Advertisement

Health Disparities in Non-Traumatic Lower Extremity Amputations. A Systematic Review and Meta-Analysis

Published:September 19, 2022DOI:https://doi.org/10.1016/j.avsg.2022.09.033

      Highlights

      • Socioeconomic status is associated with non-traumatic lower extremity amputation
      • Non-Caucasian ethnicity is associated with non-traumatic lower extremity amputation
      • Male Gender is associated with non-traumatic lower extremity amputation

      Structured Abstract

      Objectives

      Chronic diseases and their associated health outcomes have been known to disproportionately affect low socioeconomic persons around the world. The authors aim to examine the association between socioeconomic status and non-traumatic lower extremity amputation.

      Methods

      A search of current literature was performed in March 2022 across Pubmed, Scopus, Embase, and Medline for relevant literature. Keywords included “socioeconomics”, “income”, “amputation”, and “lower extremities”.

      Results

      A total of 1,164,630 patients across 5 studies were incorporated into the meta-analysis of non-traumatic lower extremity amputation and socioeconomic status. An additional three citations were used in the secondary analyses between gender and ethnicity and their relationship with amputation. An association was observed, between low socioeconomic status and non-traumatic lower extremity amputations, O.R = 1.168; [CI: 1.153, 1.183] p≤0.05. Gender and race sub-analyses were also conducted, with associations found with men and non-Caucasian with amputation; O.R = 1.044; [CI: 1.036, 1.053] p≤0.05; race O.R = 2.893; [CI: 2.866, 2.920] p≤0.05.

      Conclusion

      Socioeconomic status along with gender and race are associated with non-traumatic lower extremity amputation. These findings add additional perspectives for which populations are disproportionately affected by disease and subsequent health outcomes. The authors anticipate the results presented may further assist in future public health screening methods and interventions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Chin JW, Teague L, Mclaren A-M, Mahoney JL. Non Traumatic Lower Extremity Amputations in Younger Patients: An 11-Year Retrospective Study.; 2012. doi:10.1111/j.1742-481X.2012.00945.x

        • Barnes J.A.
        • Eid M.A.
        • Creager M.A.
        • Goodney P.P.
        Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery disease.
        Arterioscler Thromb Vasc Biol. 2020; 40: 1808-1817https://doi.org/10.1161/ATVBAHA.120.314595
        • Clark N.
        Peripheral Arterial Disease in People with Diabetes.
        Diabetes Care. 2003; 26: 3333-3341https://doi.org/10.2337/diacare.26.12.3333
        • Van Houtum W.H.
        • Lavery L.A.
        Outcomes associated with diabetes-related amputations in the Netherlands and in the state of California, USA.
        J Intern Med. 1996; 240: 227-231https://doi.org/10.1046/j.1365-2796.1996.42868000.x
        • Armstrong D.G.
        • Lavery L.A.
        • Harkless L.B.
        Validation of a diabetic wound classification system: The contribution of depth, infection, and ischemia to risk of amputation.
        Diabetes Care. 1998; 21: 855-859https://doi.org/10.2337/diacare.21.5.855
        • Girijala R.L.
        • Bush R.L.
        Review of Socioeconomic Disparities in Lower Extremity Amputations: A Continuing Healthcare Problem in the United States.
        Cureus. 2018; 10https://doi.org/10.7759/cureus.3418
        • Ziegler-Graham K.
        • MacKenzie E.J.
        • Ephraim P.L.
        • Travison T.G.
        • Brookmeyer R.
        Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050.
        Arch Phys Med Rehabil. 2008; 89: 422-429https://doi.org/10.1016/j.apmr.2007.11.005
        • Dillingham T.R.
        • Pezzin L.E.
        • Shore A.D.
        Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations.
        Arch Phys Med Rehabil. 2005; 86: 480-486https://doi.org/10.1016/j.apmr.2004.06.072
      2. Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Rayana B, Schnitzler A, Kivimaki M, Sabia S, Singh-Manoux A. Articles Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study. Published online 2020. doi:10.1016/S2468-2667(19)30226-9

        • Arpey N.C.
        • Gaglioti A.H.
        • Rosenbaum M.E.
        How socioeconomic status affects patient perceptions of health care: A qualitative study.
        J Prim Care Community Heal. 2017; 8: 169-175https://doi.org/10.1177/2150131917697439
        • Moher D.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        Ann Intern Med. 2009; 151: 264https://doi.org/10.7326/0003-4819-151-4-200908180-00135
      3. Murad MH, Montori VM, Ioannidis JPA, Prasad K, Cook DJ, Guyatt G. Fixed-Effects and Random-Effects Models | Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd Ed | JAMAevidence | McGraw Hill Medical.; 2014. https://jamaevidence.mhmedical.com/content.aspx?sectionid=69031503&bookid=847. Accessed August 11, 2021.

