Population-level incidence and temporal trends of first lower limb amputations among people with diabetes in the Western Cape, South Africa, using routine health record data (2008-2023)
1
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
2
Division of Endocrinology, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Despite the growing burden of diabetes in Africa(1,2), population-level data on diabetes-related lower limb amputation remain scarce(3–8). We aimed to describe the incidence and temporal trends of first lower limb amputations among people with diabetes in the Western Cape, South Africa, using linked routinely collected electronic health record data.
METHODS:
A retrospective population-level analysis was conducted. Individuals with an inferred diabetes diagnosis between 2008 and 2023 were included. First lower limb amputations were identified using ICD-9 procedural codes and classified as major or minor. Descriptive analyses examined temporal trends in diabetes diagnoses, first amputations, and in-hospital mortality, stratified by sex and age group. Annual population-based incidence of first lower limb amputation per 100,000 people with diabetes were estimated. Ethical approval was obtained (UCT HREC 098/2022).
RESULTS:
The final analysis cohort included 466,478 individuals with diabetes, including 7,012 with a first lower limb amputation, and 73,616 in-hospital deaths. Major amputations accounted for ~60% of first amputations. Annual amputation incidence was highest among individuals aged 40-59 and 60-79 years and in males across the study period. >60% of amputations occurred within five years of the participants’ first recorded diabetes evidence, consistent with delayed detection or advanced disease at clinical recognition. Among 7,012 participants who experienced a first amputation, ~41% died in hospital at a time point after the amputation, ~49% of which were in the first year post-first-amputation.
CONCLUSIONS:
To our awareness, we provide the first population-level estimates of first lower limb amputation incidence among people with diabetes in the Western Cape public sector. Our findings highlight a substantial burden of diabetes-related morbidity and mortality, particularly among adult men of working age. Our study underscores the need for preventative diabetes footcare pathways and emphasises the value of linked routine health data for monitoring severe outcomes and informing routine diabetes care.
Despite the growing burden of diabetes in Africa(1,2), population-level data on diabetes-related lower limb amputation remain scarce(3–8). We aimed to describe the incidence and temporal trends of first lower limb amputations among people with diabetes in the Western Cape, South Africa, using linked routinely collected electronic health record data.
METHODS:
A retrospective population-level analysis was conducted. Individuals with an inferred diabetes diagnosis between 2008 and 2023 were included. First lower limb amputations were identified using ICD-9 procedural codes and classified as major or minor. Descriptive analyses examined temporal trends in diabetes diagnoses, first amputations, and in-hospital mortality, stratified by sex and age group. Annual population-based incidence of first lower limb amputation per 100,000 people with diabetes were estimated. Ethical approval was obtained (UCT HREC 098/2022).
RESULTS:
The final analysis cohort included 466,478 individuals with diabetes, including 7,012 with a first lower limb amputation, and 73,616 in-hospital deaths. Major amputations accounted for ~60% of first amputations. Annual amputation incidence was highest among individuals aged 40-59 and 60-79 years and in males across the study period. >60% of amputations occurred within five years of the participants’ first recorded diabetes evidence, consistent with delayed detection or advanced disease at clinical recognition. Among 7,012 participants who experienced a first amputation, ~41% died in hospital at a time point after the amputation, ~49% of which were in the first year post-first-amputation.
CONCLUSIONS:
To our awareness, we provide the first population-level estimates of first lower limb amputation incidence among people with diabetes in the Western Cape public sector. Our findings highlight a substantial burden of diabetes-related morbidity and mortality, particularly among adult men of working age. Our study underscores the need for preventative diabetes footcare pathways and emphasises the value of linked routine health data for monitoring severe outcomes and informing routine diabetes care.
| eISSN: | 2654-1459 |
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