Racial differences in the incidence of limb loss secondary to peripheral vascular disease: a population-based study

OBJECTIVE: To evaluate racial differences in limb loss caused by peripheral vascular disease in a diverse, statewide population. DESIGN: Retrospective analysis of a cohort of dysvascular amputees. SETTING: Maryland State Hospital Discharge Data from 1986 to 1997. PARTICIPANTS: Persons with a procedure code for lower-limb amputation (ICD9-CM code 84.11-.19) were identified. Patients with limb loss because of trauma, malignancy, or congenital anomalies were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence rates standardized for age, gender, and race; and time trends. RESULTS: There were 27,149 discharges with dysvascular amputations, yielding an average annual rate of 44.3 per 100,000 persons. Incidence rates for dysvascular amputations increased from 41.4 per 100,000 in 1986 to 47.2 per 100,000 in 1997. For all levels of amputation, annual incidence rates among African Americans were considerably higher than those of other persons. African Americans were 2 to 4 times more likely to lose a lower limb than white persons of similar age and gender. CONCLUSIONS: Rising rates of lower-limb amputations in the general population combined with disproportionately higher rates among African Americans are concerning and warrant further investigation into their underlying causes and consequences.