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D-4 Data Details

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D-4 Reduce the rate of lower extremity amputations in persons with diagnosed diabetes

About the Data

Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

Data Source: 
National Health Interview Survey
National Hospital Discharge Survey
Changed Since the Healthy People 2020 Launch: 
No
Measure: 
per 1,000 (age adjusted—see Comments)
Baseline (Year): 
3.5 (2005–07)
Target: 
Not applicable
Target-Setting Method: 
This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
Target-Setting Method Justification: 
Data from 2005–07 show that the rate is 3.5 lower extremity amputations per 1,000 persons with diagnosed diabetes (age adjusted to the year 2000 standard population). Because of this extremely low number, no target seems reasonable. As the rate approaches zero, the decreases observed would become smaller with each percent reduction. Within a short period of time, the rate would reach a value so near zero that further reductions would be too small to be detectable.
Numerator: 

Number of hospital discharges among U.S. civilian persons with diabetes (ICD-9-CM code 250) as any listed diagnosis and amputation of the lower limb (ICD-9-CM procedure code 84.1) as any listed procedure

Denominator: 

Number of persons in the NHIS population who report that they have ever been diagnosed with diabetes

Comparable Healthy People 2010 Objective: 
Retained from HP2010 objective
Questions Used to Obtain the National Baseline Data: 

    From the 2005-2007 National Health Interview Survey

    [DENOMINATOR:]

    [For children under 18 years:]

    Has a doctor or health professional told you that {sample child} has any of these conditions?

    (List of conditions includes diabetes)

    [For adults 18 years and older:]

    [For females:]

    Other than during pregnancy, have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

    1. Yes
    2. No
    3. Borderline
    4. Don’t know/Not stated
    5. Refused

    [For males:]

    Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

    1. Yes
    2. No
    3. Borderline
    4. Don’t know/Not stated
    5. Refused
Data Collection Frequency: 
Annual
Methodology Notes: 

    The numerator for this measure is obtained from the National Hospital Discharge System (NHDS) and uses any mention ICD-9-CM procedure code 84.1 to define amputation of the lower limb and ICD-9-CM code 250 as any listed diagnosis to identify persons with diabetes. Amputations due to trauma are not included.

    Adults are considered to have diabetes if they respond “yes” to either of the two Denominator questions. Those who respond “borderline” are not included. Women who report that the only time they have been diagnosed with diabetes was during pregnancy (gestational diabetes) are also excluded. Children are considered to have diabetes if the adult proxy respondent reports that they have ever been told by a doctor that the child has diabetes.

    The numerator and denominator of this measure refer to slightly different populations. The numerator includes the U.S. civilian population; the denominator includes only the U.S. civilian, noninstitutionalized population.

    Age Adjustment Notes: 

    This Indicator uses Age-Adjustment Groups:

    • Total: 0-64, 65-74, 75+
    • Sex: 0-64, 65-74, 75+
    • Race/Ethnicity: 0-64, 65-74, 75+
    • Health Insurance Status: 0-44, 45-64
Caveats and Limitations: 
Data by race and ethnicity may be underreported in the NHDS.