{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:25:33Z","timestamp":1790799933469,"version":"4.1.0"},"reference-count":27,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T00:00:00Z","timestamp":1558310400000},"content-version":"vor","delay-in-days":41,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"name":"National Institutes of Health Institutional National Research Service Award","award":["T32 HL004"],"award-info":[{"award-number":["T32 HL004"]}]},{"name":"Freeman Heart Association"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Nontraumatic major lower extremity amputations (LEAs) have been reported to be declining nationally; however, trends in Texas have been less well described. We evaluated demographic and clinical risk factors and revascularization associations for LEAs by using inpatient hospital discharge data in Texas from 2005 to 2014.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>Inpatient hospital discharge data were obtained from the Texas Center for Health Statistics. Multivariate logistic regression analyses were performed to evaluate clinical, ethnic, and socioeconomic risk factors associated with LEA. The impact of revascularization (surgical and\/or endovascular) on LEA was analyzed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Between 2005 and 2014, of 19,939,716 admissions, 46,627 were for nontraumatic major LEAs. Over time, LEAs were constant, and revascularization rates during index admission declined. The majority of LEAs occurred in males and in individuals aged 60\u201379 years. Risk factors associated with LEA included diabetes, peripheral arterial disease, chronic kidney disease, and male sex (P &amp;lt; 0.001). Insurance status, hyperlipidemia, coronary artery disease, and stroke\/transient ischemic attack were associated with lower odds of amputation (P &amp;lt; 0.001). Hispanic (odds ratio [OR] 1.51 [95% CI 1.48, 1.55], P &amp;lt; 0.001) and black (OR 1.97 [95% CI 1.92, 2.02], P &amp;lt; 0.001) ethnicities were associated with a higher risk for amputation when compared with non-Hispanic whites. Revascularization, either surgical or endovascular (OR 0.52 [95% CI 0.5, 0.54], P &amp;lt; 0.001), was also associated with lower odds for amputation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Amputation rates in Texas have remained constant, whereas revascularization rates are declining. A higher risk for LEA was seen in minorities, including Hispanic ethnicity, which is the fastest growing demographic in Texas. Revascularization and having insurance were associated with lower odds for amputation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc19-0078","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T23:15:12Z","timestamp":1554851712000},"page":"1061-1066","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":31,"title":["A Lack of Decline in Major Nontraumatic Amputations in Texas: Contemporary Trends, Risk Factor Associations, and Impact of Revascularization"],"prefix":"10.2337","volume":"42","author":[{"given":"Marlene","family":"Garcia","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler G.","family":"Ellington","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anupama","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Michalek","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Fisher-Hoch","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph B.","family":"McCormick","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, The University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1528-7625","authenticated-orcid":false,"given":"Anand","family":"Prasad","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2019,4,9]]},"reference":[{"key":"2022031300013216100_B1","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.2337\/diacare.22.7.1029","article-title":"Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers","volume":"22","author":"Adler","year":"1999","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B2","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"2022031300013216100_B3","doi-asserted-by":"crossref","first-page":"50","DOI":"10.2337\/dc18-1380","article-title":"Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population","volume":"42","author":"Geiss","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B4","unstructured":"Centers for Disease Control and Prevention. Hospitalizations for lower extremity amputation [Internet], 2019. Available from https:\/\/gis.cdc.gov\/grasp\/diabetes\/DiabetesAtlas.html. Accessed 22 February 2019"},{"key":"2022031300013216100_B5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2337\/dc18-1078","article-title":"Factors contributing to increases in diabetes-related preventable hospitalization costs among U.S. adults during 2001\u20132014","volume":"42","author":"Shrestha","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B6","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1111\/j.1464-5491.2011.03279.x","article-title":"Lower extremity amputations--a review of global variability in incidence","volume":"28","author":"Moxey","year":"2011","journal-title":"Diabet Med"},{"key":"2022031300013216100_B7","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1001\/jamasurg.2014.1007","article-title":"Fifteen-year trends in lower limb amputation, revascularization, and preventive measures among Medicare patients","volume":"150","author":"Goodney","year":"2015","journal-title":"JAMA Surg"},{"key":"2022031300013216100_B8"},{"key":"2022031300013216100_B9","doi-asserted-by":"crossref","first-page":"273","DOI":"10.2337\/dc11-1360","article-title":"Declining rates of hospitalization for nontraumatic lower-extremity amputation in the diabetic population aged 40 years or older: U.S., 1988\u20132008","volume":"35","author":"Li","year":"2012","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B10","doi-asserted-by":"crossref","first-page":"860","DOI":"10.2337\/diacare.24.5.860","article-title":"Geographic