Incidence of lower-extremity amputation in American Indians: The Strong Heart Study

Helaine E. Resnick, Elizabeth A. Carter, Jay M Sosenko, Susan J. Henly, Richard R. Fabsitz, Frederick K. Ness, Thomas K. Welty, Elisa T. Lee, Barbara V. Howard

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

OBJECTIVE - To define incidence and predictors of nontraumatic lower-extremity amputation (LEA) in a diverse cohort of American Indians with diabetes. RESEARCH DESIGN AND METHODS - The Strong Heart Study is a study of cardiovascular disease and its risk factors in 13 American-Indian communities. Data on the presence/absence of amputations were collected at each of three serial examinations (1989-1992, 1993-1995, and 1997-1999) by direct examination of the lower extremity. The logistic regression model was used to quantify the relationship between risk of LEA and potential risk factors, including diabetes duration, HbA1c, peripheral arterial disease, and renal function. RESULTS - Of the 1,974 individuals with diabetes and without prevalent LEA at baseline, 87 (4.4%) experienced an LEA during 8 years of follow-up, and a total of 157 anatomical sites were amputated among these individuals. Amputation of toes was most common, followed by below-the-knee and above-the-knee amputations. Age-adjusted odds of LEA were higher among individuals with unfavorable combinations of risk factors, such as albuminuria and elevated HbA1c. Multivariable modeling indicated that male sex, renal dysfunction, high ankle-brachial index, longer duration of diabetes, less than a high school education, increasing systolic blood pressure, and HbA1c predicted LEA risk. CONCLUSIONS - The 8-year cumulative incidence of LEA in American Indians with diabetes is 4.4%, with marked differences in risk by sex, educational attainment, renal function, and glycemic control.

Original languageEnglish
Pages (from-to)1885-1891
Number of pages7
JournalDiabetes Care
Volume27
Issue number8
DOIs
StatePublished - Aug 1 2004

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North American Indians
Amputation
Lower Extremity
Incidence
Kidney
Knee
Logistic Models
Blood Pressure
Ankle Brachial Index
Albuminuria
Peripheral Arterial Disease
Toes
Research Design
Cardiovascular Diseases
Education

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Resnick, H. E., Carter, E. A., Sosenko, J. M., Henly, S. J., Fabsitz, R. R., Ness, F. K., ... Howard, B. V. (2004). Incidence of lower-extremity amputation in American Indians: The Strong Heart Study. Diabetes Care, 27(8), 1885-1891. https://doi.org/10.2337/diacare.27.8.1885

Incidence of lower-extremity amputation in American Indians : The Strong Heart Study. / Resnick, Helaine E.; Carter, Elizabeth A.; Sosenko, Jay M; Henly, Susan J.; Fabsitz, Richard R.; Ness, Frederick K.; Welty, Thomas K.; Lee, Elisa T.; Howard, Barbara V.

In: Diabetes Care, Vol. 27, No. 8, 01.08.2004, p. 1885-1891.

Research output: Contribution to journalArticle

Resnick, HE, Carter, EA, Sosenko, JM, Henly, SJ, Fabsitz, RR, Ness, FK, Welty, TK, Lee, ET & Howard, BV 2004, 'Incidence of lower-extremity amputation in American Indians: The Strong Heart Study', Diabetes Care, vol. 27, no. 8, pp. 1885-1891. https://doi.org/10.2337/diacare.27.8.1885
Resnick, Helaine E. ; Carter, Elizabeth A. ; Sosenko, Jay M ; Henly, Susan J. ; Fabsitz, Richard R. ; Ness, Frederick K. ; Welty, Thomas K. ; Lee, Elisa T. ; Howard, Barbara V. / Incidence of lower-extremity amputation in American Indians : The Strong Heart Study. In: Diabetes Care. 2004 ; Vol. 27, No. 8. pp. 1885-1891.
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