CIHI wishes to acknowledge and thank the individuals and organizations listed below for their contributions to the report Equity in diabetes care: A focus on lower limb amputation. Please note that the analyses and conclusions in this report do not necessarily reflect those of the individuals or organizations mentioned below.

We would also like to acknowledge (in memory) Matt Anderson’s strong advocacy for and dedication to improving diabetes foot care in Canada. We are grateful to Matt’s family for their continued support to share his story of living with diabetic foot ulcers and navigating the health system. Matt’s story is part of the Our Voices, Our Stories initiative, led by Dr. Idevania Costa, Associate Professor, School of Nursing, Lakehead University, and funded by the Social Sciences and Humanities Research Council in partnership with Lakehead University and Wounds Canada.

• Zaina Albalawi, Memorial University of Newfoundland
• Irmajean Bajnok, Wounds Canada
• Mariam Botros, Wounds Canada
• Charles de Mestral, Unity Health Toronto and Diabetes Action Canada
• Louise McRae, Public Health Agency of Canada
• Cynthia Robitaille, Public Health Agency of Canada
• Baiju Shah, Sunnybrook Health Sciences Centre and University of Toronto
   

• Health equity and population health

Diabetes accounts for about two-thirds of lower limb amputations in Canada.Reference3 This report used pan-Canadian data from 2020–2021 to 2022–2023 to examine equity in diabetes care, with a focus on lower limb amputations (i.e., amputations of the leg, ankle, foot or toe).

Diabetes-associated lower limb amputations are largely preventable, and they have high health system and societal costs. Data on these procedures is readily available in CIHI’s comprehensive hospital data holdings for reporting at national, provincial and territorial levels. In this analysis, we included amputations for patients with a diabetes diagnosis, unless the amputation was associated with trauma or cancer, or the diagnosis was for gestational diabetes.

Lower limb amputations among those with diabetes are commonly preceded by foot ulcers or infected wounds. This analysis also examined hospitalizations that involved care for diabetes-associated ulcers, gangrene and infections in the lower limb but did not involve an amputation.

Evidence suggests that diabetes-associated amputations disproportionately affect equity-deserving populations.Reference4 Reference5 Reference6 This analysis focused on inequalities defined by age; recorded sex or gender (referred to here as “sex”); neighbourhood-level measures of income, high school completion and social deprivation; and rurality/remoteness, as derived using patients’ postal codes.

To compare populations, we primarily calculated age-standardized rates relative to the overall total population. To start to understand the impact of diabetes prevalence versus diabetes management on amputation rates, we also calculated rates relative to the number of people with diabetes (i.e., prevalence), using both administrative and survey data sources.

Download methodology notes (PDF)

• Each year from 2020–2021 to 2022–2023, there were about 7,720 hospitalizations for lower limb amputations associated with diabetes. 3,080 of these involved a leg amputation. There were also 23,500 diabetes-associated hospitalizations for treatment of ulcers, gangrene or infections.
• Together, these hospitalizations accounted for approximately $750 million annually; however, this reflects a fraction of the total system costs associated with diabetic foot ulcers and amputations.
• Patients who received a leg amputation spent about 19 days in hospital. These patients often require multiple procedures during their stay and have a high risk of readmission and in-hospital death. Costs for these hospitalizations were high at about $47,000 per stay.
• About 43% of amputations occurred among those age 40 to 64. 
• Males with diabetes were 2 to 3 times more likely than females to have an amputation or to be hospitalized with a lower limb complication. 
• Lower limb complications were also more common for those living in neighbourhoods with lower income, lower high school completion and higher social deprivation, as well as in rural and remote communities. 
• Inequalities among population groups and variation among the provinces and territories appear related to both diabetes prevention and management.

These findings shed light on the potential health system and societal benefits of preventing amputations and other diabetes complications, particularly among equity-deserving populations. Health systems can use this information to support strategies that improve access to primary care and early intervention for patients at higher risk of diabetes complications. 

Wounds Canada’s Pathway for Preventing and Managing Diabetic Foot Complications outlines a risk-based approach for preventing ulcers and amputations. This approach begins with primary care services for early detection and screening, and extends to specialized services for foot and wound care.Reference7 Reference8 Stakeholders from across Canada, including Wounds Canada, have called for a strong focus on prevention, emphasizing early detection and education that is tailored to specific populations and that considers the social determinants of health and health equity. By ensuring care is both timely and effective, care pathways aim to reduce the incidence of diabetes-related complications and improve patient outcomes.  

