The Influence of Socio-economic Deprivation on Mobility, Participation, and Quality of Life Following Major Lower Extremity Amputation in the West of Scotland

Fiona Davie-Smith; Lorna Paul; Wesley Stuart; Brian Kennon; Robin Young; Sally Wyke

doi:10.1016/j.ejvs.2018.10.011

The Influence of Socio-economic Deprivation on Mobility, Participation, and Quality of Life Following Major Lower Extremity Amputation in the West of Scotland

Eur J Vasc Endovasc Surg. 2019 Apr;57(4):554-560. doi: 10.1016/j.ejvs.2018.10.011. Epub 2019 Mar 21.

Authors

Fiona Davie-Smith¹, Lorna Paul², Wesley Stuart³, Brian Kennon⁴, Robin Young⁵, Sally Wyke⁶

Affiliations

¹ WestMARC, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK. Electronic address: f.smith6@nhs.net.
² School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
³ Vascular Surgery, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK.
⁴ Diabetes Centre, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, UK.
⁵ Robertson Centre, University of Glasgow, Glasgow, UK.
⁶ Health & Wellbeing, University of Glasgow, Glasgow, UK.

PMID: 30905506
DOI: 10.1016/j.ejvs.2018.10.011

Abstract

Objective: Lower extremity amputation (LEA) is more common in people from lower socio-economic groups. This study examined this further by investigating the influence of socio-economic status on mobility, participation, and quality of life (QoL) after LEA.

Methods: Prospective data were gathered for all LEAs performed in one year in one Scottish Health Board, commencing March 2014. A postcode derived Scottish Index of Multiple Deprivation (SIMD) was applied by quintile (SIMD 1 = most deprived). Routine data were collected on the cohort of 171 patients; 101 participants consented and received postal questionnaires on QoL (EQ-5D-5L), participation (Reintegration to Normal Living Index [RNLI]), and mobility (Prosthetic Limb User Survey of Mobility), six (n = 67) and 12 months (n = 50) after LEA.

Results: The mean ± SD age of the cohort was 66.2 ± 11.4 years; 75% were male and 53% had diabetes. In total, 67% lived in SIMD 1 and 2 and 11.1% in SIMD 5. Sixty per cent had a transtibial amputation. Mortality was 6% at 30 days 17% at six, and 29% at 12 months. Those in SIMD 1 were significantly younger (62.9 years) than those in SIMD 5 (76.3 years). Significantly more participants with a transfemoral amputation (TFA) lived in SIMD 1 (44%) compared with SIMD 5 (11%) (p = .004). Participation was low (RNLI scores: 6 months = 55.7; 12 months = 56.6) and PLUS M scores suggested mobility was poor overall at six (39.1) and 12 months (38.9). Mean QoL was 0.37 at 6 months and 0.33 at 12 months.

Conclusion: Although this study observed more LEAs in those from low socio-economic areas, it is impossible to conclude whether QoL after LEA is truly influenced by socio-economic status. There was an association between the disproportionately high rate of LEAs in SIMD groups 1 and 2 and the high prevalence of smoking, 61% vs. only 21% of those in the least deprived areas (SIMD 3, 4, and 5) being current smokers.

Keywords: Lower extremity amputation; Quality of life; Scottish index of multiple deprivation.

MeSH terms

Aged
Amputation, Surgical / mortality*
Amputation, Surgical / psychology
Amputation, Surgical / rehabilitation*
Artificial Limbs
Cohort Studies
Diabetes Mellitus / epidemiology
Female
Humans
Lower Extremity
Male
Middle Aged
Prospective Studies
Quality of Life / psychology*
Scotland / epidemiology
Socioeconomic Factors
Surveys and Questionnaires