The personal cost of diabetic foot disease in the developing world—a study from Pakistan

Ali, Suad Mohammed; Fareed, Abd El Moniem; Humail, Syed Mujahid; Basit, Abdul; Ahmedani, Muhammad Yakoob; Fawwad, Asher; Miyan, Zahid

doi:10.1111/j.1464-5491.2008.02529.x

Cited by 44 publications

(16 citation statements)

References 8 publications

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“…The range of variation in total amputation rates in people without diabetes was similar (0.03-0.24 per 1,000 person-years; CV00.365). The variation between PCTs in the incidence of major amputations in diabetes was tenfold (0.22-2.20 per 1,000 person-years; CV00.365; see Figs 1,2), and was similar to that for minor amputations (0.30-3.25 per 1,000 person-years; CV00.369). There was greater variation in the incidence of major amputation in people without diabetes (0.01-0.16 per 1,000 person-years; CV00.405, see Fig.…”

Section: Resultsmentioning

confidence: 84%

“…The result is frequently devastating in terms of social functioning and mood [1]. Amputation also poses a considerable cost to providers of healthcare, while the financial burden on the patient and their family can be enormous in countries that lack a comprehensive health service [2]. Reduction in the incidence of diabetes-related amputation is a major priority worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Variation in the recorded incidence of amputation of the lower limb in England

Holman¹,

2012

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Aims/hypothesis The study aimed to explore the variation in recorded incidence of lower limb amputation in England. Methods The incidences of amputations in adults with and without diabetes were determined from hospital episode statistics over 3 years to 31 March 2010 and compared between the 151 Primary Care Trusts (PCTs) in England. Results There were 34,109 amputations, including 16,693 (48.9%) in people with diabetes. The incidence was 2.51 per 1,000 person-years in people with diabetes and 0.11 per 1,000 person-years in people without (relative diabetes risk 23.3). Incidence varied eightfold across PCTs in people both with diabetes (range 0.64-5.25 per 1,000 person-years) and without (0.03-0.24 per 1,000 person-years). Amputations in people with diabetes varied tenfold-both major (range 0.22-2.20 per 1,000 person-years) and minor (range 0.30-3.25 per 1,000 person-years). The incidences of minor and major amputations were positively correlated both in those with (r00.537, p<0.0005) and without (r00.611, p<0.0005) diabetes. Incidences of amputations were also correlated between people with and without diabetes (total amputations r00.433, p<0.0005; major amputations r00.528, p<0.0005). There was a negative correlation between the incidence of amputation and estimated prevalence of ethnic Asians. No association was found between the PCT incidence of either total amputations and general population prevalence of social deprivation (r 0−0.138, p 00.092) or smoking (r00.137, p00.096). Conclusions/interpretation Variation in amputation incidence occurs across England. Because of the similarity in amputation variation between people with and without diabetes the variation may reflect generic differences in local healthcare delivery, although racial factors may also contribute.

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Section: Resultsmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Variation in the recorded incidence of amputation of the lower limb in England

Holman¹,

2012

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“…This is more important in a resource-constrained society such as Pakistan because the economic and psychological impact of diabetic foot ulceration and amputation is considerable (5). …”

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confidence: 99%

Characteristics and Outcomes of Subjects With Diabetic Foot Ulceration

et al. 2012

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“…The average direct cost of treating a University of Texas grade 1 diabetic foot ulcer is £21 (Rs. 2886), which is more than 10 times the average health expenditure of an average Pakistani household [12]. This means that 400 000 people with foot ulcers in Pakistan (i.e., 0.22% of the population) needs double the total health budget.…”

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confidence: 99%

Diabetes Prevention in a Challenging Environment

Basit

Riaz

2013

Prevention of Diabetes

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Pakistan is a developing country with diverse economic, educational, and social patterns. It has a population of 161.66 million, of whom 68% live in rural areas. Challenges faced by Pakistan are multifactorial: 30% (42 million) of the population live below the poverty line; 45% (61 million) of the population have no access to safe drinking water; and 40% (54 million) of the population have no access to even basic health services. Nine million children under the age of 5 years are malnourished and 8 million children do not go to school. Pakistan's education indicators are the worst in South Asia [1].The health facilities available for the people of Pakistan are very poor. There are 149 201 registered doctors, with 1206 population per doctor. There are 10 958 registered dentists and 76 244 nurses [2]. There has been little increase in public sector spending in the health sector for the last 40 years. Since 1970, public expenditure on health and health infrastructure represented 0.7-0.8% of GDP and 3.5% of total government expenditure. Pakistan spends less than 30% of the health budget on the development of health infrastructure while private expenditure forms the bulk (75%) of total expenditure on health [3].The International Diabetes Federation (IDF) estimates that there are approximately 7.1 million people with diabetes in Pakistan, ranking it seventh worldwide, and with the highest number of adults with diabetes [4]. This number is predicted to increase to 13.8 million by the year 2030, making it fourth in this list. These predictions are based upon populationbased studies conducted in urban and rural areas of the four provinces of Pakistan at different periods, which show a prevalence of diabetes ranging Prevention of Diabetes, First Edition. Edited by Peter Schwarz and Prasuna Reddy.

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The personal cost of diabetic foot disease in the developing world—a study from Pakistan

Abstract: This retrospective study, despite having limitations, is important for a developing world country with limited data on health economics. Further larger scale prospective studies are needed to address this issue in more detail.

Cited by 44 publications

References 8 publications

Variation in the recorded incidence of amputation of the lower limb in England

Variation in the recorded incidence of amputation of the lower limb in England

Characteristics and Outcomes of Subjects With Diabetic Foot Ulceration

Diabetes Prevention in a Challenging Environment

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