The Influence of Socio-economic Deprivation on Rates of Major Lower Limb Amputation Secondary to Peripheral Arterial Disease

Objectives: To investigate a hypothesised link between socio-economic deprivation and rates of major lower limb amputation within the catchment of a district general hospital in the United Kingdom. Design: An analysis of a demographic database collated using patients identified by the OPCS codes for lower limb amputations. Materials: All patients undergoing a lower limb amputation as a result of peripheral vascular disease, as identified by ICD-10 code, between January 2003 and January 2009 were included in the study. Methods: A case-control study was undertaken, comparing the Index of Multiple Deprivation 2007 (IMD) scores of major lower limb amputees, to those of the catchment population. Multivariate analysis was not undertaken. Results: A total of 327 patients underwent 445 lower limb amputations during the 6-year period. A comparative plot of cumulative frequency of IMD score in the catchment and amputation groups indicates greater numbers of major amputations in more deprived postcodes (P = 0.004). The catchment population was further divided into population-matched deprivation quintiles. A significant increase in the number of amputations occurred in the two most deprived quintiles (OR (95%CI) = 1.654 (1.121-2.440), P = 0.011) Conclusions: This study indicates a positive association between increasing social deprivation and rates of lower limb amputation. If the most deprived quintiles are combined, this increase in amputation rates is approximately 65%. This inequity should be further investigated, and consideration given to targeted care within areas of greater social deprivation. 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.