Approximately 80% of leg amputations related to diabetes are preventable with the right care at the right time. Regular foot screening prevents wounds and should include a foot exam, treating high-risk features such as removing calluses, making sure a person’s footwear is protective and talking about foot health when living with diabetes. If a foot wound arises, rapid access to care, ideally multidisciplinary, is limb-saving — Dr. Charles de Mestral, Surgeon, Unity Health Toronto

CIHI and other national, provincial and territorial organizations and stakeholders are working to modernize and connect pan-Canadian health data. 

Data for equity stratification 

To enable more comprehensive analysis of health system inequalities, work is underway to embed socio-demographic data in health care data, or to link these 2 types of data. For example, as of April 2022, optional race-based and First Nations, Inuit and Métis identity data collection has been introduced for inpatient and ambulatory care data in Canada.Reference9 CIHI is committed to working in collaboration with First Nations, Inuit and Métis Peoples, communities, governments and organizations on health, wellness and data priorities, as defined by them. Standardized and more comprehensive socio-demographic data collection is also an integral component of CIHI’s Connected Care initiative.

Data to examine access to effective health care

Addressing inequities in long-term diabetes complications, such as lower limb amputations, requires an understanding of where barriers and inequities occur along the trajectory of diabetes prevention and management. To do this, recent and disaggregated data is needed on the quality of primary care. For example, an identified gap is the lack of recent data on the proportion of those diagnosed with diabetes who receive regular foot checks.Reference10

Using data collected by the provinces and territories, the Public Health Agency of Canada monitors the number of people living with diabetes in Canada through the Canadian Chronic Disease Surveillance System. Ongoing investments through the Framework for Diabetes in Canada will enhance diabetes monitoring and reporting. CIHI’s modernization of health workforce data will also allow analysis based on a provider’s area of practice (e.g., diabetes care, amputation care, foot care). 

• Measuring Health Inequalities: A Toolkit
• First Nations, Inuit and Métis health 
• Race-based and Indigenous identity data
• Connected care
• What’s New With Health Workforce Information at CIHI (PDF)

About 3.7 million people (9.4%) had been diagnosed with diabetes in Canada as of 2020–2021, and at least 2% of adults are living with undiagnosed diabetes.Reference3 The overall number of people living with diabetes is growing over time due to an aging population and increasing incidence.Reference4

For those living with diabetes, the lifetime risk of developing a foot ulcer is about 15% to 25%.Reference5 This means that roughly 550,000 to 920,000 Canadians currently living with diabetes are predicted to experience some degree of foot complication, putting them in need of specialized services and at greater risk of a lower limb amputation if their care needs are not met.Reference5

Patients with lower limb amputations may experience loss of function, reduced quality of life, depression and high risk of premature death.Reference6 Reference7 For health systems, amputations are costly and signal that there are opportunities to improve service delivery and reduce the risk of diabetes-related complications.Reference8

Sources
Armstrong DG, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. Journal of Foot and Ankle Research. 2020.
Botros M, et al.; Wounds Canada. Chapter 6: Best practice recommendations for the prevention and management of diabetic foot ulcers. In: Foundations of Best Practice for Skin and Wound Management. A supplement of Wound Care Canada. 2017.
de Mestral, et al. A population-based analysis of diabetes-related care measures, foot complications, and amputation during the COVID-19 pandemic in Ontario, Canada. JAMA Network Open. 2022.
International Working Group on the Diabetic Foot (IWGDF). IWGDF Guidelines on the Prevention and Management of Diabetes-Related Foot Disease. 2023

Based on data from 2020–2021 to 2022–2023, there were about 7,720 lower limb amputations associated with diabetes annually, among those age 18 and older in Canada. 3,080 hospitalizations involved a leg (i.e., above-ankle or “major”) amputation, and 4,640 were for an ankle, foot or toe (i.e., ankle-and-below or “minor”) amputation without also involving a leg amputation. For this analysis, each hospitalization was assigned to only 1 outcome, based on severity.

