Rates of leg and foot amputations in Illinois hospitals rose by 65% between 2016 and 2023, according to a new study from Northwestern Medicine. The research found that men, Black patients, and people living in areas with low socioeconomic status were disproportionately affected by these procedures.
The study attributes the rise in amputations mainly to increasing rates of diabetes and peripheral artery disease (PAD), both chronic conditions that often result in lower limb amputation. “Unfortunately, by the time a patient with diabetes and/or PAD presents with a foot wound or ascending leg infection, their disease might be just too advanced and amputation may be the only treatment option,” said Dr. Maggie Reilly, first author of the study and vascular surgery resident at McGaw Medical Center of Northwestern University. “The patient population with both diabetes and PAD had the biggest increase in amputation rates.”
Despite declining smoking rates and advances in medical therapies such as greater use of statins—which should help preserve limbs—these improvements have not kept pace with rising cases of diabetes and PAD. “Despite our medical advances, we’re not reaching all the communities that need it,” Reilly said. “It’s creating this bigger divide between people who are getting the necessary preventive care and those who aren’t. Unless we make changes in how we care for marginalized communities, I don’t anticipate this getting better.”
The findings were published October 30 in Diabetes Research and Clinical Practice.
Reilly noted that factors leading to amputation can also complicate recovery: “The things that make a leg amputation necessary (diabetes and PAD) can also make it harder to heal,” she said. Patients typically face at least three months of post-operative care followed by extensive physical therapy; some wait up to six months before receiving a prosthetic limb. “Going six months without walking can really make patients debilitated,” Reilly added. “It takes a big medical team to make sure patients get back to a level of independent functioning.”
She also highlighted emotional challenges faced by amputees: “People feel shame or they’re looking for someone to blame. They can feel really disenchanted with the medical system and failed by their providers, but sometimes given the progressive nature of the disease, we’ve done everything we can do,” she said. “Patients generally have a poor understanding of diabetes and PAD, which makes it hard for them to come to terms with this life-changing procedure.”
Approximately 150,000 non-traumatic leg amputations occur each year across the United States. Although this research focused on Illinois data only, its authors believe similar increases are likely happening nationwide due to Illinois’ demographic diversity across urban and rural settings.
“Using Illinois as a proxy for understanding amputation rates in the U.S. is helpful because Illinois has both metropolitan and rural areas, so it’s a good snapshot of different communities,” Reilly explained. “We have a lot of racial and ethnic diversity, especially within Chicago, so we thought our data could be generalized nationwide.”
Reilly emphasized prevention efforts: some studies suggest half of patients undergoing above-knee amputation die within one year due to systemic illness—making early detection critical. She stated: “We know from previous studies that PAD is underrecognized, underdiagnosed, and undertreated, especially for patients from marginalized populations,” adding that health systems should prioritize aggressive prevention through screening programs.
Between 2016-2023 there were 30,834 hospital admissions involving amputations at 193 hospitals statewide; annual rates climbed significantly during this period alongside increased diagnoses of diabetes as well as longer hospital stays over twenty days per case.
Men accounted for most cases (71%), while women made up less than one-third (28.8%). Older adults represented substantial proportions—20% were aged 75 or older—and Black residents comprised 25% despite representing just under 14% of Illinois’ overall population as recorded in 2020 census data.
During the study window more than four out five amputees had diabetes; increases were greatest among males (+76%), non-Hispanic Black patients (+67%) as well as those aged between sixty-five–seventy-four years old.
Other contributors include Isabel Cohen, Samantha Watson, Dr Karen Ho & Joe Feinglass; funding was provided by National Heart Lung & Blood Institute via National Institutes Of Health grant T32HL094293.