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. 2014 Dec;107(12):483-9.
doi: 10.1177/0141076814557301. Epub 2014 Nov 11.

Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data

Naseer Ahmad  1 , G Neil Thomas  2 , Paramjit Gill  3 , Colin Chan  4 , Francesco Torella  5
Affiliations

Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data

Naseer Ahmad et al. J R Soc Med. 2014 Dec.

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.

Keywords: amputation; peripheral vascular disease; prevalence; revascularisation.

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Figures

Figure 1.
Figure 1.
Proportional rate of amputation (upper value) and revascularisation (lower value) (95% confidence intervals) by English region (England rate = 100).
See this image and copyright information in PMC

Comment in

References

    1. Dormandy J, Heeck L, Vig S. Lower extremity arteriosclerosis as a reflection of a systemc process: implications for concomitant coronary and carotid disease. Sem Vasc Surg 1999; 12: 118–122. - PubMed
    1. Criqui MH, Denengerg JO. The generalised nature of atherosclerosis: how peripheral arterial disease may predict adverse events from coronary artery disease. Vasc Med 1998; 3: 241–245. - PubMed
    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 Suppl 1): S1–S75. - PubMed
    1. Fowkes FGR, Housley E, Cawood EHH, Macintyre CCA, Ruckley CV, Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 326: 381–386. - PubMed
    1. Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: the Rotterdam Study. Arterioscler Throm Vasc Biol 1998; 18: 185–192. - PubMed

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