Geospatial mapping and data linkage uncovers variability in outcomes of foot disease according to multiple deprivation: a population cohort study of people with diabetes.
Open accessAbstract
AIMS/HYPOTHESIS: Our aim was to investigate the geospatial distribution of diabetic foot ulceration (DFU), lower extremity amputation (LEA) and mortality rates in people with diabetes in small geographical areas with varying levels of multiple deprivation. METHODS: We undertook a population cohort study to extract the health records of 112,231 people with diabetes from the Scottish Care Information - Diabetes Collaboration (SCI-Diabetes) database. We linked this to health records to identify death, LEA and DFU events. These events were geospatially mapped using multiple deprivation maps for the geographical area of National Health Service (NHS) Greater Glasgow and Clyde. Tests of spatial autocorrelation and association were conducted to evaluate geographical variation and patterning, and the association between prevalence-adjusted outcome rates and multiple deprivation by quintile. RESULTS: Within our health board region, people with diabetes had crude prevalence-adjusted rates for DFU of 4.6% and for LEA of 1.3%, and an incidence rate of mortality preceded by either a DFU or LEA of 10.5 per 10,000 per year. Spatial autocorrelation identified statistically significant hot spot (high prevalence) and cold spot (low prevalence) clusters for all outcomes. Small-area maps effectively displayed near neighbour clustering across the health board geography. Disproportionately high numbers of hot spots within the most deprived quintile for DFU (p < 0.001), LEA (p < 0.001) and mortality (p < 0.001) rates were found. Conversely, a disproportionately higher number of cold spots was found within the least deprived quintile for LEA (p < 0.001). CONCLUSIONS/INTERPRETATION: In people with diabetes, DFU, LEA and mortality rates are associated with multiple deprivation and form geographical neighbourhood clusters.
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People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.
“People identifying as non-Hispanic Black and Hispanic of any race have more advanced diabetic foot ulcers and peripheral artery disease at initial presentation and are more likely to undergo lower extremity amputation without a lower extremity revascularization attempt.[16][17][18]”
From Diabetic Foot Ulcers (2023) · cites this paper as [17]
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Self-citation
- Authors
- Hurst, J. E., Barn, R., Gibson, L., Innes, H., Bus, S. A., Kennon, B., Wylie, D., & Woodburn, J.
- Affiliations
- Glasgow Caledonian University (GB)
- University of Edinburgh (GB)
- Amsterdam University Medical Centers (NL)
- Queen Elizabeth University Hospital (GB)
- Corresponding author
- Hurst, Joanne E.
- Venue
- Diabetologia
- Published
- 2019-12-17
- Volume
- 63
- Issue
- 3
- Pages
- 659-667
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6997267
- OpenAlex
- W2996177038
- Cited by
- 53
- References
- 28
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 22 · 2023: 2 · 2022: 7 · 2021: 9
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- ResearchOnline (Glasgow Caledonian University) (acceptedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- ResearchOnline (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion, cc-by)
- Funders
- Glasgow Caledonian University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- diabetic foot ulcer, lower limb amputation, diabetes mortality, multiple deprivation, spatial clustering, small-area mapping, health disparities, NHS Greater Glasgow and Clyde
- MeSH terms
- Aged, Aged, 80 and over, Cultural Deprivation, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Geography, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Scotland, Socioeconomic Factors, Cohort Studies, Information Storage and Retrieval, Treatment Outcome, Diabetic Foot, Electronic Health Records, Geographic Mapping, Patient Outcome Assessment
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