High incidence of vascular reconstructions in socioeconomically deprived areas of an urban Swedish population

Abstract

Background: In Malmö approximately 250 000 citizens live in 17 administrative areas with substantial socioeconomic differences. At the single centre for arterial reconstruction, Malmö University Hospital, all procedures are registered prospectively. Methods: Between 1987 and 2002, 1832 Malmö citizens underwent reconstruction for peripheral arterial disease, either intermittent claudication (IC) or critical leg ischaemia (CLI). A socioeconomic score based on migration rate, percentage of residents with foreign citizenship/residents with foreign background, social welfare support dependency and unemployment rate has previously been developed and validated for each area. The relationship between socioeconomic score and area-specific standardized morbidity ratios (SMRs) after vascular reconstruction was analysed by population-weighted linear regression. Results: The mean incidence of vascular reconstruction was 76 (range 27-106) per 100 000 person years. Age- and sex-adjusted SMRs ranged from 0.57 to 1.39. A strong correlation between SMR and socioeconomic score was found overall (R = 0.63; P = 0.007), in men (R = 0.63; P = 0.007) and in women (R = 0.58; P = 0.039), and for IC (R = 0.58; P = 0.015) and CLI (R = 0.58; P = 0.015). Conclusion: In an urban population with similar access to medical care, vascular reconstruction rates varied substantially. High-rate areas were characterized by inferior socioeconomic circumstances and a higher prevalence of smoking, hypertension and obesity. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.