Global Epidemiology of Amputation-Related Disability From 1990 to 2021: Geographic Variation and Projections to 2050

Amputation is a critical event leading to the permanent loss of limb function and long-term functional impairment, posing a substantial burden on global healthcare systems. However, the global burden, demographic patterns and future trajectory of amputation-related disability have not been comprehensively quantified.

We analysed Global Burden of Disease (GBD) 2021 data to assess the prevalence and years lived with disability (YLDs) for seven amputation subtypes (fingers, thumbs, toes, unilateral and bilateral upper and lower limbs) from 1990 to 2021. Projections to 2050 were made using the Bayesian age-period-cohort (BAPC) modelling.

In 2021, the global total number of amputation cases reached approximately 445 million (95% uncertainty intervals [UI]: 409-486 million), with an age-standardized rate (ASR) of 5330 (95% UI: 4890-5820) cases per 100 000 population. From 1990 to 2021, the overall global burden of amputation demonstrated a declining trend in ASR, although the absolute number of cases increased substantially. Among all amputation subtypes, finger amputation (AMP-F) had the highest prevalence, accounting for 50.3% of all cases, followed by thumb amputation (AMP-Th) at 22.4% and toe amputation (AMP-Toe) at 19.0%; these three subtypes alone accounted for over 91% of all cases. Regarding YLDs, unilateral lower limb amputation (AMP-LL1) contributed most significantly (20.8%), followed by bilateral upper limb amputation (AMP-UL2) at 18.9%, despite their relatively lower prevalence. In terms of the YLD burden, the age distribution exhibited a spindle-shaped pattern, peaking in the 30-59 age group overall, with notable subtype-specific variations (e.g., AMP-LL1 peaking at ≥ 95 years and bilateral lower limb amputation [AMP-LL2] prominent in middle-aged groups, particularly 50-64 years in certain regions). Additionally, the etiological profile shifted markedly, with conflict and terrorism rising sharply from the 8th to the 4th leading driver of amputation burden globally, exerting a particularly strong impact in North Africa and the Middle East. Projections indicate substantial future increases in both prevalence and YLDs associated with AMP-LL1, necessitating heightened vigilance.

Although the age-standardized prevalence of amputation slightly declined globally from 1990 to 2021, the absolute number of cases increased significantly, exhibiting pronounced demographic and geographic disparities. To mitigate this escalating burden, tailored strategies integrating prevention and long-term rehabilitation planning are urgently needed.