Regional and Rural-Urban Differences in Incidence Rates of Types 1 and 2 Diabetes Mellitus-Related Foot Complications and Lower-Extremity Amputation in Selected Canadian Provinces and Territories.

OBJECTIVE

To evaluate provincial/territorial and rural-urban differences in rates of diabetes-related foot complications (DFCs) and amputations across Canada.

METHODS

Canadian adults, excluding Québec residents, who were hospitalized for a first DFC, major (above-ankle) amputation, or major or minor (toe or partial-foot) amputation were identified from the Canadian Institute for Health Information's Discharge Abstract Database (April 1, 2017, to March 31, 2022). Age- and sex-adjusted mean annual event rates (per 100,000 residents) were calculated and compared across provinces/territories and by rural/urban residence.

RESULTS

The mean annual rate of major amputation was 8.7 per 100,000 residents, ranging from 6.6 to 15.3 per 100,000 across provinces/territories. The highest rates of major amputation were in Manitoba, Newfoundland and Labrador, and Nova Scotia. The lowest rates of major amputation were in the Territories, British Columbia, and Prince Edward Island. Rates of major or minor amputation and DFC ranged across provinces/territories from 10.3 to 29.6 per 100,000 and from 16.9 to 36.4 per 100,000, respectively. The rate of all events was approximately 2 times higher among residents of rural regions compared with urban regions. However, provinces and territories with the highest proportion of rural residents did not consistently exhibit the highest amputation rates.

CONCLUSIONS

DFCs and amputation rates vary widely across provinces/territories and are higher among people living in rural areas. Further research is required to better understand risk factor management and amputation prevention efforts in provinces/territories with a high proportion of rural residents but comparatively low amputation rates.