Key result
Socioeconomic deprivation was a significant predictor of major lower limb amputation (HR 0.502) following bypass surgery for chronic limb-threatening ischaemia, whereas health literacy levels did not significantly affect clinical outcomes.
Why the study?
Research has suggested a relationship between health literacy, socioeconomic status, and health-related outcomes, but their association with outcomes after infra-inguinal bypass surgery for chronic limb-threatening ischaemia required investigation.
Do health literacy and socioeconomic deprivation predict outcomes in patients undergoing lower limb surgical revascularisation for chronic limb-threatening ischaemia?
Cross-Sectional (n=50)
No
Do health literacy and socioeconomic deprivation predict outcomes in patients undergoing lower limb surgical revascularisation for chronic limb-threatening ischaemia?
Socioeconomic deprivation and lower haemoglobin levels are significant predictors of major lower limb amputation following bypass surgery for chronic limb-threatening ischaemia.
Introduction: Research has suggested a relationship between health literacy, socioeconomic status and health-related outcomes. The aim of the study was to study the association between health literacy, socioeconomic status and outcomes following infra-inguinal bypass surgery for chronic limb-threatening ischaemia (CLTI). Methods: Patients with CLTI undergoing lower limb surgical bypass graft operations between January 2016 and December 2018 were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s health literacy as inadequate, problematic, sufficient or excellent. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD). Primary outcomes were major lower limb amputation (MLLA) and adverse cardiovascular events. Secondary outcomes included length of hospital stay, and early postoperative complications including pneumonia, surgical site and graft infection. Kaplan– Meier survival curves were used to compare health literacy and amputation, and Cox proportional regression analysis was conducted to identify differences in limb loss risk against health literacy and social deprivation levels. Results: The study consisted of 50 patients with an average age of 70±8.7 years. The participants' levels of health literacy were classified as inadequate (28%), problematic (38%), sufficient (24%) or excellent (10%). Approximately 40% of the patients lived in the most deprived areas. While all health literacy groups had similar postoperative outcomes, low health literacy was connected with lower socioeconomic status (r=0.308, p=0.029). IMD (p=0.017, HR 0.502 (95% CI 0.285 to 0.883)) and haemoglobin (p=0.001, HR 0.919 (95% CI 0.872 to 0.968)) were significant predictors of MLLA. Conclusion: Patients with lower health literacy are more likely to face higher levels of social deprivation, which may predict amputation following bypass surgery. Enhancing health literacy could play a role in reducing health disparities caused by social deprivation, thereby potentially addressing a vascular James Lind Alliance priority.
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Bishop et al. (2023) conducted a cross-sectional in Chronic limb-threatening ischaemia (CLTI) (n=50). Socioeconomic deprivation (Index of Multiple Deprivation) vs. Lower socioeconomic deprivation was evaluated on Major lower limb amputation (MLLA) (HR 0.502, 95% CI 0.285 to 0.883, p=0.017). Socioeconomic deprivation was a significant predictor of major lower limb amputation (HR 0.502) following bypass surgery for chronic limb-threatening ischaemia, whereas health literacy levels did not significantly affect clinical outcomes.
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