JMIR Publications

ABSTRACT

Background:

Lower extremity amputation (LEA) causes long-term functional impairment, reduced work capacity, and restricted social participation, yet comparable evidence on its non-fatal burden and cause-specific patterns in low- and middle-income countries (LMICs) remains limited. We aimed to quantify age, temporal, national, sex, and etiological patterns of LEA-related years lived with disability (YLDs) in LMICs.

Objective:

To assess the non-fatal burden, temporal trends, and cross-country differences of lower extremity amputation in 133 low- and middle-income countries from 1990 to 2023 using data from the Global Burden of Disease Study 2023.

Methods:

Using Global Burden of Disease Study 2023 data, we estimated YLDs and age-standardized YLD rates for LEA in 133 LMICs from 1990 to 2023. LEA was defined as the combined burden of bilateral lower extremity amputation, unilateral lower extremity amputation, and single or multiple toe amputation. Estimates were analysed by country, age group, sex, year, and World Bank income group. Spearman rank correlation assessed associations between gross national income (GNI) per capita and sex-specific age-standardized YLD rates and the female-to-male YLD rate ratio. Cause rankings and heat maps described etiological profiles.

Results:

In 2023, age-specific YLD rates for LEA in LMICs were generally higher than the global level and showed a clear income gradient, with the highest burden in low-income countries and the lowest in upper-middle-income countries. Age patterns differed across income groups: rates increased gradually with age in upper-middle-income countries, rose markedly after age 75 years in lower-middle-income countries, and showed additional elevations at ages 15–34 and 50–59 years in low-income countries. Across 133 LMICs, age-standardized YLD rates varied nearly 19-fold, from 20.4 per 100,000 population in Cabo Verde (95% UI 12.8–30.9) to 381.0 per 100,000 in Afghanistan (133.0–994.0). From 1990 to 2023, the global age-standardized YLD rate declined, but income-related gradients persisted. GNI per capita was negatively correlated with female and male age-standardized YLD rates and the female-to-male YLD rate ratio. Falls ranked first globally and in lower-middle- and upper-middle-income countries, whereas conflict and terrorism ranked first in low-income countries; exposure to mechanical forces was a leading cause.

Conclusions:

LEA-related non-fatal health loss remains concentrated in LMICs, especially low-income and fragile settings. Stratified strategies integrating trauma prevention, emergency care, fall prevention, chronic disease management, and rehabilitation are needed. Clinical Trial: Not applicable. This study was a secondary analysis of publicly available aggregated data from the Global Burden of Disease Study 2023 and did not involve a clinical trial.