J Korean Foot Ankle Soc.  2019 Sep;23(3):121-130. 10.14193/jkfas.2019.23.3.121.

Regional Variation in the Incidence of Diabetes-Related Lower Limb Amputations and Its Relationship with the Regional Factors

  • 1Department of Orthopedic Surgery, Soon Chun Hyang University Seoul Hospital, Korea.
  • 2Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Korea.
  • 3Department of Biostatistics, Soon Chun Hyang University Seoul Hospital, Seoul, Korea.
  • 4Division of Genome Research, Center for Genome Science, Korea National Institute of Health, Cheongju, Korea.
  • 5Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. hohotoy@nate.com


To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors.
This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis.
The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent.
The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.


Diabetes mellitus; Diabetic foot; Amputation; Spatial analysis

MeSH Terms

Delivery of Health Care
Diabetes Mellitus
Diabetic Foot
Health Policy
Insurance, Health
Lower Extremity*
Socioeconomic Factors
Spatial Analysis
Spatial Regression


  • Figure 1 Summary of research model.

  • Figure 2 Spatial distribution in the incidence of diabetes-related lower limb amputation. (A) Standardized Incidence rate of diabetes-related lower limb amputation per 100,000 population based on city, province (n=16). (B) Standardized Incidence rate of diabetes-related lower limb amputation per 100,000 population based on city, gun, gu (n=228).

  • Figure 3 Distribution of regression coefficients variables based on city, gun, gu (n=228). (A) National Health Insurance premium per capita. (B) Financial independence. (C) Number of registered car per capita. (D) Number of healthcare institution per 100,000 population. (E) Number of doctors per 100,000 population.


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