Epidemiology of Nontraumatic Lower-Extremity Amputation in Area 7, Madrid, Between 1989 and 1999

Diabetes remains the main cause of lower-extremity amputations (LEAs) (1,2,3). Recently (3), the number of LEAs carried out worldwide has been estimated to be >162 × 106 each year, with a high economic and social cost. More than 50% of these LEAs are performed in subjects with diabetes. Differences in the incidence of LEAs could reflect variations in risk factors, diabetes prevalence, health care systems, and lifestyle, as well as differences in population age-structure, the sources from which the case was identified, the levels of ascertainment, and the definitions of LEAs and the distinctions between major and minor LEAs. Recently, a standard approach to data collection has been described (4,5), and the first article (3) about the epidemiology of LEAs in several countries has been published. In this study, area 7 from Madrid presents the lowest LEA rates. The purpose of this article is to compare the incidence of LEAs in diabetic and nondiabetic subjects—in relation to the provision of improved foot-care after the St. Vincent Declaration—by use of a standardized approach, in the area 7 of Madrid between 1989 and 1993, between 1994 and 1996, and between 1997 and 1999. The National Health Service has divided Madrid into 13 health care areas. The public health care system is serving >99% of the total population from the area 7 and is provided by a single hospital (Hospital Clinico San Carlos) with a single specialized service for vascular patients. According to the census in 1991, the total population for the catchment area was 569,307 (261,529 men and 307,778 women). The population with diabetes was calculated according to the Lejona study (6). In this study, the prevalence of diabetes was estimated by a randomized sample stratified by 5-year age-groups and sex. The data of this …