Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

Abstract

ObjectiveLow socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.DesignPopulation-based register study.SettingFinland, nationwide individual-level data.ParticipantsAll persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).MethodsThree outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.ResultsThe risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.ConclusionsAccording to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.

Geographic Clustering Of Diabetic Lower-Extremity Amputations In Low-Income Regions Of California

“…(30) They are also similar to findings from a recent observational study in Finland that demonstrated a significant association between diabetic lower extremity amputation rate and socioeconomic status, with an approximately two-fold increase from lowest to highest socioeconomic status strata, despite universal access to health services. (10)…”

“…(7, 8) Evidence shows that patients residing in low-income households receive lower quality diabetes care, even in settings where universal coverage for primary health care exists. (9, 10) Several studies have used mapping methods to assess diabetes-related processes and outcomes, including neurologic and renal complications (11), diabetes prevalence and treatment resources (12), and effectiveness of targeted programs to improve quality of diabetes care in zip codes with high minority populations (13). Other existing studies have analyzed disparities in diabetic amputations, but have generally focused on specific patient sub-groups or settings.…”

“…Other existing studies have analyzed disparities in diabetic amputations, but have generally focused on specific patient sub-groups or settings. (10, 14–17) No studies to our knowledge have assessed the relationship between socio-economic status and lower-limb amputation in the US. We sought to understand the relationship between socioeconomic status and amputation rate among all diabetic adults in California, using detailed geographic analysis of existing administrative data sets.…”

A perifériás verőérbetegséggel és a cukorbetegséggel összefüggő alsó végtagi amputációk. Epidemiológiai adatok bemutatása és a megelőző stratégia lehetőségeinek elemzése

“…Számos tanulmány bizonyította, hogy ha az alapvető demográfiai, epidemiológiai jellemzőkön túl bővítjük a számba veendő potenciálisan meghatározó tényezők kö-rét, számos, társadalmi szerepre, gazdasági állapotra vonatkozó tényező ismerhető fel, amelyek egyértelmű ösz-szefüggést mutatnak az amputációs adatokkal. Finn, amerikai, ausztrál és angol közlemények számolnak be arról, hogy a lakóhely, a településméret, a népsűrűség, az iskolai végzettség, a jövedelem, a foglalkoztatottság, az egészségügyi ellátáshoz való hozzájutás, a biztosítási ál-lapot, a rassz, az etnikum, a higiéniás viszonyok mind olyan tényezők, amelyek szerepe az amputációk előfor-dulásában nem elhanyagolható [33][34][35][36]. Ezekből a té-nyezőkből képzett deprivációs indexek szintén magyarázhatják az észlelt egészség egyenlőtlenséget.…”

Predictors of Amputation in Patients with Critical Lower Limb Ischemia

“…Numerous variables are involved in its etiology and complications. The long duration of the disease and poor metabolic control [3,4] demonstrated by the high glycated hemoglobin and fasting glycemic levels in the amputee groups, reinforce the higher risk of amputation in these patients, as well of the higher frequency of fatal cardiovascular events.…”