Geographic variation in first lower extremity amputations related to diabetes and/or peripheral arterial disease

• Published in: Canadian journal of cardiology
• Main Authors: Drudi, Laura M., Blanchette, Virginie, Sylvain-Morneau, Jérémie, Poirier, Paul, Blais, Claudia, O’Connor, Sarah
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 10.09.2024
• ISSN: 0828-282X; 1916-7075; 1916-7075
• DOI: 10.1016/j.cjca.2024.09.006

To assess trends of first cases of lower extremity amputations (LEA) related to diabetes and/or peripheral arterial disease (PAD), according to areas of residency and neighbourhood material/social deprivation quintiles, in the province of Quebec, Canada. Using the Quebec Integrated Chronic Disease Surveillance System, we calculated crude and age-standardized annual incidence rates of first LEA (total, minor and major) among adults ≥40 years with diabetes and/or PAD between fiscal years 2006 to 2019. Area of residency was compiled in three categories: 1) Montreal/other census metropolitan areas (CMAs), 2) midsize agglomerations (10,000 to 100,000 inhabitants), and 3) small towns/rural areas (<10,000 inhabitants). We also stratified by neighbourhood material/social deprivation quintiles. One-year and 5-year all-cause mortality after first LEA was compared between areas of residency. Among the 10,275 individuals who had a first LEA, age-standardized LEA rates remained stable between 2006 and 2019, while major LEA declined in all geographical areas whereas minor LEA increased (31.6%) in small towns/rural areas. In 2019, age-standardized LEA rates were higher in midsize agglomerations and small towns/rural areas compared with CMAs. Age-standardized LEA rates in 2019 were higher among the most deprived quintile compared with the most privileged quintile, for both material/social deprivation. No difference was observed in mortality after first LEA between areas of residency. There are health disparities in the burden of diabetes and PAD related first LEA in the province of Quebec. In order to improve preventive care and reduce the burden of LEA, targeted actions should be taken among the most deprived groups and rural settings.