VARIATION IN THE INCIDENCE AND PROPORTION AT DIABETES-RELATED AMPUTATIONS IN MINORITIES

OBJECTIVE - To identify the age-adjusted and level-specific incidence of amputations associated with diabetes in Hispanics, African-American s, and non-Hispanic whites. RESEARCH DESIGN AND METHODS - We used a da tabase from the Office of State-wide Planning and Development in Calif ornia that identified all hospitalizations for lower-extremity amputat ions in the state in 1991. Amputation level was defined by ICD-9-CM co des 84.11-84.18 and were categorized as toe, foot, leg, and thigh ampu tations. RESULTS - The age-adjusted incidence of diabetes-related ampu tation per 10,000 persons with diabetes in 1998 was 95.25 in African-A mericans, 55.98 in non-Hispanic whites, and 44.43 in Hispanics. Hispan ics had a higher proportion of amputations (82.7%) associated with dia betes than did African-Americans (61.6%) or non-Hispanic whites (56.8% ) (P < 0.001). African-Americans had the highest age adjusted incidenc e rate for each level in people with and without diabetes. African-Ame ricans underwent more proximal amputations compared with non-Hispanic whites and Hispanics (P < 0.001). Diabetes-related amputations were 1. 72 and 2.17 times more likely in African-Americans compared with non-H ispanic whites and Hispanics, respectively. CONCLUSIONS - Hispanics ha d proportionally more amputations associated with diabetes than did Af rican-Americans or non-Hispanic whites. A significant excess incidence of both diabetes- and non-diabetes-related amputations and proportion ally more proximal amputations were identified in African-Americans co mpared with Hispanics and non-Hispanic whites. A possible explanation could be the higher prevalence of peripheral vascular disease in Afric an-Americans. Public health initiatives, which have been demonstrated to reduce the incidence of diabetes-related lower-extremity amputation s, should be implemented, and additional work should focus on minority groups.