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, F., Paul, L., Stuart, W., Kennon, B., Young, R. and Wyke, S. (2019) The influence of socio-economic deprivation on mobility, participation, and quality of life following major lower extremity amputation in the West of Scotland. European Journal of Vascular and Endovascular Surgery, 57(4), pp. 554-560. (doi: 10.1016/j.ejvs.2018.10.011) (PMID:30905506)

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.

• Item Type: Articles
• Additional Information: Funded by Diabetes UK, Sir George Alberti Fellowship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wyke, Professor Sally and Stuart, Mr Wesley and Kennon, Professor Brian and Paul, Dr Lorna and Davie-Smith, Fiona and Young, Dr Robin
• Authors: Davie-Smith, F., Paul, L., Stuart, W., Kennon, B., Young, R., and Wyke, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Social Scientists working in Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: European Journal of Vascular and Endovascular Surgery
• Publisher: Elsevier
• ISSN: 1078-5884
• ISSN (Online): 1532-2165
• Published Online: 21 March 2019
• Copyright Holders: Copyright © 2018 Crown Copyright
• First Published: First published in European Journal of Vascular and Endovascular Surgery 57(4): 554-560
• Publisher Policy: Reproduced in accordance with the publisher copyright policy