Leg amputations are considered the more severe type of lower limb amputation and are used internationally and within Canada for health system reporting and monitoring of diabetes care quality.Reference9 Reference10 Reference11 Reference12 Reference13 It is widely cited that up to 85% of leg amputations are preventable.Reference2 Reference5

Ankle, foot and toe amputations associated with diabetes are also undesirable and preventable outcomes that reflect unmet health care needs; they often precede or accompany a leg amputation. In some provinces and territories, rates of ankle-and-below amputations have increased over time, which may reflect changing surgical practices and efforts to save limbs (i.e., carrying out a foot or toe amputation to prevent a leg amputation).Reference14 Reference15 Reference16

Among those receiving an amputation, 86% had a documented diagnosis of both diabetes and peripheral arterial disease (PAD). Having both PAD and diabetes increases the risk of amputation.Reference14 Reference15 Diabetes was also accompanied by hypertension (39% of amputations), chronic kidney disease (7%) and chronic obstructive pulmonary disease (4%). For more information on patient characteristics as well as crude and age-standardized rates, view the data tables on the Download the data page. 

Hospitalizations for ulcers, gangrene and infections that do not result in amputation are also undesirable outcomes for those living with diabetes. Examining these hospitalizations provides additional insight into the systemic and societal burden of unmet care needs for those with diabetes. Our analysis found that each year, there were about 23,500 hospitalizations for diabetes-associated ulcers, gangrene or infections (UGI) in the lower limbs, where an amputation procedure did not also occur. 

In this report, we collectively refer to diabetes-associated lower limb amputations and hospitalizations for UGI as diabetes-associated lower limb complications. 

Hospitalization costs exceed $750 million annually

Sources
Discharge Abstract Database, National Ambulatory Care Reporting System, Hospital Morbidity Database and Canadian MIS Database, 2020–2021 to 2022–2023; Case Mix Group+ Methodology, 2023; and Comprehensive Ambulatory Classification System, 2023, Canadian Institute for Health Information.

These cost estimates do not include physician compensation or account for the high proportion of patients who require further acute inpatient care, rehabilitation, home care services and mobility aids such as prosthetics and wheelchairs. They also do not account for emergency department visits or community-based care costs incurred leading up to hospitalization. For example, foot ulcers and other lower limb complications are treated in the community through primary care and footcare clinics.Reference17 Moreover, data from Ontario and Alberta suggests that for every 1 hospital stay for lower limb ulcers, gangrene and infections there are 2 to 3 emergency department visits.Reference18 These care encounters are not captured in the hospitalization rates and costs presented in this report.

Experiencing a lower limb amputation and being hospitalized for UGI are significant medical events from the patient’s and health system’s perspectives

• For leg amputation, the median length of stay was 19 days. 15% of these hospitalizations involved more than one amputation. Both the length of stay and complexity of care contribute to the high costs of hospitalization. 
• Close to one-third of hospitalizations for leg amputation led to the patient being discharged to their home. Most patients were transferred to other inpatient or rehabilitation care. 
• For both ankle, foot and toe amputations and hospitalizations for UGI, the median length of stay was about 8 days. Around 77% and 65% of patients, respectively, were discharged home. 
   

Many patients who are hospitalized for an ulcer or amputation undergo repeat hospitalizations related to lower limb complications. Of the 31,220 hospitalizations annually for diabetes-associated lower limb complications, about 19,100 were for unique patients. The remaining 12,120 were repeat visits within the year. 

Our analysis also shows that 19% of patients who received a leg amputation were readmitted for another amputation or for treatment for UGI within 12 months. For patients receiving ankle, foot or toe amputations and treatment for UGI, about 37% and 31%, respectively, were readmitted within 12 months for a diabetes-associated lower limb complication. 
 

As many as 8% of patients died in hospital within 30 days of a hospitalization for a leg amputation. This is more than 4 times the rate of 30-day in-hospital mortality following a major surgery.Reference19 The 30-day in-hospital mortality rates for ankle, foot or toe amputations and for hospitalizations for UGI are 3% and 8%, respectively. 

The risk of death is high for patients receiving an amputation or treatment for UGI due to the risk of stroke, heart attack and other cardiovascular or renal complications that are also associated with diabetes.Reference7 Reference20

For all 3 complications, mortality rates increase with age. Our analysis found that 5% of patients younger than 65 died within 30 days of a leg amputation, increasing to 15% for patients age 85 and older. 
 

About 43% of amputations occurred among people with diabetes age 40 to 64. For individuals with type 1 diabetes, about 63% of amputations occurred in this age group. For hospitalizations for UGI, about 35% and 53% were for people age 40 to 64 with type 2 and type 1 diabetes, respectively. 

For individuals in the workforce, the time required to address foot care needs and to recover from an amputation may result in loss of income, lost employment opportunities and other non-monetary losses.Reference6  

This analysis found large inequalities related to sex and to neighbourhood-level income, high school completion and social deprivation.

