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Between 2001 and 2007–08, the rate of hospitalisations for lower-limb amputations fell.

The rate of hospitalisations for lower-limb amputation among people with diabetes varies significantly between population groups of interest.

Why is this an important indicator for diabetes?

If people do not manage their diabetes well they are at risk from conditions such as neuropathy (nerve damage) and microvascular disease (such as peripheral vascular disease) (AIHW 2008). These conditions can cause foot ulcers. In the most severe cases, these ulcers may lead to the amputation of the affected toes, foot and lower leg.

This indicator shows trends in the rate of hospitalisations for lower-limb amputation among people with diabetes in:

  • the general population
  • people of culturally and linguistically diverse backgrounds, and
  • people living in different geographic areas.

What are the results?

The general population

  • Between 2001 and 2007–08, the rate of hospitalisations for lower-limb amputations declined, especially in males (Figure 1).
  • In 2007-08, males with diabetes were around twice as likely to have hospitalisations for lower-limb amputations as females.

Figure 1: Rate of hospitalisations for lower-limb amputation among people with diabetes, 2001 to 2007–08

Indicators - amputations GIF

Notes

  1. Directly age-standardised to the 2001 ABS NHS diabetes population.\
  2. Gestational diabetes was excluded from the analysis.

Sources: AIHW NHMD; AIHW analysis of ABS NHS 2001, 2004–05 and 2007–08 (reissue).

Other population groups

  • Between 2001 and 2007-08, the rate of hospitalisations for lower-limb amputations among Australian-born people with diabetes remained steady, whereas the rate for overseas-born people with diabetes declined between 2001 and 2004–05, then stabilised (Table 1).
  • In 2007–08, people with diabetes living in outer regional and remote areas had higher rates of hospitalisations for lower-limb amputations than those living in major cities and inner regional areas.
  • There is no clear difference between those living in inner regional areas and those living in major cities between 2001 and 2004–05, but there is a significant difference between 2004–05 and 2007–08.
Table 1: Rates of hospitalisations for lower-limb amputation per 1,000 people with diabetes, 2001 to 2007–08
Population groups 2001 2004–05 2007–08
All people with diabetes 4.8 4.3 4.1
Country of birth
Born in Australia 4.6 4.8 4.6
Born overseas 5.1 3.3 3.1
Geographic areas
Major cities 4.6 4.1 4.1
Inner regional 4.7 4.1 3.2
Outer regional and remote 6.5 5.6 6.1

Notes

  1. Directly age-standardised to the 2001 ABS NHS diabetes population.
  2. Data with missing age have been excluded.

Sources: AIHW NHMD; AIHW analysis of ABS NHS 2001, 2004–05 and 2007–08 (reissue).

What are the data sources?

The main data sources for this indicator are:

  • The National Hospital Morbidity Database (NHMD), and
  • The 2001, 2004–05 and 2007–08 (Reissue) Australian Bureau of Statistics (ABS) National Health Survey (NHS) (ABS cat. no. 4634.0)

How is this indicator calculated?

The data in this indicator are directly age-standardised and presented as the number of hospitalisations for non-traumatic lower-limb amputations per 1,000 persons with diabetes.

In each of these population groups:

  • all people
  • people of culturally and linguistically diverse backgrounds, and
  • people living in different geographic areas.

the rates compare

  • numerator: the number of hospitalisations for non-traumatic lower-limb amputations (from the NHMD), to
  • denominator: the number of people with diabetes (from the NHS)

Are there any data limitations?

  • The NHMD is a compilation of episode level records (or separations) from admitted patient morbidity data collection systems in Australian hospitals. This indicator presents information on separations (or hospitalisations) where there was a diagnosis of diabetes and a lower-limb amputation. These data count separations from hospital where this procedure is performed at least once.
  • The NHS is a survey which relies on self-reporting for health conditions.
  • Country of birth has been used as a proxy for cultural and linguistic diversity. This does not fully represent the complexity of cultural diversity in Australia.
  • Geographical location data are area-based measures, and may not be representative at the individual level.
  • Currently, data are not complete enough to compare socio-economic groups or Indigenous status.

Definitions

A separation is an episode of care for an admitted patient, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute to rehabilitation). Separation also means the process by which an admitted patient completes an episode of care either by being discharged, dying, transferring to another hospital or changing type of care (AIHW 2011).

Hospitalisations refers to the number of hospital separations where a non-traumatic lower-limb amputation is performed. An individual could have more than one lower limb amputation during a hospital separation; however they are only recorded once in this indicator.

Lower-limb amputations
Data were selected from the NHMD with the following codes (Table 1):

Table 1: Diabetes and amputation coding
Code ICD-10-AM codes
Diabetes: principal or additional diagnosis E10, E11, E13, E14, O240, O241, O242, O243, O249
Amputation: procedure 44367-01, 44367-02, 44370-00, 44373-00, 44367-00, 44338-00, 44358-00, 90557-00, 44361-00, 44364-01, 44361-01

Where can I find more information?

AIHW 2011. Australian hospital statistics 2009–10. Health services series no. 40. Cat. no. HSE 107. Canberra: AIHW.

AIHW 2008. Diabetes: Australian facts 2008. Diabetes series no. 8. Cat. no. CVD 40. Canberra: AIHW.

AIHW 2007. National indicators for monitoring diabetes: report of the Diabetes Indicators Review Subcommittee of the National Diabetes Data Working Group. Diabetes series no. 6. Cat. no. CVD 38. Canberra: AIHW.

Abbreviations

ABS
Australian Bureau of Statistics
AIHW
Australian Institute of Health and Welfare
ICD-10-AM
International Classification of Disease Tenth Revision Australian Modification
NHMD
National Hospital Morbidity Database
NHS
National Health Survey