The influence of socio-economic deprivation on rates of major lower limb amputation secondary to peripheral arterial disease

Eur J Vasc Endovasc Surg. 2010 Jul;40(1):76-80. doi: 10.1016/j.ejvs.2010.03.008. Epub 2010 Apr 1.


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.

MeSH terms

  • Amputation, Surgical / statistics & numerical data*
  • Amputees / statistics & numerical data*
  • Case-Control Studies
  • Chi-Square Distribution
  • England / epidemiology
  • Hospitals, District / statistics & numerical data
  • Hospitals, General / statistics & numerical data
  • Humans
  • Logistic Models
  • Lower Extremity / blood supply*
  • Odds Ratio
  • Patient Acceptance of Health Care
  • Peripheral Vascular Diseases / epidemiology
  • Peripheral Vascular Diseases / psychology
  • Peripheral Vascular Diseases / surgery*
  • Postal Service
  • Poverty Areas
  • Residence Characteristics / statistics & numerical data
  • Risk Assessment
  • Risk Factors
  • Social Class
  • Socioeconomic Factors*