FRI618 Lifetime Risk Of Nontraumatic Lower-extremity Amputation

Disclosure: N. Ding: None. Y. Mok: None. M. Salameh: None. W. Tang: None. E. Selvin: None. K.R. Butler: None. K. Matsushita: None. Introduction: Nontraumatic lower-extremity amputation (NLEA) is mainly caused by diabetes and peripheral artery disease. Although the annual incidence of NLEA is generally well-documented, no lifetime risk estimates are currently available. Furthermore, it is unknown whether the estimates vary by sociodemographic characteristics. Methods: In 14,108 ARIC participants aged 45-64 at baseline (1987-89), we estimated the cumulative incidence of NLEA (identified from discharge ICD codes) in the lifespan from age 50 through 80 using Fine and Gray’s proportional subhazards models accounting for the competing risk of death. We also explored the lifetime risk of NLEA by sex, race, annual household income, and in participants with diabetes. Additionally, we estimated the cumulative mortality among participants with and without NLEA using Kaplan-Meier analysis, in the scheme of a 1:2 matched cohort study. Results: There were 226 NLEA cases during a median follow-up time of 30 years. The estimated overall lifetime risk of NLEA from 50 years of age was 1.5% (95% confidence interval [CI], 1.3%-1.7%). The lifetime risk was highest in Black men (4.2% [3.1%-5.5%]), followed by Black women (2.7% [2.1%-3.5%]), White men (1.1% [0.8%-1.5%]), and White women (0.7% [0.5%-0.9%]). When further categorized by income, Black men with low income showed the highest lifetime risk (5.2% [3.7%-7.0%]), while White men with high income had a lifetime risk of 0.9% (0.6%-1.2%). Diabetes drastically increased the risk of NLEA by 5-fold in each race-sex group. Black men with diabetes have a 14% risk of developing NLEA in their lifetime. In the matched cohort study, we included 225 participants with NLEA and 450 without NLEA. The 1-year mortality was 30.9% (25.3%-37.4%) among those with NLEA and 4.1% (2.6%-6.4%) among those without NLEA, while the 10-year mortality was 83.5% (77.7%-88.6%) among those with NLEA and 38.9% (34.2%-44.1%) among those without. Conclusions: In this community-based cohort, 3%-4% of Black individuals experienced NLEA during their lifetime, while 1% of White individuals did. The lifetime risk was enhanced in people with low income and diabetes. Those with NLEA had greater short-term and long-term mortality than those without. Future public health efforts to prevent limb loss should prioritize racial minorities, those with low socioeconomic status, and diabetes. Presentation: Friday, June 16, 2023