{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T01:31:47Z","timestamp":1790904707376,"version":"4.1.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR\n                      <jats:sub>2015<\/jats:sub>\n                      \u2009=\u20092.0 [CI95%\u2009=\u20091.5, 2.6]) and in Madrid (IR\n                      <jats:sub>2015<\/jats:sub>\n                      \u2009=\u20090.1 [CI95%\u2009=\u20090.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95%\u2009=\u20091.4; 2.1),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] and La Rioja the lowest risk (0.5 [CI95%\u2009=\u20090.2; 0.9];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026). The longest hospital stay was registered in the Canary Islands [(CI95%\u2009=\u200911.4;13.3],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001)], and the shortest in the Valencian Community [(CI95%\u2009=\u2009\u2212\u20097.3; \u2212\u20095.8), p\u2009&lt;\u20090.001)].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-019-8137-7","type":"journal-article","created":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T13:02:39Z","timestamp":1579006959000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Major amputations in type 2 diabetes between 2001 and 2015 in Spain: regional differences"],"prefix":"10.1186","volume":"20","author":[{"given":"Mar\u00eda del Cristo","family":"Rodr\u00edguez P\u00e9rez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Chines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo J.","family":"Pedrero Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djeniffer","family":"Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Cuevas Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itahisa","family":"Marcelino-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Dom\u00ednguez Coello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4745-3405","authenticated-orcid":false,"given":"Antonio","family":"Cabrera de Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,14]]},"reference":[{"key":"8137_CR1","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1111\/j.1464-5491.2011.03279.x","volume":"28","author":"PW Moxey","year":"2011","unstructured":"Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower extremity amputations: a review of global variability in incidence. Diabet Med. 2011;28:1144\u201353.","journal-title":"Diabet Med"},{"key":"8137_CR2","doi-asserted-by":"publisher","first-page":"475","DOI":"10.2147\/CLEP.S146484","volume":"10","author":"H Claessen","year":"2018","unstructured":"Claessen H, Narres M, Haastert B, Arend W, Hoffman H, Morbach S, et al. Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012- an analysis of more than 30 million inhabitants. Clin Epidemiol. 2018;10:475\u201388.","journal-title":"Clin Epidemiol"},{"key":"8137_CR3","doi-asserted-by":"publisher","first-page":"e000795","DOI":"10.1136\/bmjdrc-2019-000795","volume":"7","author":"CW Lin","year":"2019","unstructured":"Lin CW, Armstrong DG, Lin CH, Liu PH, Hung SY, Lee SR, Huang CH, Huang YY. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care. 2019;7:e000795.","journal-title":"BMJ Open Diabetes Res Care"},{"key":"8137_CR4","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1097\/MLR.0000000000000309","volume":"53","author":"AP Yashkin","year":"2015","unstructured":"Yashkin AP, Picone G, Sloan F. Causes of the Change in the Rates of Mortality and Severe Complications of Diabetes Mellitus: 1992\u20132012. Med Care. 2015;53:268\u201375.","journal-title":"Med Care"},{"key":"8137_CR5","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1186\/s12874-016-0265-5","volume":"16","author":"A Lopez-de-Andres","year":"2016","unstructured":"Lopez-de-Andres A, Hernandez-Barrera V, Lopez R, Martin-Junco P, Jimenez-Trujillo I, Alvarez-Mecca A, et al. Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks. BMC Med Res Methodol. 