{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T03:28:00Z","timestamp":1773890880646,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["21K17227"],"award-info":[{"award-number":["21K17227"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>COVID\u201019 has been linked to increased vascular complications, but its long\u2010term impact on amputation rates is unclear. This study evaluated amputation risk post\u2010COVID\u201019 using a nationwide insurance claims database in Japan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study using data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. COVID\u201019 cases were identified via insurance payment waivers, and amputations were defined by procedure codes. Propensity score matching created balanced cohorts of COVID\u201019 exposed and unexposed individuals. Matched cohorts were compared for amputation incidence, calculating incidence rate ratios (IRRs), and differences (IRDs). Sensitivity analyses examined outcomes at different time points, and subgroup analyses stratified results by key characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included 3,098,948 matched pairs. Over a median follow\u2010up of 7\u2009months, 286 amputations occurred in the COVID\u201019 group vs 123 in controls (IRR 2.33, 95% CI 1.88\u20132.90; IRD 5.57 per 1,000,000 person\u2010months, 95% CI 4.22\u20136.92). The elevated risk persisted beyond 2\u2009years post infection (IRR 2.03, 95% CI 1.31\u20133.20). Subgroup analyses showed higher risks in individuals with higher comorbidity burden (Charlson Comorbidity Index [CCI] \u22652; IRR 2.45 95% CI 1.92, 2.79) vs lower comorbidity burden (CCI 0\u20131; IRR 0.71 95%CI 0.29, 1.71) with significant interaction (<jats:italic>P<\/jats:italic>\u2009=\u20090.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Amputation rates increased among COVID\u201019 survivors, persisting for over 2\u2009years post infection. The interaction between COVID\u201019 and comorbidity burden highlights the need for vigilant long\u2010term monitoring and management of vascular complications in COVID\u201019 survivors, particularly those with multiple comorbidities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdi.70078","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T03:05:24Z","timestamp":1747969524000},"page":"1551-1560","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Elevated amputation rates in <scp>COVID<\/scp>\u201019 survivors: Insights from a large\u2010scale Japanese cohort study"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1352-3738","authenticated-orcid":false,"given":"Daisuke","family":"Miyamori","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhei","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12684"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-070230","article-title":"Development and validation of the symptom burden questionnaire for long covid (SBQ\u2010LC): Rasch analysis","volume":"377","author":"Hughes SE","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141-022-00352-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1009705"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.686029"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcab054"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.13130"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.07.074"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv114"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13727"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2019.12.006"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/diseases12040074"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.07.222"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60828-3"},{"key":"e_1_2_9_18_1","unstructured":"Mnistry of Health Lavour and Wellfar.Resonse to COVID\u201019 after the classification change. 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