GSB 7.1 Standardlösung

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Diabetes-related amputations

Over time, diabetes can lead to vascular disorders and nerve damage in the extremities. Late or inadequate treatment for conditions such as diabetic foot syndrome can necessitate amputation of the lower limb. This indicator is also part of the biennial Health at a Glance report from the Organisation for Economic Co-operation and Development (OECD) (OECD, 2023).

Key messages

  • While diabetes-related amputations decrease for women in 2022, they rise to 16.2 per 100,000 residents for men.
  • In 2022, 5,702 diabetes-related amputations were required on men and 2,084 on women.
  • The rate of diabetes-related amputations is significantly increased in federal states with a higher diabetes prevalence and regions with high socioeconomic deprivation.

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By state

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  • By gender

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  • By age

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  • By regional socioeconomical deprivation

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Results

Between 2015 and 2019, major amputation rates for diabetes per 100,000 residents show a constant decrease from 11.3 to 10.6. The rate stagnates in 2020 and remains at this level in 2021 (10.8) and 2022 (10.8). While the amputation rate for women decreases to 5.7 per 100,000 residents in 2022 compared to the previous year, the rate for men increases significantly to 16.2 per 100,000 inhabitants. The federal states of Thuringia, Mecklenburg-Western Pomerania, or Saxony-Anhalt show significantly higher diabetes amputation rates per 100,000 residents in 2022, with values of 8.4, 9.0, and 12.2 for women and 29.4, 34.5, and 32.6 for men, respectively, compared with federal states such as Baden-Württemberg (women: 4.3; men: 13.7), Berlin (women: 4.1; men: 12.3), or Hamburg (women: 2.9; men: 7.7). For both women and men, the highest rates of diabetes-related amputations are shown in regions with high socioeconomic deprivation.

Conclusion

From 2015 to 2019, diabetes-related major amputations decreased steadily. While this trend continues for women with the exception of 2021, the rate of amputations for men increases continuously between 2020 and 2022. Standardized by age, this increase is slightly lower. An analysis based on data from a statutory health insurance also showed that the decline in amputation rate does not continue in 2020 for persons with diabetes (Narres et al. 2022). Regional differences can be observed for both sexes, which correspond to the distribution of diabetes prevalence by federal state. The same applies to regions with high socioeconomic deprivation, as diabetes prevalence is also higher here than in less deprived regions (Grundmann et al. 2014). The results indicate that men and people in socio-economically disadvantaged regions in particular should be given more attention with regard to the care of diabetic foot syndrome.

Show more information on methodology and data sources

Definition

The indicator Diabetes-related amputations is defined as the number of amputations of the lower limb above the ankle (major amputations, OPS Codes: 5‑864/5‑865.0) per 100,000 residents (in patients aged 15 years and over with a main or secondary diagnosis of diabetes, E10.-/E11.-E13.-/E14.) per year.

Reference population

All hospital cases that are billed in accordance with the DRG remuneration system.

Data source

Diagnosis-related groups statistics (DRG statistics) that include all approximately 19 million inpatient cases per year in Germany.

Calculation

  • Observed relative values: The number of amputations per 100,000 residents.
  • Observed absolute values: Number of lower extremity amputation cases above the ankle (OPS codes: 5-864/5-865.0) in persons (over 15 years) with principal or secondary diagnosis (E10.-/E11.-E13.-/E14.).
  • Age standardisation: Direct age standardisation used five-year age groups for the ages 15 to 19 until 80 to 84, and a separate group for the ages 85 and over. The resident population of Germany as of 31 December 2022 was used as the reference population.
  • Stratification: The stratification by federal state is based on place of residence. Stratification by regional socioeconomic deprivation is based on the German Index of Socioeconomic Deprivation (GISD; Years 2019-20: GISD Release 2020; Years 2021-22: GISD Release 2022 v0.2) (Michalski et al. 2022). The GISD provides information on all rural and urban districts and divides them into quintiles ranging from low to high socioeconomic deprivation. The amputation rate was calculated stratified for each quintile after linkage of the GISD with diabetes-related amputations at the district level (ecological correlation).

Data quality

Diagnosis-related Groups (DRG) statistics contain information on all hospitalisations in Germany. They include main and secondary diagnoses, operations and other procedures, as well as information on patients’ age, sex and place of residence. The data are documented on a case by case basis, which means that a person hospitalised more than once will be classified as several cases. Data quality depends on coding practices and other aspects of documentation.

Data download

References and links

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