        • Diez-Roux A.V.
        • Nieto F.J.
        • Muntaner C.
        • Tyroler H.A.
        • Comstock G.W.
        • Shahar E.
        • Cooper L.S.
        • Watson R.L.
        • Szklo M.
        Neighborhood Environments and Coronary Heart Disease: A Multilevel Analysis.
        Am J Epidemiol. 1997; 146: 48-63https://doi.org/10.1093/oxfordjournals.aje.a009191
        • Yammine K.
        • Hayek F.
        • Assi C.
        A meta-analysis of mortality after minor amputation among patients with diabetes and/or peripheral vascular disease.
        J Vasc Surg. 2020; 72: 2197-2207https://doi.org/10.1016/j.jvs.2020.07.086
        • Tang Z.Q.
        • Chen H.L.
        • Zhao F.F.
        Gender differences of lower extremity amputation risk in patients with diabetic foot: A meta-analysis.
        Int J Low Extrem Wounds. 2014; 13: 197-204https://doi.org/10.1177/1534734614545872
        • Pampel F.C.
        • Krueger P.M.
        • Denney J.T.
        Socioeconomic disparities in health behaviors.
        Annu Rev Sociol. 2010; 36: 349-370https://doi.org/10.1146/annurev.soc.012809.102529
        • Rhee S.Y.
        • Kim Y.S.
        Peripheral arterial disease in patients with type 2 diabetes mellitus.
        Diabetes Metab J. 2015; 39: 283-290https://doi.org/10.4093/dmj.2015.39.4.283
        • Sohn H.
        Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage Over the Life-Course.
        Popul Res Policy Rev. 2017; 36: 181-201https://doi.org/10.1007/s11113-016-9416-y
        • Hilmers A.
        • Hilmers D.C.
        • Dave J.
        Neighborhood disparities in access to healthy foods and their effects on environmental justice.
        Am J Public Health. 2012; 102: 1644-1654https://doi.org/10.2105/AJPH.2012.300865
        • Lee R.E.
        • Heinrich K.M.
        • Medina A.V.
        • Regan G.R.
        • Reese-Smith J.Y.
        • Jokura Y.
        • Maddock J.E.
        A Picture of the Healthful Food Environment in Two Diverse Urban Cities.
        Environ Health Insights. 2010; 4https://doi.org/10.4137/EHI.S3594
        • Bird Y.
        • Lemstra M.
        • Rogers M.
        • Moraros J.
        The relationship between socioeconomic status/income and prevalence of diabetes and associated conditions: A cross-sectional population-based study in Saskatchewan, Canada.
        Int J Equity Health. 2015; 14https://doi.org/10.1186/s12939-015-0237-0
        • Pande R.L.
        • Creager M.A.
        Socioeconomic inequality and peripheral artery disease prevalence in US adults.
        Circ Cardiovasc Qual Outcomes. 2014; 7: 532-539https://doi.org/10.1161/CIRCOUTCOMES.113.000618
        • El-Sayed A.M.
        • Vail D.
        • Kruk M.E.
        Ineffective insurance in lower and middle income countries is an obstacle to universal health coverage.
        J Glob Health. 2018; 8https://doi.org/10.7189/jogh.08.020402
        • Nguyen K.H.
        • Sommers B.D.
        Access and quality of care by insurance type for low-income adults before the affordable care act.
        Am J Public Health. 2016; 106: 1409-1415https://doi.org/10.2105/AJPH.2016.303156
        • Sommers A.S.
        • Paradise J.
        • Miller C.
        Physician willingness and resources to serve more medicaid patients: Perspectives from primary care physicians.
        Medicare Medicaid Res Rev. 2011; 1https://doi.org/10.5600/mmrr.001.02.a01
        • Weinick R.M.
        • Byron S.C.
        • Bierman A.S.
        Who can’t pay for health care?.
        J Gen Intern Med. 2005; 20: 504-509https://doi.org/10.1111/j.1525-1497.2005.0087.x
        • Williams D.R.
        • Mohammed S.A.
        • Leavell J.
        • Collins C.
        Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities.
        Ann N Y Acad Sci. 2010; 1186: 69-101https://doi.org/10.1111/j.1749-6632.2009.05339.x
        • Bloome D.
        Racial Inequality Trends and the Intergenerational Persistence of Income and Family Structure.
        Am Sociol Rev. 2014; 79: 1196-1225https://doi.org/10.1177/0003122414554947