# Epidemiology of Lower Extremity Amputations in the United States: An Analysis of the Global Burden of Disease Database From 1990 to 2019

## TL;DR

This study analyzed trends in lower limb amputations in the US from 1990 to 2019, finding regional and gender disparities in incidence and disability.

## Contribution

The study provides a detailed, region- and sex-specific analysis of lower extremity amputation trends in the US using the Global Burden of Disease database.

## Key findings

- The US saw a decrease in YLDs, prevalence, and incidence of bilateral LEAs from 1990 to 2019.
- Men had higher rates of LEAs than women across all regions.
- The West had the highest incidence and prevalence of LEAs, while the South had the lowest by 2019.

## Abstract

Background: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

Methods: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

Results: From 1990 to 2019, the US experienced an overall decrease in YLDs (33.07%), incidence (22.11%), and prevalence (29.93%) of bilateral LEAs. Unilateral LEAs saw a decrease in YLDs (21.43%) and prevalence (15.61%), but an increase in incidence (9.05%). Men surpassed women in YLDs, incidence, and prevalence of unilateral and bilateral LEAs in all regions. The West had the highest incidence and prevalence of both bilateral and unilateral LEAs from 1990 to 2019. By 2019, the South had the lowest incidence, and the Northeast had the lowest YLDs and prevalence of bilateral and unilateral LEAs.

Conclusions: From 1990 to 2019, the US experienced decreases in YLDs, prevalence, and incidence of unilateral and bilateral LEAs, except for an increased incidence of unilateral LEAs. Men experienced higher rates than women across each region. The West generally had the highest overall rates. These trends highlight sex-specific and regional disparities of LEAs.