OUTCOMES ASSOCIATED WITH DIABETES-RELATED AMPUTATIONS IN THE NETHERLANDS AND IN THE STATE OF CALIFORNIA, USA

Objective. The purpose of this study is to compare the incidence, rela tive risk, in-hospital mortality and hospital stay of diabetes-related lower extremity amputations in the state of California and the Nether lands in the year 1991. Research design and methods. We used establish ed data obtained from the Office of Statewide Planning and Development for the state of California and from SIG Health Care Information in t he Netherlands to identify all hospitalisations for lower extremity am putations, We used age- and sex-specific prevalence rates of diabetes mellitus from the National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey for the state of California and rates from the Central Bureau of Statistics for the Ne therlands. A direct standardisation technique with the 1991 Netherland s population as the standard population was used to calculate age-adju sted incidence rates, Age was categorised into four different groups; 25-44, 45-64, 65-74 and 75+. Amputations were defined by four levels; toe, foot, leg and thigh. Results. The age-adjusted incidence of diabe tes-related lower extremity amputations was significantly higher in th e state of California than in the Netherlands (49.9 vs, 36.1 per 10000 diabetics, P <0.01). The relative risk, comparing the risk in the dia betic with that in the non-diabetic population, was California 23.7 vs . the Netherlands 19.7. The length of hospital stay was significantly higher in the Netherlands: 40.8 vs, 16.0 (P <0.01). Conclusions. There are some significant differences in the outcomes associated with diab etes-related lower extremity amputations, Some of these differences ma y be explained by differences in access to health care.