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Currently, about 1.9 million people are living with limb loss in the United States. People lose their limbs for many reasons. Of the 1.9 million, 54 percent lost their limb(s) due to complications related to vascular disease (including diabetes and peripheral arterial disease), 45 percent lost their limb(s) due to a traumatic accident, and less than 2 percent had an amputation due to cancer. Non-whites make up about 42 percent of the limb loss population in the United States. The number of people living with limb loss in the country is expected to double by 2050 due to growing rates of diabetes and vascular disease (1).
Each year, an estimated 185,000 amputations are performed in the United States (2). The leading causes of amputation in adults are vascular disease (including complications related to diabetes and peripheral arterial disease), trauma and cancer. According to the Centers for Disease Control and Prevention, in 2009 there were 68,000 amputations due to complications from diabetes (3).
A total of 4,817 amputations were performed in Michigan hospitals in 2012. This fact sheet discusses the trends and most current incidence of amputation in Michigan.
1. AMPUTATION TRENDS (2001 – 2012)
According to national hospital discharge data, the number of amputations performed in Michigan decreased by 10.8 percent from 2001 to 2007, and then increased by the 10.4 percent between 2007 and 2012 (see Graph 1.1). From 2001 to 2012, the number of amputations performed in the United States increased by 0.1 percent.
A total of 54,375 procedures were performed in Michigan in this time period. This represents 2.4 percent of the 2,294,679 amputation procedures performed in the U.S. from 2001 to 2012.
From 2001 to 2012, a total of 3,709 upper-limb amputations were performed in Michigan (see Graph 1.2). This represents 6.8 percent of all amputation procedures performed in the state during this time period.
From 2001 to 2012, 123,113 upper-limb amputations were performed in the United States. The number of upper-limb amputations performed in the state of Michigan represents 3 percent of this national total.
The number of upper-limb amputations performed in Michigan ultimately increased 3.8 percent in these years. The leading causes of upper limb loss are trauma, cancer, and congenital anomaly (1, 4, 5).
From 2001 to 2012, a total of 50,317 lower-limb amputation procedures were performed in the state of Michigan (see Graph 1.3). This represents 92.5 percent of all amputation procedures performed in the state.
From 2001 to 2012, 1,584,020 lower-limb amputations were performed in the United States. The number of lower-limb amputation procedures performed in Michigan represents 3.2 percent of this national total.
The leading causes of lower-limb amputation are complications resulting from dysvascular diseases such as diabetes, and the number of people who lose a limb due to diabetes is expected to almost triple by the year 2050 (1, 4).
2. INCIDENCE OF AMPUTATION (2012)
A total of 4,817 amputation procedures were performed in the state of Michigan in 2012, including 298 upper-limb amputations (6.2 percent) and 4,483 lower-limb amputations (93.1 percent).
Most upper-limb amputations involved the fingers (78.9 percent). Amputations of the thumb accounted for 11.4 percent, and amputations below the elbow accounted for 6 percent of the upper-limb procedures performed in the state of Michigan in 2012 (see Graph 2.1).
A total of 4,483 lower-limb amputation procedures were performed in 2012. Almost half of these involved the toes (43.1 percent). Blow-knee amputations accounted for 23.2 percent and above-knee counted for 16.6 percent of the lower-limb amputations performed in the state in that year (see Graph 2.2).
3. WHO LOSES A LIMB? (2012)
In 2012, almost half of the amputations in Michigan were performed on individuals aged 45-64 years old (45.9 percent), followed by the age group of 65-84 year olds (37.1 percent) (see Graph 3.1). These trends largely reflect the aging population, and cases of amputations resulting from dysvascular conditions, especially diabetes, which are more common in older individuals (1).
There were over 2 times more amputations performed on male patients in Michigan than on female patients (See Graph 3.2).
In 2012, most of the amputations in the state of Michigan were performed on patients who were White (56.7 percent) or African American (24.1 percent) (see Graph 3.3).
Many studies have published research that shows evidence for inequalities in terms of amputation incidence among minorities when compared to the proportion of amputations in the White population. A few studies offer suggestions for why this happens, such as certain ethnic populations being genetically more likely than others to experience diseases such as diabetes that can lead to amputation. Various socioeconomic factors and a population’s access to healthcare can also affect these numbers. (4, 6, 7)
4. AMPUTATION COSTS
Paying for an amputation can place a large burden on the patient. For people with a unilateral lower-limb amputation, the two-year healthcare costs, including initial hospitalization, inpatient rehabilitation, outpatient physical therapy, and purchase and maintenance of a prosthetic device, is estimated to be $91,106. The lifetime healthcare cost for people with a unilateral lower-limb amputation is estimated to be more than $500,000 (8).
Many factors contribute to the variation in healthcare costs for people with limb loss. Having a higher amputation level and multiple amputations can lead to increased costs for prosthetic devices. For example, the two-year healthcare costs for a person with an above-knee amputation are estimated to be $110,039, compared to $86,244 for a person with a below-knee amputation (8).
For 2012, the burden of costs associated with limb loss were largely experienced by Medicare, which paid for over half of the amputation procedures performed in the State of Michigan (see Graph 4.1).
1. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation2008;89(3):422-9.
2. Owings MF. Ambulatory Procedures in the US 1996. National Center for Health Statistics Vital Health Stat1998;13(139).
3. NCfHS CfDCaP. Number (in Thousands) of Hospital Discharges for Nontraumatic Lower Extremity Amputation with Diabetes as a Listed Diagnosis, United States, 1988–2009. 2012.
4. Dillingham TR. Limb amputation and limb deficiency: Epidemiology and recent trends in the United States. Southern Medical Journal2002;95(8):875-83.
5. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, Anderson P, Mason CA, Collins JS, Kirby RS, Correa A. Updated national birth prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Research Part A: Clinical and Molecular Teratology2010;88(12):1008-16.
6. Fisher ES. Disparities in health and health care among medicare beneficiaries. Dartmouth Atlas Project Report Commissioned for the Aligning Forces for Quality Program2008.
7. Lefebvre K. Disparities in amputations in minorities. Clinical Orthopaedics and Related Research2011;469(7):1941-50.
8. MacKenzie EJ. Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury. The Journal of Bone and Joint Surgery (American)2007;89(8):1685.
It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care.
National Limb Loss Resource Center, a program of the Amputee Coalition, located at 900 East Hill Ave., Suite 390, Knoxville, TN 37915 | 888/267-5669
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