTS Between 2005 and 2014, of 19,939,716 admissions, 46,627 were for nontraumatic major LEAs. Over time, LEAs were constant, and revascularization rates during index admission declined. The majority of LEAs occurred in males and in individuals aged 60–79 years. Risk factors associated with LEA included diabetes, peripheral arterial disease, chronic kidney disease, and male sex (P < 0.001). Insurance status, hyperlipidemia, coronary artery disease, and stroke/transient ischemic attack were associated with lower odds of amputation (P < 0.001). Hispanic (odds ratio [OR] 1.51 [95% CI 1.48, 1.55], P < 0.001) and black (OR 1.97 [95% CI 1.92, 2.02], P < 0.001) ethnicities were associated with a higher risk for amputation when compared with non-Hispanic whites. Revascularization, either surgical or endovascular (OR 0.52 [95% CI 0.5, 0.54], P < 0.001), was also associated with lower odds for amputation. CONCLUSIONS Amputation rates in Texas have remained constant, whereas revascularization rates are declining. A higher risk for LEA was seen in minorities, including Hispanic ethnicity, which is the fastest growing demographic in Texas. Revascularization and having insurance were associated with lower odds for amputation.

Funder

National Institutes of Health Institutional National Research Service Award

Freeman Heart Association

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference27 articles.

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3. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population;Geiss;Diabetes Care,2019

4. Centers for Disease Control and Prevention. Hospitalizations for lower extremity amputation [Internet], 2019. Available from https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html. Accessed 22 February 2019

5. Factors contributing to increases in diabetes-related preventable hospitalization costs among U.S. adults during 2001–2014;Shrestha;Diabetes Care,2019

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