Estimating the Prevalence of Limb Loss in the United States

How to estimate the prevalence of Limb Loss in US? Most of the current Statistics are from the paper [1], There are nearly 2 million people living with limb loss in the United States. In the paper, the author projected by the year 2050, there will be 3.6 million people with the loss of a limb. Based on the limitation of the data on the first amputations, the estimation may have great uncertainty.

Among those living with limb loss, main causes are vascular disease (54%) and Trauma (45%). The number of person that undergo amputation of an upper or lower limb each year is 185,000. But little is known about the number of people currently living with the loss of a limb. The trend of increasing number prevalence will trigger the demand of prosthetic device. If the prevalence is underestimate, there will be unmet need for the limb loss survivors.

We currently don not have a national surveillance system for monitoring limb loss. The NHANES system does not contain the questions related to limb loss, but the 2011  NATIONAL HEALTH INTERVIEW SURVEY contains some questions related to limb loss as (Adults 18+),


Question ID:  AHS.200_00.000 
What condition or health problem causes you to have difficulty with {names of up to 3 specified activities/these activities}?

Missing or amputated limb/finger/digit causes difficulty with activity
1  Mentioned --- 70 mentioned
2  Not mentioned
7  Refused
8  Not ascertained
9  Don't know


Question ID:  AHS.318_01.000 RECODE  
How long have you had missing limbs (fingers, toes, or digits)?

Duration of missing limbs (fingers, toes, or digits); amputation: Number of units
01-94  1-94
95  95+
96  Since birth
97  Refused
98  Not ascertained
99  Don't know

Question ID:  AHS.318_02.000 RECODE
How long have you had missing limbs (fingers, toes, or digits)?

Duration of missing limbs (fingers, toes, or digits); amputation: Time unit
1  Day(s)
2  Week(s)
3  Month(s)
4  Year(s)
6  Since  birth
7  Refused
8  Not ascertained
9  Don't know





Duration (in years) of missing limbs (fingers, toes, or digits); amputation, recode 1
00  Less than 1 year --- 6 less than a year
01-84  01-84 years --- 62 1-84 years
85  85+ years
96  Unknown number of years
97  Refused
98  Not ascertained
99  Don't know


Duration of missing limbs (fingers, toes, or digits); amputation, recode 2
1  Less than 3 months --- 3 less 3 month
2  3-5 months
3  6-12 months --- 6 within 6-12 months
4  More than 1 year --- 59 more than a year
7  Refused
8  Not ascertained
9  Don't know




Missing limbs (fingers, toes, or digits); amputation condition status recode
1  Chronic --- 70 Chronic
2  Not chronic
9  Unknown if chronic

The new available national statistics, may help us address some new issues about the trend.




Reference:
1. Ziegler‐Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation2008;89(3):422‐9. link: http://www.sciencedirect.com/science/article/pii/S0003999307017480#

2. NHIS questions, link: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2011/samadult_layout.pdf

3. NHIS frequency, link: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2011/samadult_freq.pdf