Objective To analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012-2013 compared to previous cohorts in 1991-1992 and 2003-2004. Design Retrospective cohort study. Participants Adults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5-81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM). Main outcome measures Crude and age-standardized incidence rates of major LEA per 100.000 person-years. Results Crude incidence rate (IR) of first ever major LEA in 2012-2013 was 9.9 per 100.000 person-years, while the age-standardized IR was 7.7 per 100.000 person-years. A Poisson regression analysis showed that amputation rates among men were 2.3 times higher compared to women (95%CI 1.9-2.6), while in 2012-2013 the population aged >63 years had decreased amputation rates compared to 1991-1992. In the DM population the crude IR decreased from 142.6 per 100.000 person-years in 2003-2004 to 89.2 per 100.000 person-years in 2012-2013 (p Conclusions In 2012-2013 a decrease in age-standardized IR for the general population and a decrease in crude IR for the DM population were observed compared to cohorts from the previous two decades, despite considerable shifts in the age distribution of the Dutch population towards more elderly people and increased prevalence of DM. These findings might suggest that improved treatment of patients at risk of dysvascular amputations is associated with reduced incidence rates of major LEA at the population level.