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Prevalence of Lower-Extremity Disease in the U.S. Adult Population 40 Years of Age With and Without Diabetes

1999–2000 National Health and Nutrition Examination Survey

¹ Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
² Epidemiology and Biometry Program, National Heart, Lung and Blood Institute, the National Institutes of Health, Bethesda, Maryland
³ Division of Health and Nutrition Examination Surveys and Division of Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland

Address correspondence and reprint requests to Edward W. Gregg, PhD, Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy., NE Mailstop K-10, Atlanta, GA 30341. E-mail: edg7{at}cdc.gov

OBJECTIVE—Although lower-extremity disease (LED), which includes lower-extremity peripheral arterial disease (PAD) and peripheral neuropathy (PN), is disabling and costly, no nationally representative estimates of its prevalence exist. The aim of this study was to examine the prevalence of lower-extremity PAD, PN, and overall LED in the overall U.S. population and among those with and without diagnosed diabetes.

RESEARCH DESIGN AND METHODS—The analysis consisted of data for 2,873 men and women aged 40 years, including 419 with diagnosed diabetes, from the 1999–2000 National Health and Nutrition Examination Survey. The main outcome measures consisted of the prevalence of lower-extremity PAD (defined as ankle-brachial index <0.9), PN (defined as 1 insensate area based on monofilament testing), and of any LED (defined as either PAD, PN, or history of foot ulcer or lower-extremity amputations).

RESULTS—Of the U.S. population aged 40 years, 4.5% (95% CI 3.4–5.6) have lower-extremity PAD, 14.8% (12.8–16.8) have PN, and 18.7% (15.9–21.4) have any LED. Prevalence of PAD, PN, and overall LED increases steeply with age and is higher (P < 0.05) in non-Hispanic blacks and Mexican Americans than non-Hispanic whites. The prevalence of LEDs is approximately twice as high for individuals with diagnosed diabetes (PAD 9.5% [5.5–13.4]; PN 28.5% [22.0–35.1]; any LED 30.2% [22.1–38.3]) as the overall population.

CONCLUSIONS—LED is common in the U.S. and twice as high among individuals with diagnosed diabetes. These conditions disproportionately affect the elderly, non-Hispanic blacks, and Mexican Americans.

Abbreviations: ABI, ankle-brachial index • CVD, cardiovascular disease • LED, lower-extremity disease • NHANES, National Health and Nutrition Examination Survey • PAD, peripheral arterial disease • PN, peripheral neuropathy

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