Estimating the prevalence of limb loss in the United States: 2005 to 2050

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Ziegler-Graham, Kathryn¹; MacKenzie, Ellen J.²; Ephraim, Patti L.²; Travison, Thomas G.³; Brookmeyer, Ron⁴

Estimating the prevalence of limb loss in the United States: 2005 to 2050

Arch Phys Med Rehabil. March 2008;89(3):422-429

©2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Affiliations

¹Department of Mathematics, Statistics and Computer Science, St. Olaf College, Northfield, MN

²Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

³New England Research Institutes, Waltham, MA

⁴Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Abstract

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.
Links

DOI: 10.1016/j.apmr.2007.11.005

PubMed: 18295618

WoS: 000253958100006
Cited Works (1)

Year Entry

2002 Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. October 9, 2002;288(14):1723-1727.

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2016	Pickle NT. Dynamic Balance and Muscle Function in Individuals With and Without Unilateral Transtibial Amputation During Sloped Walking [PhD thesis]. Colorado School of Mines; 2016.
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2015	Noble GJ. Evaluation of a Press Fit, Percutaneous, Skeletally Anchored Endoprosthesis for Prosthetic Limb Attachment: Bone Response and the Effect of Low Intensity Vibration [PhD thesis]. The Ohio State University; 2015.
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2018	Low S. Effect of Foot Shells on Mechanical Properties of Prosthetic Foot Systems [Master's thesis]. Queen's University; February 2018.
2018	Tsimiklis AF. Effect of Sagittal Foot Alignment on Centre of Pressure Progression Velocity in Transtibial Prosthesis Users [Master's thesis]. Queen's University; April 2018.
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2018	Kolbeinsdóttir R. Shank Kinematics and Kinetics in Prosthetic Gait: Implications for Improved Design of Prosthetic Systems [Master's thesis]. University of Delaware; 2018.
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2022	Nolasco LA. Biomechanical Adaptations to Lower Limb Amputation During Functional Mobility Tasks [PhD thesis]. University of Michigan; 2022.
2023	Gonzalez MA. Closing the Loop: How Sensation Impacts Prosthetic Function and Control [PhD thesis]. University of Michigan; 2023.
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