Notes
Based on analysis of age-standardized rates per 100,000 people age 18 and older in the general population. Income, high school completion and social deprivation were defined at the neighbourhood level using the patient’s residential postal code. Refer to the methodology notes for more information on these measures. 
Quebec was not included in results for high school completion or social deprivation.

Sources
Discharge Abstract Database, National Ambulatory Care Reporting System and Hospital Morbidity Database, 2020–2021 to 2022–2023, Canadian Institute for Health Information.

Results for income, high school completion and social deprivation compare the least and most disadvantaged neighbourhood levels (i.e., quintiles). 

Social deprivation is a combined measure that aims to identify those with less extensive social networks, based on the population who lived alone, were single parents or were separated, divorced or widowed.Reference1

Inequalities were similar for diabetes-associated ankle, foot or toe amputations and hospitalizations for ulcers, gangrene and infections (UGI). Results at the national, provincial and territorial levels can be found in the data tables on the Download the data page. 

People have intersecting identities and social positions (e.g., sex and gender, socio-economic status, racial identity).Reference2 Examining interactions between equity stratifiers can provide a better reflection of an individual’s lived experience and the layered inequalities they may face. Our analysis focused on the interactions of income, geography, education and social deprivation with sex and age.

As neighbourhood income level increased, amputation rates decreased for both males and females. Males living in the lowest-income neighbourhoods had very high amputation rates. At 24 per 100,000, the age-standardized rate of leg amputations for males living in the lowest-income neighbourhoods is 8 times higher than the rate for females in the highest-income neighbourhoods (3 per 100,000).

We observed similar patterns for neighbourhood-level income and age, as well as by sex for neighbourhood-level high school completion and social deprivation. 

Urban and rural/remote communities can be defined using a range of measures. This report uses 2 different measures from Statistics Canada: the Index of Remoteness and the Statistical Area Classification type. Refer to the methodology notes for more information on how these measures were used.

Using the Index of Remoteness, which combines estimates of travel cost and population size, rates of leg amputation ranged from a low of 7 per 100,000 in easily accessible major urban centres to a high of 49 per 100,000 in very remote communities. Across Canada, more than three-quarters (77%) of the total population live in easily accessible urban areas, and about 2% live in either remote or very remote areas, as defined by the 5 categories in the Index of Remoteness. 

Fewer health providers practising in rural and remote communities contributes to higher travel costs and longer wait times to access services. Recent analysis shows that per capita provider rates in rural and remote areas of Canada are decreasing over time.Reference3

For diabetes foot care, providers who deliver critical preventive services — such as chiropodists, podiatrists, foot care nurses and physician specialists (e.g., vascular surgeons) — are concentrated in large urban centres.Reference4 Reference5 A study in Ontario found that higher leg amputation rates in rural and remote regions were correlated with lower rates of vascular services (assessments and procedures). Reference5

CIHI’s Rural Health Systems Model provides contextual considerations when planning health services for rural regions or health systems, such as the socio-demographic characteristics of a rural population and opportunities to partner with community organizations.

Diabetes is more prevalent among males and populations with lower neighbourhood income and education. Reference6

To account for these differences in prevalence, we also calculated rates of lower limb amputation relative to the number of people diagnosed with diabetes. This analysis found significant, though smaller, inequalities by sex and neighbourhood-level income, education and social deprivation, compared with the inequalities using the general population. For example, the age-standardized rates of leg amputation were

• 2.8 times higher for males than females (14 versus 5 per 100,000) in the general population 
• 2 times higher for males than females (86 versus 42 per 100,000) when using diabetes-specific population estimates from the Canadian Chronic Disease Surveillance System

This suggests that inequalities in diabetes lower limb complications are not solely due to differences in diabetes prevalence, and that differences in diabetes management may also contribute to inequalities.

There is limited variation in diabetes prevalence between urban and rural/remote communities;Reference6 however, these survey-based estimates may be affected by who is included in the data and other limitations. 

For this analysis, we focused on inequalities between population groups for which the required socio-demographic data (i.e., equity stratifiers) was readily available. As such, we were not able to examine all inequalities relevant for advancing equity in diabetes prevention and management.

For example, higher diabetes prevalence and poorer outcomes, including lower limb amputations, are well documented for First Nations and Métis Peoples in Canada.Reference7 Evidence also suggests that other populations, including Black and South Asian populations, have a higher prevalence of diabetes and may face challenges with effective diabetes management, such as language barriers in health care settings.Reference8 Reference9 Reference10 Reference11 For Canadian hospital data, socio-demographic information — including patients' race, ethnicity and language — is not routinely collected, limiting the potential to analyze inequalities. 

