{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:42:05Z","timestamp":1770460925543,"version":"3.49.0"},"reference-count":42,"publisher":"Hogrefe Publishing Group","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vasa"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p> Summary: Background: Lower limb major amputations represent a substantial public health burden in Hungary, where previous research revealed markedly high rates with significant spatial variations. Therefore, we aimed to assess to what extent healthcare and socio-economic factors in the local environment explain the regional disparity. Patients and methods: In a retrospective cohort analysis, based on the healthcare administrative data of the Hungarian population, lower limb major amputations were identified from 1<jats:sup>st<\/jats:sup> of January 2017 to 31<jats:sup>st<\/jats:sup> of December 2019. The permanent residence of the amputees on the local administrative level (197 geographic units) was used to identify potential healthcare (outpatient care, revascularisation activity) and socio-economic (educational attainment, local infrastructure and services, income and employment) determinants of amputations. Spatial effects were modelled using the spatial Durbin error regression model. Results: 10,209 patients underwent 11,649 lower limb major amputations in the observational period. In our spatial analysis, outpatient care was not associated with local amputation rates. However, revascularisation activity in a geographic unit entailed an increased rate of amputations, while revascularisations in the neighbouring areas were associated with a lower rate of amputations, resulting in an overall neutral effect (\u03b2=\u22120.002, 95% CI: \u22120.05 \u2013 0.04, p=0.96). The local socio-economic environment had a significant direct inverse association with amputations (\u03b2=\u22127.45, 95% CI: \u221210.50 \u2013 \u22124.42, p&lt;0.0001) . Our spatial model showed better performance than the traditional statistical modelling (ordinary least squares regression), explaining 37% of the variation in amputations rates. Conclusions: Regional environmental factors explain a substantial portion of spatial disparities in amputation practice. While the socio-economic environment shows a significant inverse relationship with the regional amputation rates, the impact of the local healthcare-related factors (outpatient care, revascularisation activity) is not straightforward. Unravelling the impact of the location on amputation practice requires complex spatial modelling, which may guide efficient healthcare policy decisions. <\/jats:p>","DOI":"10.1024\/0301-1526\/a000995","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T08:48:17Z","timestamp":1646988497000},"page":"158-166","source":"Crossref","is-referenced-by-count":6,"title":["Spatial analysis of factors impacting lower limb major amputation \t\t\t\t\trates in Hungary"],"prefix":"10.1024","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-6175","authenticated-orcid":true,"given":"Endre","family":"Kolossv\u00e1ry","sequence":"first","affiliation":[{"name":"Department of Angiology, St. Imre University Teaching \t\t\t\t\tHospital, Budapest, Hungary"},{"name":"Department of Vascular Surgery (Section of \t\t\t\t\tAngiology), Heart and Vascular Center, Semmelweis University of Medicine, \t\t\t\t\tBudapest, 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