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Gender differences in the impact of poverty on health: disparities in risk of diabetes‐related amputation
Author(s) -
Amin L.,
Shah B. R.,
Bierman A. S.,
Lipscombe L. L.,
Wu C. F.,
Feig D. S.,
Booth G. L.
Publication year - 2014
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12507
Subject(s) - medicine , hazard ratio , amputation , demography , incidence (geometry) , population , residence , gerontology , diabetes mellitus , socioeconomic status , confidence interval , surgery , environmental health , physics , sociology , optics , endocrinology
Aims To assess the combined impact of socio‐economic status and gender on the risk of diabetes‐related lower extremity amputation within a universal healthcare system. Methods We conducted a population‐based cohort study using administrative health databases from Ontario, Canada. Adults with pre‐existing or newly diagnosed diabetes ( N = 606 494) were included and the incidence of lower extremity amputation was assessed for the period 1 April 2002 to 31 March 2009. Socio‐economic status was based on neighbourhood‐level income groups, assigned to individuals using the Canadian Census and their postal code of residence. Results Low socio‐economic status was associated with a significantly higher incidence of lower extremity amputation (27.0 vs 19.3 per 10,000 person‐years in the lowest (Q1) vs the highest (Q5) socio‐economic status quintile. This relationship persisted after adjusting for primary care use, region of residence and comorbidity, and was greater among men (adjusted Q1:Q5 hazard ratio 1.41, 95% CI 1.30–1.54; P < 0.0001 for all male gender–socio‐economic status interactions) than women (hazard ratio 1.20, 95% CI 1.06–1.36). Overall, the incidence of lower extremity amputation was higher among men than women (hazard ratio for men vs women: 1.87, 95% CI 1.79–1.96), with the greatest disparity between men in the lowest socio‐economic status category and women in the highest (hazard ratio 2.39, 95% CI 2.06–2.77 and hazard ratio 2.30, 95% CI 1.97–2.68, for major and minor amputation, respectively). Conclusions Despite universal access to hospital and physician care, we found marked socio‐economic status and gender disparities in the risk of lower extremity amputation among patients with diabetes. Men living in low‐income neighbourhoods were at greatest risk.