• Measuring Health Inequalities: A Toolkit
• Equity stratifiers
• Health equity and population health
• Rural Health Systems Model

Preventing diabetes complications such as amputations begins with reducing the risk of developing type 2 diabetes and ensuring that all forms of diabetes are detected promptly. 

Primary care is an important setting for people to regularly access diabetes prevention interventions, including programs for smoking cessation, cardiovascular risk reduction, physical activity, weight loss and healthy behaviour interventions. Most screenings for type 2 diabetes also take place in primary care. Screening is recommended every 3 years starting at age 40, or earlier if the patient is at high risk.Reference2

Surveillance activities, public health promotion and policy development also play a critical role in the prevention and early detection of diabetes. These efforts facilitate interventions that increase awareness of risk factors for diabetes, promote healthier environments (e.g., walkable neighbourhoods to support regular physical activity, improved access to healthier foods) and make screening for diabetes more widely available.Reference3

Understanding inequalities in diabetes risk factors, access to primary care and early detection is a first step for developing targeted risk reduction interventions. 

• 2% of people in Canada are living with undiagnosed diabetes,Reference4 leading to missed opportunities for early intervention. 
• Many people in Canada struggle to access a regular health care provider. Some groups, including men and people with a lower household income or lower educational attainment, are less likely to have a regular primary care provider in Canada.Reference5 Reference6
• A study of primary care settings in Alberta found that diabetes screening guidelines were met less often for men than for women. Adherence to the guidelines was lowest for young men.Reference7
• Smoking, poor nutrition, food insecurity and low physical activity are among the risk factors for developing type 2 diabetes.Reference1 Reference3 These circumstances are more common for those with lower income.Reference1 Smoking prevalence is also higher among men, people with lower educational attainment and people living in remote areas.Reference1 Reference8
• Smoking cessation attempts are less successful among people with lower socio-economic status (SES). Compared with people with higher SES, they face greater systemic barriers to quitting, including higher levels of stress.Reference9 Health systems can increase rates of cessation through more consistent delivery of evidence-based treatment, including pharmacotherapy and counselling, in primary care settings. Clinicians have cited barriers to delivering these kinds of treatments, including the lack of time, training and practice supports for delivering accessible smoking cessation interventions.Reference10

For the 3.7 million people diagnosed with diabetes in Canada, the delivery of high-quality health care services and self-management education for diabetes is supported by national and international guidelines and resources. These guidelines and resources cover areas such as foot care (including annual checks by a health care provider), glycemic (blood sugar) management, cardiovascular risk management, smoking cessation supports and patient education.Reference11 Reference12 Reference13 Reference4

Primary care physicians, nurses, diabetes educators and other health professionals aim to provide coordinated services that support patients to live a healthy life with their condition (i.e., self-management) and reduce the risk of short- and long-term diabetes complications.

Accessing guideline-aligned health care services and adhering to diabetes care plans may be challenging for populations with lower income, lower educational attainment or limited social support. 

• People diagnosed with diabetes were about 5% less likely to report having a regular care provider if they lived in neighbourhoods with the lowest income or high school completion levels compared with the highest levels.Reference15
• Performing regular foot checks and other self-care practices at home, as well as accessing health care services, may be especially challenging for those living alone or with less social support. Survey data from New Brunswick, Ontario and the Northwest Territories in 2015 shows that about 40% of people with diabetes did not see a health care professional for their annual foot check.Reference16 More recent and comprehensive data is needed on measures of diabetes care, including foot checks.Reference17
• Individuals with lower educational attainment are more likely to experience challenges with finding, understanding and using health information and services for diabetes management.Reference18 A diabetes management program that addresses literacy, such as by using techniques that enhance comprehension, may be particularly beneficial for improving clinical outcomes for patients with low literacy.Reference19
• Only 54% of patients with diabetes who were hospitalized reported receiving enough information about what to do if they were worried about their condition or treatment after discharge.Reference20 This finding highlights that patients may experience a knowledge gap when leaving the hospital. Exploring opportunities to enhance discharge practices may be a worthwhile quality improvement initiative for this population.

Cost barriers affect diabetes management for people living with the condition.