2016;16:160.","journal-title":"BMC Med Res Methodol"},{"key":"8137_CR6","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-de-Andr\u00e9s A, Jim\u00e9nez-Garc\u00eda R, Esteban-Vasallo MD, Hern\u00e1ndez-Barrera V, Aragon-S\u00e1nchez J, Jim\u00e9nez-Trujillo I, de Miguel-Diez J, Palomar-Gallego MA, Romero-Maroto M, Perez-Farinos N. Time Trends in the Incidence of Long-Term Mortality in T2DM Patients Who Have Undergone a Lower Extremity Amputation. Results of a Descriptive and Retrospective Cohort Study. J Clin Med. 2019; 8. pii: E1597.","DOI":"10.3390\/jcm8101597"},{"key":"8137_CR7","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.diabres.2015.01.010","volume":"108","author":"A L\u00f3pez-de Andr\u00e9s","year":"2015","unstructured":"L\u00f3pez-de Andr\u00e9s A, Jim\u00e9nez-Garc\u00eda R, Arag\u00f3n-S\u00e1nchez J. National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001\u20132012. Diab Res Clin Pract. 2015;108:499\u2013507.","journal-title":"Diab Res Clin Pract"},{"key":"8137_CR8","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.avdiab.2013.07.007","volume":"29","author":"C Crespo","year":"2013","unstructured":"Crespo C, Brosa M, Soria-Juanc A, Lopez-Alba A, Lopez-Martinez N, Soria B. Direct costs of diabetes mellitus and its complications in Spain (SECCAID study: Spain estimated cost Ciberdem-Cabimer in diabetes). Av Diabetol. 2013;29:182\u20139.","journal-title":"Av Diabetol"},{"key":"8137_CR9","unstructured":"Carlos III Health Institute (Spanish Government). National Center of Epidemiology, http:\/\/raziel.cne.isciii.es\/maps\/fMap.php ; 2019 []."},{"key":"8137_CR10","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1111\/j.1464-5491.2011.03420.x","volume":"29","author":"AC de Leon","year":"2012","unstructured":"de Leon AC, Coello SD, Gonz\u00e1lez DA, Diaz BB, Castillo JC, Hern\u00e1ndez AG, et al. Impaired fasting glucose, ancestry and waist-to-height ratio: main predictors of diabetes in the Canary Islands. Diabet Med. 2012;29:399\u2013403.","journal-title":"Diabet Med"},{"key":"8137_CR11","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.recesp.2010.11.005","volume":"64","author":"M Grau","year":"2011","unstructured":"Grau M, Elosua R, Cabrera de Le\u00f3n A, Guembe MJ, Baena-D\u00edez JM, Vega Alonso T, et al. Cardiovascular Risk Factors in Spain in the First Decade of the 21st Century, a Pooled Analysis with Individual Data from 11 Population-Based Studies: the DARIOS Study. Rev Esp Cardiol. 2011;64:295\u2013304.","journal-title":"Rev Esp Cardiol"},{"key":"8137_CR12","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.diabres.2015.10.024","volume":"111","author":"I Marcelino","year":"2016","unstructured":"Marcelino I, Elosua R, Perez Mdel C, Fernandez-Berges D, Guembe MJ, Alonso TV, et al. On the problem of diabetes mortality in the Canary Islands, Spain. The DARIOS study. Diabetes Res Clin Pract. 2016;111:74\u201382.","journal-title":"Diabetes Res Clin Pract"},{"key":"8137_CR13","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1016\/j.diabres.2009.06.015","volume":"86","author":"J Arag\u00f3n-S\u00e1nchez","year":"2009","unstructured":"Arag\u00f3n-S\u00e1nchez J, Garc\u00eda-Rojas A, L\u00e1zaro-Mart\u00ednez JL, Quintana-Marrero Y, Maynar-Moliner M, Rabellino M, et al. Epidemiology of diabetes-related lower extremity amputations in gran Canaria, Canary Islands (Spain). Diabetes Res Clin Pract. 2009;86:e6\u20138.","journal-title":"Diabetes Res Clin Pract"},{"key":"8137_CR14","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1186\/1471-2458-14-1059","volume":"14","author":"E Alonso-Mor\u00e1n","year":"2014","unstructured":"Alonso-Mor\u00e1n E, Orueta JF, Fraile Esteban JI, Arteagoitia Axpe JM, Marqu\u00e9s Gonz\u00e1lez ML, Toro Polanco N, Ezkurra Loiola P, Gaztambide S, Nu\u00f1o-Solinis R. The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country. BMC Public Health. 2014;14:1059.","journal-title":"BMC Public Health"},{"key":"8137_CR15","unstructured":"Spanish National Institute of Statistics, http:\/\/www.ine.es\/jaxiT3\/Tabla.htm?t=9681&L=1 [accessed December 2, 2019]."