Original article
Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050

https://doi.org/10.1016/j.apmr.2007.11.005Get rights and content

Abstract

Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050.

Objective

To estimate the current prevalence of limb loss in the United States and project the future prevalence to the year 2050.

Design

Estimates were constructed using age-, sex-, and race-specific incidence rates for amputation combined with age-, sex-, and race-specific assumptions about mortality. Incidence rates were derived from the 1988 to 1999 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, corrected for the likelihood of reamputation among those undergoing amputation for vascular disease. Incidence rates were assumed to remain constant over time and applied to historic mortality and population data along with the best available estimates of relative risk, future mortality, and future population projections. To investigate the sensitivity of our projections to increasing or decreasing incidence, we developed alternative sets of estimates of limb loss related to dysvascular conditions based on assumptions of a 10% or 25% increase or decrease in incidence of amputations for these conditions.

Setting

Community, nonfederal, short-term hospitals in the United States.

Participants

Persons who were discharged from a hospital with a procedure code for upper-limb or lower-limb amputation or diagnosis code of traumatic amputation.

Interventions

Not applicable.

Main Outcome Measures

Prevalence of limb loss by age, sex, race, etiology, and level in 2005 and projections to the year 2050.

Results

In the year 2005, 1.6 million persons were living with the loss of a limb. Of these subjects, 42% were nonwhite and 38% had an amputation secondary to dysvascular disease with a comorbid diagnosis of diabetes mellitus. It is projected that the number of people living with the loss of a limb will more than double by the year 2050 to 3.6 million. If incidence rates secondary to dysvascular disease can be reduced by 10%, this number would be lowered by 225,000.

Conclusions

One in 190 Americans is currently living with the loss of a limb. Unchecked, this number may double by the year 2050.

Section snippets

Overview

Our methodology is based on a multistate probabilistic model in which persons may move from a state without limb loss to the limb-loss state.27 Persons are at risk of death in each state. The model is illustrated schematically in figure 1. The input parameters to the model are the transition probabilities, which are the probabilities of moving from 1 state to the other. As described below, these transition probabilities are allowed to depend on age and calendar year. The model calculations are

2005 Estimates

An estimated 1.6 million persons were living with the loss of a limb in the year 2005. Table 1 illustrates how prevalence varies by etiology of the limb loss, age, sex, and race. Amputations secondary to dysvascular disease (n=846,000) account for most (54%) cases and of these, over two thirds have a comorbid diagnosis of diabetes (n=592,000). Limb loss secondary to trauma accounts for an additional 45% of the prevalent cases (n=704,000) and cancer for the remaining less than 2% (n=18,000).

Discussion

To our knowledge, this is the first study since 1996 to provide comprehensive estimates of the prevalence of limb loss in the U.S. population. The NHIS estimated 1.2 million cases of limb loss for 1996.26 Our result of 1.6 million in 2005 appears to be consistent with these results. The NHIS consisted of 40,000 households and includes cases of congenital limb loss and those treated on an outpatient basis, but it excludes persons who are institutionalized and those with amputations of only

Conclusions

This study estimated the prevalence of limb loss in the United States and projected these numbers into the future. As additional, more precise estimates of the incidence and mortality consequences of amputation become available, it will be possible to refine the magnitude of our estimates. Regardless of some uncertainty associated with the absolute size of our estimates, it is clear that the number of people living with the loss of a limb will continue to increase, driven in particular by the

Acknowledgment

The views expressed in this study are those of the authors. No official endorsement by the U.S. Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services is intended or should be inferred.

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    Supported by the U.S. Centers for Disease Control and Prevention (grant no. R04/CCU322981-02).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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