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

Abstract

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. 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. 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). 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.