Ethnic differences in lower limb revascularisation and amputation rates. Implications for the aetiopathology of atherosclerosis?

OBJECTIVE: Peripheral arterial disease, as a result of atherosclerosis, is the commonest reason for lower limb revascularisation and amputation in England. We describe the prevalence rate of these procedures among the White, South Asian and Black populations living in England and describe the association of ethnicity to amputation, both with and without, revascularisation.

METHOD: We extracted data from 90 million English hospital admissions between 2003 and 2009 and calculated prevalence rates among 50-84 year olds using census data. Logistic regression demonstrated whether ethnicity was related to amputation, both with and without revascularisation, independent of demographic (age, sex, social class) and disease risk factors (diabetes, hypertension, hypercholesterolaemia, coronary and cerebral vascular disease, smoking).

RESULTS: There were 25,308 amputations and 136,215 revascularisations. The age adjusted prevalence rate for amputation was 26/100,000 and revascularisation 142/100,000. The prevalence ratio (95% confidence intervals) (White British=100) of amputation in the Asian and Black populations was; 60 (54-66) and 169 (155-183) respectively with revascularisation ratios; 89 (86-92) and 94 (89-98) respectively. South Asians had approximately half the risk of amputation both with and without a revascularisation than Whites despite much higher rates of known atherosclerotic risk factors. The odds of having an amputation without any revascularisation was 63% higher in Blacks but fully attenuated by demographic and disease risk factors.

CONCLUSION: South Asians experience the lowest rate of both major lower limb amputation and revascularisation in England. The association cannot be explained by demographic or cardiovascular risk factors. This may have implications in the aetiopathology of atherosclerosis.