ArticleBMJ open2013
Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 61 citations in OpenAlex.
- Risk factors for diabetic foot complications in type 2 diabetes-A systematic review.Endocrinology, diabetes & metabolism · 2021Pooled it
- Socioeconomic and ethnic disparities in major lower limb amputation related to peripheral arterial disease in England.BJS open · 2025Article
- The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil.Journal of clinical medicine · 2024Article
- Visit to Visit Hemoglobin A1c Variation and Long-term Risk of Major Adverse Limb Events in Patients With Type 2 Diabetes.The Journal of clinical endocrinology and metabolism · 2023Article
- Factors influencing diabetes-related foot ulcer healing in Australian adults: A prospective cohort study.Diabetic medicine : a journal of the British Diabetic Association · 2023Article
- Prognostic Value of Wagner Grade and Platelet Level in Diabetics with Infected Foot Ulcers After Antibiotic Therapy.Infection and drug resistance · 2023Article
- Level of education is associated with coronary heart disease and chronic kidney disease in individuals with type 2 diabetes: a population-based study.BMJ open diabetes research & care · 2022Article
- Disparities in Advanced Peripheral Arterial Disease Presentation by Socioeconomic Status.World journal of surgery · 2022Article
- Diabetic foot complications-lessons learned from real-world data derived from a specialized Austrian hospital.Wiener klinische Wochenschrift · 2022Article
- Association between socioeconomic position and diabetic foot ulcer outcomes: a population-based cohort study in South Korea.BMC public health · 2021Article
- Assessing data on the incidence of lower limb amputation in diabetes.Diabetologia · 2021Article
- National diabetes registries: do they make a difference?Acta diabetologica · 2021Review
- The Potential Impact of Social Genomics on Wound Healing.Advances in wound care · 2020Review
- Article
- The effect of income and insurance on the likelihood of major leg amputation.Journal of vascular surgery · 2019Article
- Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium.Diabetologia · 2018Article
- Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 - an analysis of more than 30 million inhabitants.Clinical epidemiology · 2018Article
- Predictors of major amputation.Internal and emergency medicine · 2017Article
- Remote ischaemic conditioning in the context of type 2 diabetes and neuropathy: the case for repeat application as a novel therapy for lower extremity ulceration.Cardiovascular diabetology · 2016Review
- Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection.Journal of diabetes research · 2016Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveLow socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.
designPopulation-based register study.
settingFinland, nationwide individual-level data.
participantsAll persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).
methodsThree outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.
resultsThe risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.
conclusionsAccording to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.
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Registered trials
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