Citation: Lower limb amputation in England: prevalence, regional variation and
relationship with revascularisation, deprivation and risk factors. A
retrospective review of hospital data.
J R Soc Med. 2014 Dec;107(12):483-9
Authors: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Abstract: OBJECTIVE: We describe the prevalence of major lower limb
amputation across England and its relationship with revascularisation, patient
demography and disease risk factors.
DESIGN: Retrospective cohort
study.
SETTING: England 1 April 2003 to 31 March 2009.
PARTICIPANTS:
Patients aged 50-84 years.
MAIN OUTCOME MEASURES: Age standardised prevalence
rates were calculated using Hospital Episode Statistics as the numerator with
census data as the denominator. The outcome measure 'amputation with
revascularisation' was created if an amputation could be linked with a
revascularisation. Logistic regression determined the odds of having an
amputation with a revascularisation across England. Regression was performed
unadjusted and repeated after controlling for demographic (age, sex, social
deprivation) and disease risk factors (diabetes, hypertension, coronary heart
disease, cerebrovascular disease, smoking).
RESULTS: There were 25,312
amputations and 136,215 revascularisations, and 7543 cases were linked. The
prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3
(26.0-26.6) with rates significantly higher in Northern England (North: 31.7;
31.0-32.3, Midlands: 26.0; 25.3-26.7, South: 23.1; 22.6-23.5). The
revascularisation rate was 141.6 (140.8-142.3) with significantly higher rates
again in Northern England (North: 182.1; 180.5-183.7, Midlands: 121.3;
119.8-122.9, South 124.9; 123.9-125.8). The odds of having an amputation with a
revascularisation remained significantly higher in the North (OR 1.22;
1.13-1.33) even after controlling demographic and disease risk
factors.
CONCLUSIONS: There is a North-South divide in England for both major
lower limb amputation and revascularisation. The higher odds of having an
amputation with a revascularisation in the North were not fully explained by
greater levels of deprivation or disease risk factors.
PMID: 25389229 [PubMed - indexed for MEDLINE]
Link to Pubmed Record
