TY - JOUR
T1 - An in-depth assessment of diabetes-related lower extremity amputation rates 2000–2013 delivered by twenty-one countries for the data collection 2015 of the Organization for Economic Cooperation and Development (OECD)
AU - Carinci, Fabrizio
AU - Uccioli, Luigi
AU - Massi Benedetti, Massimo
AU - Klazinga, Nicolaas Sieds
N1 - Funding Information: The conduction of this study has been made possible through in kind support offered by the Italian Ministry of Health, represented by F. Carle, Director of Office VI, Directorate of Health Policy and Planning, in collaboration with the Italian Agency for Regional Health Services (AGENAS). The new OECD standardized definitions applied in this paper have been delivered with the active contribution of the following members of the EUBIROD network: Jana Lepiksone (Centre for Disease Control, Latvia); Karianne Fjeld Loovas (Noklus, Norway), Scott Cunningham, (University of Dundee, Scotland); Zeliko Metelko (CrodiabNet, University of Zagreb, Croatia); Tamara Poljicanin (National Institute of Public Health, Croatia); Joseph Azzopardi (University of Malta, Malta); Przemka Jarosz-Chobot (Medical University of Silesia, Poland); Iztok Stotl (University of Ljubljana, Slovenia). The following members of the HCQI Expert Group participated to the targeted OECD R&D Study: Deirdre Mulholland and Grainne Cosgrove (Department of Health, Ireland); Yael Applbaum and Ziona Haklai (Ministry of Health, Israel); Hanne Narvulbold (Directorate of Health, Norway) and Veena Raleigh (The King’s Fund, England). The authors are particularly grateful to Ian Brownwood and Nelly Biondi from the OECD Health Division, for their continuous assistance with issues related to the OECD data collection. Publisher Copyright: © 2019, Springer-Verlag Italia S.r.l., part of Springer Nature. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: International comparisons of diabetes-related lower extremity amputation rates are still hampered by different criteria used for data collection and analysis. We aimed to evaluate trends and variation of major/minor amputations, using agreed definitions adopted by the Organization for Economic Cooperation and Development in 2015. Methods: Direct age–sex standardized rates were calculated per 100,000 subjects per year between 2000 and 2013, using major/minor amputations with diabetes diagnosis as numerators and the total population or number of people with diabetes as denominators. Longitudinal trends were investigated using generalized estimating equations. Results: Twenty-one countries reported major amputations referred to the general population, showing a mean reduction from 10.8 to 7.5 per 100,000 (− 30.6%). Eleven countries also reported major amputations among people with diabetes, showing a mean reduction from 182.9 to 128.3 per 100,000 (− 29.8%). Minor amputations remained stable over the study period. Longitudinal trends showed a significant average annual decrease of − 0.19 per 100,000 in the general population (95% CI − 0.36 to − 0.02; p =.03) and − 4.52 per 100,000 among subjects with diabetes (95% CI − 6.09 to − 2.94; p <.001). The coefficient of variation of major amputation rates between countries was fairly high (64%—in the total population, 67% among people with diabetes). Conclusions: The study highlighted a clinically significant reduction of major amputations, in both the general population and among people with diabetes. The use of standardized definitions, while increasing the comparability of multinational data, highlighted remarkable differences between countries. These results can help identifying and sharing best practices effectively on a global scale.
AB - Background: International comparisons of diabetes-related lower extremity amputation rates are still hampered by different criteria used for data collection and analysis. We aimed to evaluate trends and variation of major/minor amputations, using agreed definitions adopted by the Organization for Economic Cooperation and Development in 2015. Methods: Direct age–sex standardized rates were calculated per 100,000 subjects per year between 2000 and 2013, using major/minor amputations with diabetes diagnosis as numerators and the total population or number of people with diabetes as denominators. Longitudinal trends were investigated using generalized estimating equations. Results: Twenty-one countries reported major amputations referred to the general population, showing a mean reduction from 10.8 to 7.5 per 100,000 (− 30.6%). Eleven countries also reported major amputations among people with diabetes, showing a mean reduction from 182.9 to 128.3 per 100,000 (− 29.8%). Minor amputations remained stable over the study period. Longitudinal trends showed a significant average annual decrease of − 0.19 per 100,000 in the general population (95% CI − 0.36 to − 0.02; p =.03) and − 4.52 per 100,000 among subjects with diabetes (95% CI − 6.09 to − 2.94; p <.001). The coefficient of variation of major amputation rates between countries was fairly high (64%—in the total population, 67% among people with diabetes). Conclusions: The study highlighted a clinically significant reduction of major amputations, in both the general population and among people with diabetes. The use of standardized definitions, while increasing the comparability of multinational data, highlighted remarkable differences between countries. These results can help identifying and sharing best practices effectively on a global scale.
KW - Diabetes care
KW - Generalized estimating equations
KW - Health systems performance assessment
KW - Healthcare Quality Indicators
KW - Lower extremity amputations in diabetes
UR - http://www.scopus.com/inward/record.url?scp=85074532896&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00592-019-01423-5
DO - https://doi.org/10.1007/s00592-019-01423-5
M3 - Article
C2 - 31605210
SN - 0940-5429
VL - 57
SP - 347
EP - 357
JO - Acta Diabetologica
JF - Acta Diabetologica
IS - 3
ER -