{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:01:50Z","timestamp":1791946910124,"version":"4.3.4"},"reference-count":18,"publisher":"American Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T00:00:00Z","timestamp":1545264000000},"content-version":"vor","delay-in-days":42,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To determine whether declining trends in lower-extremity amputations have continued into the current decade.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We calculated hospitalization rates for nontraumatic lower-extremity amputation (NLEA) for the years 2000\u20132015 using nationally representative, serial cross-sectional data from the Nationwide Inpatient Sample on NLEA procedures and from the National Health Interview Survey for estimates of the populations with and without diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Age-adjusted NLEA rates per 1,000 adults with diabetes decreased 43% between 2000 (5.38 [95% CI 4.93\u20135.84]) and 2009 (3.07 [95% CI 2.79\u20133.34]) (P &amp;lt; 0.001) and then rebounded by 50% between 2009 and 2015 (4.62 [95% CI 4.25\u20135.00]) (P &amp;lt; 0.001). In contrast, age-adjusted NLEA rates per 1,000 adults without diabetes decreased 22%, from 0.23 per 1,000 (95% CI 0.22\u20130.25) in 2000 to 0.18 per 1,000 (95% CI 0.17\u20130.18) in 2015 (P &amp;lt; 0.001). The increase in diabetes-related NLEA rates between 2009 and 2015 was driven by a 62% increase in the rate of minor amputations (from 2.03 [95% CI 1.83\u20132.22] to 3.29 [95% CI 3.01\u20133.57], P &amp;lt; 0.001) and a smaller, but also statistically significant, 29% increase in major NLEAs (from 1.04 [95% CI 0.94\u20131.13] to 1.34 [95% CI 1.22\u20131.45]). The increases in rates of total, major, and minor amputations were most pronounced in young (age 18\u201344 years) and middle-aged (age 45\u201364 years) adults and more pronounced in men than women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>After a two-decade decline in lower-extremity amputations, the U.S. may now be experiencing a reversal in the progress, particularly in young and middle-aged adults.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc18-1380","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T19:25:18Z","timestamp":1541705118000},"page":"50-54","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":291,"title":["Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population"],"prefix":"10.2337","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9523-267X","authenticated-orcid":false,"given":"Linda S.","family":"Geiss","sequence":"first","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfeng","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Israel","family":"Hora","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Albright","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Rolka","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2381-6822","authenticated-orcid":false,"given":"Edward W.","family":"Gregg","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2018,11,8]]},"reference":[{"key":"2022031300561942800_B1","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.2337\/diacare.22.7.1029","article-title":"Lower-extremity amputation in diabetes. 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