variation of lower-extremity major amputation in individuals with and without diabetes in the Medicare population","volume":"24","author":"Wrobel","year":"2001","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B11","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.2337\/dc11-0807","article-title":"Location, location, location: geographic clustering of lower-extremity amputation among Medicare beneficiaries with diabetes","volume":"34","author":"Margolis","year":"2011","journal-title":"Diabetes Care"},{"key":"2022031300013216100_B12","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1016\/j.jacc.2016.02.040","article-title":"Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003-2011","volume":"67","author":"Agarwal","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2022031300013216100_B13","unstructured":"Texas Department of State Health Services. The health status of Texas 2014 [Internet], 2014. Available from https:\/\/www.dshs.texas.gov\/chs\/HealthStatusTexas2014.pdf. Accessed 10 October 2014"},{"key":"2022031300013216100_B14","unstructured":"Goodney PP, Dzebisashvili N, Goodman DC, Bronner KK. Variation in the care of surgical conditions: diabetes and peripheral arterial disease. A Dartmouth Atlas of Health Care Series [Internet], 2014. Available from http:\/\/archive.dartmouthatlas.org\/downloads\/reports\/Diabetes_report_10_14_14.pdf. Accessed 11 November 2015"},{"key":"2022031300013216100_B15","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1590\/S1020-49892010000900012","article-title":"Ethnic and health correlates of diabetes-related amputations at the Texas-Mexico border","volume":"28","author":"Mier","year":"2010","journal-title":"Rev Panam Salud Publica"},{"key":"2022031300013216100_B16","unstructured":"Texas Health and Human Services. Texas hospital inpatient discharge research data file. Quarters 1-4, 2005-2014 [Internet]. Available from http:\/\/www.dshs.texas.gov\/thcic\/hospitals\/Inpatientpudf.shtm. Accessed 10 May 2015"},{"key":"2022031300013216100_B17","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jvs.2006.09.044","article-title":"The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia","volume":"45","author":"Eslami","year":"2007","journal-title":"J Vasc Surg"},{"key":"2022031300013216100_B18","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1001\/archsurg.135.1.75","article-title":"Peripheral bypass surgery and amputation: northern Illinois demographics, 1993 to 1997","volume":"135","author":"Feinglass","year":"2000","journal-title":"Arch Surg"},{"key":"2022031300013216100_B19","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1007\/s11999-011-1842-x","article-title":"Disparities in amputations in minorities","volume":"469","author":"Lefebvre","year":"2011","journal-title":"Clin Orthop Relat Res"},{"key":"2022031300013216100_B20","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.jvs.2005.01.040","article-title":"Racial differences in primary and repeat lower extremity amputation: results from a multihospital study","volume":"41","author":"Feinglass","year":"2005","journal-title":"J Vasc Surg"},{"key":"2022031300013216100_B21","doi-asserted-by":"crossref","first-page":"I106","DOI":"10.1097\/00005650-200201001-00012","article-title":"Lower extremity nontraumatic amputation among veterans with peripheral arterial disease: is race an independent factor","volume":"40","author":"Collins","year":"2002","journal-title":"Med Care"},{"key":"2022031300013216100_B22","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/00007611-199906000-00008","article-title":"Diabetes-related lower-extremity amputations disproportionately affect blacks and Mexican Americans","volume":"92","author":"Lavery","year":"1999","journal-title":"South Med J"},{"key":"2022031300013216100_B23","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.jvs.2007.07.021","article-title":"Disparities in the treatment and outcomes of vascular disease in Hispanic patients","volume":"46","author":"Morrissey","year":"2007","journal-title":"J Vasc Surg"},{"key":"2022031300013216100_B24","unstructured":"Ura A, Ahmed N. Hispanic Texans on pace to become largest population group in state by 2022 [Internet]. The Texas Tribune, 21 June 2018. Available from https:\/\/www.texastribune.org\/2018\/06\/21\/hispanic-texans-pace-become-biggest-population-group-state-2022\/. Accessed 20 November 2018"},{"key":"2022031300013216100_B25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jvs.2005.03.023","article-title":"Physician supply, treatment, and amputation rates for peripheral arterial disease","volume":"42","author":"Ho","year":"2005","journal-title":"J Vasc Surg"},{"key":"2022031300013216100_B26","first-page":"60","author":"Barnett","year":"2017"},{"key":"2022031300013216100_B27","first-page":"110298","article-title":"Missed opportunities for diagnosis and treatment of diabetes, hypertension, and hypercholesterolemia in a Mexican American population, Cameron County Hispanic cohort, 2003-2008","volume":"9","author":"Fisher-Hoch","year":"2012","journal-title":"Prev Chronic Dis"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc19-0078","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/42\/6\/1061\/553060\/dc190078.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/42\/6\/1061\/553060\/dc190078.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T22:01:50Z","timestamp":1647122510000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/42\/6\/1061\/36047\/A-Lack-of-Decline-in-Major-Nontraumatic"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,9]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,4,9]]},"published-print":{"date-parts":[[2019,6,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc19-0078","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,9]]}}}