• In 2015, 25% of Canadians with diabetes reported that adhering to their treatments was affected by cost. In some cases, people needed to choose between basic expenses and buying their medications.Reference21
• Estimated out-of-pocket costs in 2022 varied across Canada’s provinces and territories. The costs were as high as $18,300 per year for people living with type 1 diabetes and as high as $10,000 per year for those living with type 2 diabetes.Reference22 Although government programs may cover or partly cover the costs of medications, devices and/or supplies for some people, lower-income adults were still estimated to spend the most out of pocket relative to their family income.Reference22
• The Government of Canada is working toward making a range of diabetes medications free, as part of a first phase of national universal pharmacare.Reference23

I [had] wounds [on my foot] and then I worked on them. I used to be a superintendent in an automotive factory... I was on my feet in steel-toed boots all the time... I couldn't really afford to go off work. Footnotei — Matt Anderson, patient partner of Our Voices Our Stories initiative

The lifetime risk of developing a foot ulcer is about 15% to 25% among those with diabetes; Reference24 however, data for Canada is lacking. Access to integrated specialized care and supplies for these patients is critical to prevent worsening complications. 

Patients can face challenges accessing the specialist services and interventions required to prevent or to heal diabetic foot ulcers (DFUs), such as special footwear, insoles or devices that redistribute and offload pressure under the foot. Reference24 Some offloading devices such as casts need customization and repeated visits to trained professionals with expertise in foot care.Reference24 Although coverage varies across Canada, public funding is limited for visits to foot specialists such as podiatrists and chiropodists, and for the costs of offloading devices, prosthetics and other mobility devices.Reference25 Total contact casts, custom braces and other devices can improve outcomes for patients with a DFU but are not widely used due to affordability issues.Reference26 Economic analyses indicate that public funding for offloading devices could increase use of these devices by patients and lead to net cost savings for the health care system.Reference26

With an infected foot ulcer, you can go to a hospital and receive the required antibiotics, surgical debridement, revascularization and, if required, amputation, all covered by publicly funded health care services. What you may not have received up to this point is care that could have prevented the tissue breakdown which led to the ulcer, infection and amputation. That requires the skills of practitioners like chiropodists or podiatrists, orthotists, pedorthists and more, which are seldom publicly funded. They are sometimes covered by private insurance, which people at greatest risk rarely have. — Tom Weisz, patient partner with Diabetes Action Canada, retired chiropodist/podiatrist, and former social services worker

Patients with a higher level of risk (e.g., active infection, critical ischemia) require immediate access to vascular services for potential revascularization and tissue preservation.Reference13 Reference27 For example, delays between receiving a diagnosis of limb-threatening ischemia (impaired blood flow) and receiving endovascular revascularization have been shown to increase the risk of leg amputation.Reference28 The phrase “time is tissue” highlights that timely intervention and access to specialists are critical for limb preservation. 

If you want to run a wound care clinic, and you want to heal wounds, you need to employ every discipline in the same clinic so that you can heal the wound together. Footnotei — Matt Anderson, patient partner of Our Voices Our Stories initiative

For patients with complex care needs, including a history of a DFU, access to a multidisciplinary diabetes foot care team is a well-established method to support limb preservation efforts.Reference24 Reference26 Patients who receive care from a multidisciplinary team have better outcomes, such as fewer amputations.Reference29 Improving access to multidisciplinary teams would help address gaps in treatment of diabetes foot complications in Canada.Reference25 Reference27

• Continuum of care
• Primary care
• Canadian Patient Experiences Survey — Inpatient Care

There was a 3-fold difference between the jurisdictions with the highest and lowest age-standardized rates of lower limb complications associated with diabetes. The variation in rates between the jurisdictions remained similar when examining rates relative to the general or diabetes-specific population. This finding suggests that factors other than the number of people diagnosed with diabetes are contributing to variation across the country. These factors could include differences in diabetes diagnoses and management, and access to specialized services to manage foot ulcers and wounds. 

For crude and age-standardized rates relative to the general and diabetes-specific populations, refer to the data tables on the Download the data page. Refer to the methodology notes for additional information on how rates were calculated. For more information on how the prevalence of diabetes varies across the country, refer to the Public Health Agency of Canada’s Health Inequalities Data Tool and Canadian Chronic Disease Surveillance System (see Related resources below). 
 

Cost estimates and results on inequalities for each province and territory can be found in the data tables on the Download the data page. 

• Health Inequalities Data Tool (PHAC)
• Canadian Chronic Disease Surveillance System (CCDSS) (PHAC)