{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:56:48Z","timestamp":1789505808660,"version":"build-2803163510"},"reference-count":18,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T00:00:00Z","timestamp":1415664000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J R Soc Med"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We describe the prevalence of major lower limb amputation across England and its relationship with revascularisation, patient demography and disease risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>England 1 April 2003 to 31 March 2009.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients aged 50\u201384 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Age standardised prevalence rates were calculated using Hospital Episode Statistics as the numerator with census data as the denominator. The outcome measure \u2018amputation with revascularisation\u2019 was created if an amputation could be linked with a revascularisation. Logistic regression determined the odds of having an amputation with a revascularisation across England. Regression was performed unadjusted and repeated after controlling for demographic (age, sex, social deprivation) and disease risk factors (diabetes, hypertension, coronary heart disease, cerebrovascular disease, smoking).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 25,312 amputations and 136,215 revascularisations, and 7543 cases were linked. The prevalence rate per 100,000 (95% confidence intervals) for amputation was 26.3 (26.0\u201326.6) with rates significantly higher in Northern England (North: 31.7; 31.0\u201332.3, Midlands: 26.0; 25.3\u201326.7, South: 23.1; 22.6\u201323.5). The revascularisation rate was 141.6 (140.8\u2013142.3) with significantly higher rates again in Northern England (North: 182.1; 180.5\u2013183.7, Midlands: 121.3; 119.8\u2013122.9, South 124.9; 123.9\u2013125.8). The odds of having an amputation with a revascularisation remained significantly higher in the North (OR 1.22; 1.13\u20131.33) even after controlling demographic and disease risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is a North\u2013South divide in England for both major lower limb amputation and revascularisation. The higher odds of having an amputation with a revascularisation in the North were not fully explained by greater levels of deprivation or disease risk factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0141076814557301","type":"journal-article","created":{"date-parts":[[2014,11,11]],"date-time":"2014-11-11T22:36:41Z","timestamp":1415745401000},"page":"483-489","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":92,"title":["Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data"],"prefix":"10.1177","volume":"107","author":[{"given":"Naseer","family":"Ahmad","sequence":"first","affiliation":[{"name":"Liverpool Vascular and Endovascular Service (LiVES), Royal Liverpool University Hospital, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G Neil","family":"Thomas","sequence":"additional","affiliation":[{"name":"Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paramjit","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Primary Care Research, University of Birmingham, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Wirral University Hospital NHS Foundation Trust, Wirral CH49, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Torella","sequence":"additional","affiliation":[{"name":"Liverpool Vascular and Endovascular Service (LiVES), Royal Liverpool University Hospital, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,11,11]]},"reference":[{"key":"bibr1-0141076814557301","first-page":"118","volume":"12","author":"Dormandy J","year":"1999","journal-title":"Sem Vasc Surg"},{"key":"bibr2-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1177\/1358836X9800300311"},{"key":"bibr3-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2006.09.024"},{"key":"bibr4-0141076814557301","first-page":"381","volume":"326","author":"Fowkes FGR","year":"1991","journal-title":"Int J Epidemiol"},{"key":"bibr5-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.18.2.185"},{"key":"bibr6-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(03)00204-1"},{"key":"bibr7-0141076814557301","unstructured":"The Amputee Statistical Database for the United Kingdom 2006\/2007.\n                      Information Service Division NHS Scotland. Edinburgh, 2009\n                      . See www.limbless-statistics.org\/documents\/Report2006-07.pdf (last checked 4 April 2014)."},{"key":"bibr8-0141076814557301","unstructured":"What is Hospital Episode Statistic Data? Hesonline, 2014\n                      . See http:\/\/www.hscic.gov.uk\/hes (last checked 4 April 2014)."},{"key":"bibr9-0141076814557301","unstructured":"OPCS-4 Classification. The\n                      NHS Classifications Service, 2011. OPCS code 4.5\n                      . See http:\/\/www.connectingforhealth.nhs.uk\/systemsandservices\/data\/clinicalcoding\/codingstandards\/opcs4 (last checked 4 April 2014)."},{"key":"bibr10-0141076814557301","unstructured":"International Statistical Classification of Diseases and Related Health Problems 10th Revision.\n                      World Health Organisation, 2010\n                      . See http:\/\/apps.who.int\/ classifications\/icd10\/browse\/2010\/en (last checked 4 April 2014)."},{"key":"bibr11-0141076814557301","unstructured":"Population estimate by Age and Sex mid 2001\u20132008.\n                      Office for National Statistics, 2011\n                      . See http:\/\/www.ons.gov.uk\/ons\/taxonomy\/index.html?nscl=Population+Estimates+by+Age+and+Sex (last checked 4 April 2014)."},{"key":"bibr12-0141076814557301","volume-title":"Essentials of Medical Statistics","author":"Kirkwood BR","year":"1988"},{"key":"bibr13-0141076814557301","unstructured":"The English Indices of Deprivation 2010.\n                      Office for National Statistics, 2011\n                      . See https:\/\/www.gov.uk\/government\/publications\/english-indices-of-deprivation-2010 (last checked 4 April 2014)."},{"key":"bibr14-0141076814557301","volume-title":"SPSS for Windows","author":"SPSS Inc","year":"2011"},{"key":"bibr15-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7092"},{"key":"bibr16-0141076814557301","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2468-6"},{"key":"bibr17-0141076814557301","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.18.4.509"},{"key":"bibr18-0141076814557301","first-page":"121","volume":"99","author":"Earnshaw C","year":"2012","journal-title":"Br J Surg"}],"container-title":["Journal of the Royal Society of Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0141076814557301","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0141076814557301","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0141076814557301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:46:13Z","timestamp":1777527973000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0141076814557301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,11]]},"references-count":18,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2014,12]]}},"alternative-id":["10.1177\/0141076814557301"],"URL":"https:\/\/doi.org\/10.1177\/0141076814557301","relation":{},"ISSN":["0141-0768","1758-1095"],"issn-type":[{"value":"0141-0768","type":"print"},{"value":"1758-1095","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11,11]]}}}