Bilal Ahmad, Amarasena Danuksha K, Pillai Anand
Orthopaedics and Traumatology, Wythenshawe Hospital, Manchester, GBR.
Faculty of Medicine, University of Manchester, Manchester, GBR.
Cureus. 2023 Aug 31;15(8):e44426. doi: 10.7759/cureus.44426. eCollection 2023 Aug.
Objective The prevalence of diabetes and its complications are on the rise worldwide. This is particularly prevalent in low- and middle-income countries. The Index of Multiple Deprivation (IMD) is a measure of relative social deprivation. This index classifies England into small subsets called lower layer super output areas (LSOAs) and then ranks these LSOAs into deciles from the most deprived to the least deprived area. We used this to analyse the relationship between deprivation and outcomes in diabetic foot disease (DFD). Methods We evaluated patients admitted to our multidisciplinary unit with DFD over a five-year period. Their postal codes were used to classify these patients into IMD deciles with decile 1 representing the 10% of most deprived LSOAs and decile 10 the least deprived areas in the country. We used this classification to analyse the relationship between deprivation and its influence on surgical outcomes and lower limb amputation. We specifically compared those falling in the top five against the bottom five deciles. Results Our cohort consisted of 70 patients with diabetes who had surgery on their diabetic foot. Of this cohort, 33 (47%) of these underwent amputation. The majority of these procedures were minor amputations conducted on the forefoot (75.6%) and there were no below knee amputations. Of those requiring an amputation, 27 patients (81.8%) had an IMD decile of 5 or below, and only six (18.2%) patients had above 5. Conclusion Our study shows that the likelihood of amputations related to diabetic foot disease is inversely proportional to the index of multiple deprivation.
目的 糖尿病及其并发症在全球的患病率呈上升趋势。这在低收入和中等收入国家尤为普遍。多重剥夺指数（IMD）是衡量相对社会剥夺程度的指标。该指数将英格兰划分为称为下层超级输出区（LSOA）的小子集，然后将这些LSOA从最贫困到最不贫困的地区排名为十分位数。我们用此来分析贫困与糖尿病足病（DFD）结局之间的关系。方法 我们评估了在五年期间入住我们多学科病房的DFD患者。他们的邮政编码用于将这些患者分类到IMD十分位数中，十分位数1代表该国最贫困的10%的LSOA，十分位数10代表最不贫困的地区。我们用这种分类来分析贫困及其对手术结局和下肢截肢的影响之间的关系。我们特别比较了处于前五个十分位数与后五个十分位数的患者。结果 我们的队列包括70例糖尿病足接受手术的患者。在这个队列中，33例（47%）接受了截肢手术。这些手术大多数是在前足进行的小截肢（75.6%），没有膝下截肢。在需要截肢的患者中，27例（81.8%）的IMD十分位数为5或更低，只有6例（18.2%）患者的IMD十分位数高于5。结论 我们的研究表明，与糖尿病足病相关的截肢可能性与多重剥夺指数成反比。
