OBJECTIVE To assess trends in rates of hospitalization for nontraumatic lower-extremity amputation (NLEA) in U.S. diabetic and nondiabetic populations and disparities in NLEA rates within the diabetic population.

RESEARCH DESIGN AND METHODS We calculated NLEA hospitalization rates, by diabetes status, among persons aged ≥40 years on the basis of National Hospital Discharge Survey data on NLEA procedures and National Health Interview Survey data on diabetes prevalence. We used joinpoint regression to calculate the annual percentage change (APC) and to assess trends in rates from 1988 to 2008.

RESULTS The age-adjusted NLEA discharge rate per 1,000 persons among those diagnosed with diabetes and aged ≥40 years decreased from 11.2 in 1996 to 3.9 in 2008 (APC −8.6%; P < 0.01), while rates among persons without diagnosed diabetes changed little. NLEA rates in the diabetic population decreased significantly from 1996 to 2008 in all demographic groups examined (all P < 0.05). Throughout the entire study period, rates of diabetes-related NLEA were higher among persons aged ≥75 years than among those who were younger, higher among men than women, and higher among blacks than whites.

CONCLUSIONS From 1996 to 2008, NLEA discharge rates declined significantly in the U.S. diabetic population. Nevertheless, NLEA continues to be substantially higher in the diabetic population than in the nondiabetic population and disproportionately affects people aged ≥75 years, blacks, and men. Continued efforts are needed to decrease the prevalence of NLEA risk factors and to improve foot care among certain subgroups within the U.S. diabetic population that are at higher risk.

Diabetes is a leading cause of nontraumatic lower-extremity amputations (NLEAs). Rates of NLEAs serve as an important gauge of the effectiveness of efforts to reduce diabetes complications because they are associated with numerous modifiable risk factors, including high blood pressure, high lipid and glycemic levels, and screening and care for high-risk feet. Evidence suggests that effective risk factor management, patient education, and appropriate foot care can prevent the majority of NLEAs (1,2). In the last few decades, preventive care and the control of cardiovascular risk factors and glycemic levels have all improved significantly among U.S adults with diabetes (3,4). Accompanying these improvements have been reductions in rates of diabetes-related complications (5,6) and cardiovascular disease (6).

Although results of several recent studies (6–9) have shown encouraging trends in rates of NLEA in various populations and evidence of subgroup disparities among people with diabetes, no comprehensive studies have examined trends in NLEA rates or characteristics associated with diabetes-related NLEAs in the overall U.S. population. In this study, we used data from two nationally representative surveys to assess trends in NLEA hospital discharge rates by patients’ diabetes status and to determine whether disparities in NLEA rates within the diabetic population persist.