Abstract
Background
Given the importance in prevention of lower extremity amputations (LEAs) associated
with diabetes or peripheral artery disease (PAD), we sought to document the trends
of primary LEA in Québec, Canada, from years 2006 to 2019.
Methods
Using the Québec Integrated Chronic Disease Surveillance System, we calculated crude
and age-standardized annual incidence rates of primary LEA associated with diabetes
and PAD among adults ≥ 40 years (99% confidence intervals [CI]), and all-cause 1-year
mortality proportion trends following a primary LEA (95% CI), stratified by minor
or major as the highest level of LEA during the same hospital stay and age groups.
Trends were assessed using multivariate regression models.
Results
In 2019, the crude rate of primary LEA was 116.0 per 100,000 (n = 825) with 93.7 and
21.9 per 100,000 of minor (n = 665) and major (n = 160) LEA, respectively. A tendency
of decrease by 8% (–15.0 to 0.4%) of age-standardized incidence of primary LEA was
observed between 2006 and 2019, while the absolute number of primary LEA increased
from 610 to 825 cases. Minor LEA increased by 14.2% (3.7 to 25.9%) and major LEA decreased
by 49.5% (–57.1 to –40.5%). Incidence trends remained stable among the 40 to 64 years,
and declined by 14.6% and 20.1% for the 65 to 79 and ≥ 80 years of age groups, respectively.
Major LEA decreased in all age groups, whereas minor LEA increased by 26.2% among
the patients 40 to 64 years of age only. Age-standardized 1-year mortality decreased
by 35.1% (95% CI, –43.4 to –25.7%) between 2006 and 2019, with a crude 1-year mortality
of 11.3% in 2019.
Conclusions
The reduction of major LEA and 1-year mortality are encouraging, although increased
minor LEA, especially in younger age groups, emphasizes the importance to improve
preventive care further.
Résumé
Contexte
Étant donné l’importance de prévenir les amputations d’un membre inférieur associées
au diabète et à la maladie artérielle périphérique (MAP), nous avons voulu documenter
l'incidence des amputations primaires d’un membre inférieur au Québec (Canada) entre
2006 et 2019.
Méthodologie
À l’aide du Système intégré de surveillance des ma- ladies chroniques du Québec, nous
avons calculé le taux d’incidence annuel brut et le taux d’incidence annuel standardisé
selon l’âge des amputations primaires d’un membre inférieur associées au diabète et
à la MAP chez les adultes de 40 ans ou plus (intervalles de confiance [IC] à 99 %),
et les proportions de mortalité de toute cause à 1 an après une amputation primaire
d’un membre inférieur (IC à 95 %). Nous avons ensuite stratifié ces données selon
le niveau de l’amputation lors d’un même séjour à l’hôpital (mineure ou majeure),
et par groupes d’âge. Les tendances ont été évaluées à l’aide de modèles de régression
multivariés.
Résultats
En 2019, le taux brut d’amputations primaires d’un membre inférieur était de 116,0
pour 100 000 cas (n = 825), avec 93,7 amputations mineures (n = 665) et 21,9 amputations
majeures (n = 160) pour 100 000 cas. Une tendance à la baisse de 8 % (-15,0 à 0,4
%) a été notée dans l’incidence standardisée selon l’âge des amputations primaires
entre 2006 et 2019, avec une augmentation du nombre d'amputations de 610 à 825 cas.
Les amputations mineures étaient en hausse de 14,2 % (3,7 à 25,9 %) et les amputations
majeures, en baisse de 49,5 % (-57,1 à -40,5 %). La tendance dans le taux d’incidence
est demeurée stable chez les 40 à 64 ans, et a chuté de 14,6 % et de 20,1 % chez les
65 à 79 ans et chez les 80 ans ou plus, respectivement. Les amputations majeures étaient
en baisse dans tous les groupes d’âge, alors qu’il y a eu une hausse de 26,2 % des
amputations mineures chez les patients de 40 à 64 ans seulement. Le taux de mortalité
à un an standardisé selon l’âge a diminué de 35,1 % (IC à 95 % : -43,4 à -25,7 %)
entre 2006 et 2019, avec un taux de mortalité brut à un an de 11,3 % en 2019.
Conclusions
La réduction des amputations majeures d’un membre inférieur et de la mortalité à un
an est encourageante, mais l’augmentation des amputations mineures d’un membre inférieur,
surtout dans les groupes plus jeunes, souligne l’importance d’améliorer encore davantage
les soins préventifs.
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Article info
Publication history
Published online: November 26, 2022
Accepted:
November 24,
2022
Received:
July 8,
2022
Footnotes
See editorial by Hackam, pages 331-332 of this issue.
See page 329 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Contrasting Trends in Vascular Amputations: Progress or Peril?Canadian Journal of CardiologyVol. 39Issue 3
- PreviewAmputation is a dreaded complication of peripheral artery disease (PAD) and diabetes mellitus. In this issue of the Canadian Journal of Cardiology, O’Connor et al. studied secular trends in the incidence of primary lower-extremity amputations (LEAs) associated with PAD or diabetes in the province of Québec, Canada, between the years 2006 and 2019.1 The investigators used large administrative databases linked together in the Quebec Integrated Chronic Disease Surveillance System to capture episodes of LEA, subclassifying these as major and minor, based on the highest level of amputation.
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