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U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion

Reduce the rate of foot and leg amputations in adults with diabetes — D‑08 Data Methodology and Measurement

On this page:  About the National Data  |  Methodology  |  History

About the National Data

Data

Data Sources:  Healthcare Cost and Utilization Project - National (Nationwide) Inpatient Sample (HCUP-NIS), Agency for Healthcare Research and Quality (AHRQ); National Health Interview Survey (NHIS), CDC/NCHS

Baseline: 6.2 lower extremity amputations per 1,000 adults aged 18 years and over with diagnosed diabetes occurred in 2019

Target: 5.5 per 1,000

Numerator
Number of hospital discharges among adults aged 18 years and over with diabetes (ICD-10-CM code E10, E11, or E13) as any listed diagnosis and any listed procedure of nontraumatic amputation of the lower limb (ICD-10-PCS codes: 0Y62 Hindquarter, Right; 0Y63 Hindquarter, Left; 0Y64 Hindquarter, Bilateral; 0Y67 Femoral Region, Right; 0Y68 Femoral Region, Left; 0Y6C Upper Leg, Right; 0Y6D Upper Leg, Left; 0Y6F Knee Region, Right; 0Y6G Knee Region, Left; 0Y6H Lower Leg, Right; 0Y6J Lower Leg, Left; 0Y6M Foot, Right; 0Y6N Foot, Left; 0Y6P 1st Toe, Right; 0Y6Q 1st Toe, Left; 0Y6R 2nd Toe, Right; 0Y6S 2nd Toe, Left; 0Y6T 3rd Toe, Right; 0Y6U 3rd Toe, Left; 0Y6V 4th Toe, Right; 0Y6W 4th Toe, Left; 0Y6X 5th Toe, Right; 0Y6Y 5th Toe, Left) and excludes amputations due to trauma ( ICD-10 codes: S78, S88, S98).
Denominator
Number of adults aged 18 years and over with diagnosed diabetes.
Target-setting method
Minimal statistical significance
Target-setting method details
Minimal statistical significance, assuming the same standard error for the target as for the baseline.
Target-setting method justification
Trend data were evaluated for this objective but it was not possible to project a target because the trend was moving away from the desired direction. The standard error was used to calculate a target based on minimal statistical significance assuming the same standard error for the target as for the baseline. This method was used because it was a statistically significant improvement from the baseline.

Methodology

Questions used to obtain the national baseline data

(For additional information, please visit the data source pages linked above.)

From the 2019 National Health Interview Survey:

Denominator:
[Not including (gestational diabetes, prediabetes)] Has a doctor or other health professional EVER told you that you had diabetes?
  1. Yes
  2. No
  3. Refused
  4. Don't know

Methodology notes

Hospital discharges for any non-traumatic lower extremity amputation (LEA) procedure were compiled and rates calculated using estimates of the population with diagnosed diabetes from CDC's National Health Interview Survey. Hospital discharges for LEA includes discharges for adults aged 18 years and over with diabetes (ICD-10-CM code E10, E11, or E13) as any listed diagnosis and any listed procedure of nontraumatic amputation of the lower limb (ICD-10-PCS codes: 0Y62 Hindquarter, Right; 0Y63 Hindquarter, Left; 0Y64 Hindquarter, Bilateral; 0Y67 Femoral Region, Right; 0Y68 Femoral Region, Left; 0Y6C Upper Leg, Right; 0Y6D Upper Leg, Left; 0Y6F Knee Region, Right; 0Y6G Knee Region, Left; 0Y6H Lower Leg, Right; 0Y6J Lower Leg, Left; 0Y6M Foot, Right; 0Y6N Foot, Left; 0Y6P 1st Toe, Right; 0Y6Q 1st Toe, Left; 0Y6R 2nd Toe, Right; 0Y6S 2nd Toe, Left; 0Y6T 3rd Toe, Right; 0Y6U 3rd Toe, Left; 0Y6V 4th Toe, Right; 0Y6W 4th Toe, Left; 0Y6X 5th Toe, Right; 0Y6Y 5th Toe, Left). Discharges with diagnosis codes for any traumatic amputation (ICD-10-PCS codes S78, S88, and S98) were excluded. Rates were age-adjusted to the 2000 US standard population using age groups <45, 45-64, 65-74, and ≥75 years.

The NIS data represent hospital discharges, not individual persons. Patients with multiple LEA hospitalizations in a given year could be counted multiple times. NIS underestimates the total number of LEA discharges because it does not include those LEAs occurring at federal hospitals and outpatient settings.

Age-adjustment notes

This Indicator uses Age-Adjustment Groups:

  • Total: 18-44, 45-64, 65-74, 75+
  • Sex: 18-44, 45-64, 65-74, 75+
  • Race/Ethnicity: 18-44, 45-64, 65-74, 75+

History

Comparable HP2020 objective
Modified, which includes core objectives that are continuing from Healthy People 2020 but underwent a change in measurement.
Changes between HP2020 and HP2030
This objective differs from Healthy People 2020 objective D-4 in that the data source for objective D-4 was the National Hospital Discharge Survey (which is no longer conducted), while the data sources for this objective are the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) and the National Health Interview Survey (NHIS).
Revision History
Revised. 

In 2024, the baseline year was revised from 2016 to 2019 due to the 2019 NHIS redesign (denominator source). As part of the redesign, the denominator question was revised from "[Other than during pregnancy], have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?" to "[Not including (gestational diabetes, prediabetes)] Has a doctor or other health professional EVER told you that you had diabetes?". As a result, the baseline was revised from 4.9/1000 in 2016 to 6.2/1000 in 2019. Due to the change in baseline, the target is revised from 4.3/1000 to 5.5/1000 using the original target setting method of MSS.