},{"key":"8137_CR16","doi-asserted-by":"publisher","first-page":"e86405","DOI":"10.1371\/journal.pone.0086405","volume":"9","author":"FL Lombardo","year":"2014","unstructured":"Lombardo FL, Maggini M, De Bellis A. Lower extremity amputations in persons with and without diabetes in Italy: 2001-2010. PLoS One. 2014;9:e86405.","journal-title":"PLoS One"},{"key":"8137_CR17","doi-asserted-by":"publisher","first-page":"2588","DOI":"10.2337\/dc12-0511","volume":"35","author":"B Kennon","year":"2012","unstructured":"Kennon B, Leese G, Cochrane L, et al. Reduced incidence of lower extremity amputations in people with diabetes in Scotland. Diabetes Care. 2012;35:2588\u201390.","journal-title":"Diabetes Care"},{"key":"8137_CR18","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1007\/s00125-018-4655-6","volume":"61","author":"H Claessen","year":"2018","unstructured":"Claessen H, Avalosse H, Guillaume J, Narres M, Kvitkina T, Arend W, et al. Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium. Diabetologia. 2018;61:1966\u201377.","journal-title":"Diabetologia"},{"key":"8137_CR19","first-page":"170","volume":"27","author":"D Alcal\u00e1 Mart\u00ednez-G\u00f3mez","year":"2014","unstructured":"Alcal\u00e1 Mart\u00ednez-G\u00f3mez D, Moreno-Carrillo MA, Campillo-Soto A. Reduction in diabetic amputations over 15 years in a defined Spain population. Benefits of a critical pathway approach and multidisciplinary team work. Rev Esp Quimioter. 2014;27:170\u20139.","journal-title":"Rev Esp Quimioter"},{"key":"8137_CR20","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s00125-012-2588-z","volume":"55","author":"NC Schaper","year":"2012","unstructured":"Schaper NC. Apelqvist J, Bakker K (2012). Reducing lower leg amputations in diabetes: a challenge for patients, healthcare providers and the healthcare system. Diabetologia. 2012;55:1869\u201372.","journal-title":"Diabetologia"},{"key":"8137_CR21","unstructured":"Spanish National Health Survey of 2017, https:\/\/www.mscbs.gob.es\/en\/estadEstudios\/estadisticas\/encuestaNacional\/encuesta2017.htm. ; 2019 [accessed 2 December 2019]."},{"key":"8137_CR22","doi-asserted-by":"publisher","first-page":"19178","DOI":"10.3402\/dfa.v3i0.19178","volume":"3","author":"JJ Anderson","year":"2012","unstructured":"Anderson JJ, Boone J, Hansen M, Spencer L, Fowler Z. A comparison of diabetic smokers and non-smokers who undergo lower extremity amputation: a retrospective review of 112 patients. Diabetic Foot Ankle. 2012;3:19178.","journal-title":"Diabetic Foot Ankle"},{"key":"8137_CR23","doi-asserted-by":"publisher","first-page":"e0182081","DOI":"10.1371\/journal.pone.0182081","volume":"12","author":"M Narres","year":"2017","unstructured":"Narres M, Kvitkina T, Claessen H. Incidence of lower extremity amputations in the diabetic compared with the non-diabetic population : a systematic review. PLoS One. 2017;12:e0182081.","journal-title":"PLoS One"},{"key":"8137_CR24","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1157\/13124995","volume":"61","author":"A Ribera","year":"2008","unstructured":"Ribera A, Marsal J, Ferreira-Gonz\u00e1lez I, et al. Predicting in-hospital mortality with coronary bypass surgery using hospital discharge data: comparison with a prospective observational study. Rev Esp Cardiol. 2008;61:843\u201352.","journal-title":"Rev Esp Cardiol"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-8137-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-019-8137-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-019-8137-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T19:18:06Z","timestamp":1610479086000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-019-8137-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,14]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["8137"],"URL":"https:\/\/doi.org\/10.1186\/s12889-019-8137-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.2.17111\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.17111\/v1","asserted-by":"object"}]},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,14]]},"assertion":[{"value":"4 November 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The database for this study was produced by the Ministry of Health with aggregated fully anonymized data. The Ministry did not require prior approval of an ethics committee, but a commitment to confidentiality that the authors signed (under the Spanish Organic Law 3\/2018 on the protection of personal data and digital rights, which transcribe the European Union General Data Protection Regulation 2016\/679).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}