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

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)554-560
Number of pages7
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume57
Issue number4
Early online date21 Mar 2019
DOIs
Publication statusPublished - Apr 2019

Fingerprint

Scotland
Amputation
Lower Extremity
Economics
Quality of Life
Extremities
Smoking
Mortality
Health
Surveys and Questionnaires

Keywords

  • quality of life
  • Scottish Index of Multiple Deprivation
  • lower extremity amputation

Cite this

@article{f6cf098ecd6f42f69b22a30020def52c,
title = "The influence of socio-economic deprivation on mobility, participation and quality of life following major lower extremity amputation in the West of Scotland",
abstract = "ObjectiveLower 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.MethodsProspective 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.ResultsThe 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.ConclusionAlthough 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 = "quality of life, Scottish Index of Multiple Deprivation, lower extremity amputation",
author = "Fiona Davie-Smith and Lorna Paul and Wesley Stuart and Brian Kennon and Robin Young and Sally Wyke",
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The influence of socio-economic deprivation on mobility, participation and quality of life following major lower extremity amputation in the West of Scotland. / Davie-Smith, Fiona ; Paul, Lorna; Stuart, Wesley ; Kennon, Brian; Young, Robin; Wyke, Sally.

In: European Journal of Vascular and Endovascular Surgery, Vol. 57, No. 4, 04.2019, p. 554-560.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The influence of socio-economic deprivation on mobility, participation and quality of life following major lower extremity amputation in the West of Scotland

AU - Davie-Smith, Fiona

AU - Paul, Lorna

AU - Stuart, Wesley

AU - Kennon, Brian

AU - Young, Robin

AU - Wyke, Sally

N1 - Acceptance in SAN AAM: 12m embargo

PY - 2019/4

Y1 - 2019/4

N2 - ObjectiveLower 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.MethodsProspective 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.ResultsThe 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.ConclusionAlthough 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.

AB - ObjectiveLower 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.MethodsProspective 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.ResultsThe 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.ConclusionAlthough 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.

KW - quality of life

KW - Scottish Index of Multiple Deprivation

KW - lower extremity amputation

U2 - 10.1016/j.ejvs.2018.10.011

DO - 10.1016/j.ejvs.2018.10.011

M3 - Article

VL - 57

SP - 554

EP - 560

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

IS - 4

ER -