# Global burden of amputation among children and adolescents from 1990 to 2021: systematic analysis of the Global Burden of Disease study 2021

## TL;DR

This study shows a global decline in amputation rates among children and teens from 1990 to 2021, but disparities remain in low-income and conflict-affected regions.

## Contribution

The study provides the first comprehensive global analysis of amputation trends in children and adolescents using GBD data from 1990 to 2021.

## Key findings

- Global age-standardized incidence rates of amputation in children and adolescents decreased from 207.3 to 141.5 per 100,000 between 1990 and 2021.
- High-SDI countries saw the largest declines in amputation burden, while low-SDI and conflict-affected regions experienced increases.
- Males aged 15–19 had the highest incidence of amputation with a relative risk of 1.28 compared to other age groups.

## Abstract

Amputation among children and adolescents, with its substantial physical, psychological, and economic impacts, remains a significant global health issue.

This study uses data from the Global Burden of Disease (GBD) to examine trends in amputation burden among youth aged 0–19 from 1990 to 2021.

This study utilized the 2021 GBD dataset, focusing on the incidence, prevalence, and years lived with disabilities (YLDs) associated with amputations. We applied pinpoint regression and age-period-cohort models to explore trends across the socio-demographic index (SDI) regions, GBD regions, and sex groups from 1990 to 2021, while also forecasting the burden of amputations up to 2040.

We found a global decline in the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate (ASYR) for children and adolescents. Specifically, the ASIR decreased from 207.3 per 100,000 people in 1990 to 141.5 per 100,000 in 2021, while the ASPR declined from 2,119.6 to 1,437.8 per 100,000 people. Over the same period, YLDs dropped from 30.7 per 100,000 to 18.3 per 100,000. High-SDI countries experienced the greatest declines, reflecting improvements in healthcare and rehabilitation services. In contrast, low-SDI regions and conflict-affected countries like Afghanistan and Syria saw increments in the incidence and prevalence rates. The highest incidence was observed among males aged 15–19 years, with a relative risk of 1.28 compared with the other age groups. Projections indicate that although global incidence rates may continue declining until 2040, disparities in high-risk areas will persist without targeted interventions.

This study highlights a global decline in the burden of amputations among children and adolescents but reveals significant disparities based on SDI regions, sex, and age. Targeted public health strategies and resource allocation are, needed to address these inequalities, improve trauma care, and enhance rehabilitation services, especially in high-risk areas.