Podiatry Department, Dandenong Hospital, Melbourne, Victoria, 3172, Australia.
J Foot Ankle Res. 2011 Jun 20;4:17. doi: 10.1186/1757-1146-4-17.
Information describing variation in health outcomes for individuals with diabetes related foot disease, across socioeconomic strata is lacking. The aim of this study was to investigate variation in rates of hospital separations for diabetes related foot disease and the relationship with levels of social advantage and disadvantage.
Using the Index of Relative Socioeconomic Disadvantage (IRSD) each local government area (LGA) across Victoria was ranked from most to least disadvantaged. Those LGAs ranked at the lowest end of the scale and therefore at greater disadvantage (Group D) were compared with those at the highest end of the scale (Group A), in terms of total and per capita hospital separations for peripheral neuropathy, peripheral vascular disease, foot ulceration, cellulitis and osteomyelitis and amputation. Hospital separations data were compiled from the Victorian Admitted Episodes Database.
Total and per capita separations were 2,268 (75.3/1,000 with diabetes) and 2,734 (62.3/1,000 with diabetes) for Group D and Group A respectively. Most notable variation was for foot ulceration (Group D, 18.1/1,000 versus Group A, 12.7/1,000, rate ratio 1.4, 95% CI 1.3, 1.6) and below knee amputation (Group D 7.4/1,000 versus Group A 4.1/1,000, rate ratio 1.8, 95% CI 1.5, 2.2). Males recorded a greater overall number of hospital separations across both socioeconomic strata with 66.2% of all separations for Group D and 81.0% of all separations for Group A recorded by males. However, when comparing mean age, males from Group D tended to be younger compared with males from Group A (mean age; 53.0 years versus 68.7 years).
Variation appears to exist for hospital separations for diabetes related foot disease across socioeconomic strata. Specific strategies should be incorporated into health policy and planning to combat disparities between health outcomes and social status.
缺乏有关糖尿病相关足部疾病患者健康结果在社会经济阶层之间差异的信息。本研究的目的是调查糖尿病相关足部疾病住院率的差异，并研究其与社会优势和劣势程度的关系。
使用相对社会经济劣势指数（IRSD），对维多利亚州的每个地方政府区域（LGA）进行排名，从最不利到最有利。排在最底层（D 组）的 LGA 被认为处于更大的劣势，因此与排在最高层（A 组）的 LGA 相比，D 组的外周神经病变、外周血管疾病、足部溃疡、蜂窝织炎和骨髓炎以及截肢的总住院率和人均住院率均更高。住院数据来自维多利亚州住院病例数据库。
D 组和 A 组的总住院率和人均住院率分别为 2268（1000 人中有 75.3 例）和 2734（1000 人中有 62.3 例）。最显著的差异是足部溃疡（D 组 18.1/1000，A 组 12.7/1000，发病率比 1.4，95%CI 1.3，1.6）和膝下截肢（D 组 7.4/1000，A 组 4.1/1000，发病率比 1.8，95%CI 1.5，2.2）。男性在两个社会经济阶层中的住院人数都更多，D 组的所有住院病例中有 66.2%，A 组的所有住院病例中有 81.0%是男性。然而，在比较平均年龄时，D 组的男性比 A 组的男性更年轻（平均年龄分别为 53.0 岁和 68.7 岁）。
在糖尿病相关足部疾病的住院治疗方面，社会经济阶层之间似乎存在差异。应将具体策略纳入卫生政策和规划中，以解决健康结果与社会地位之间的差距。
