Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database
There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulc...
Gespeichert in:
| Veröffentlicht in: | PloS one 2013-03, Vol.8 (3), p.e58948-e58948 |
|---|---|
| Hauptverfasser: | , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e58948 |
|---|---|
| container_issue | 3 |
| container_start_page | e58948 |
| container_title | PloS one |
| container_volume | 8 |
| creator | Petherick, Emily S Cullum, Nicky A Pickett, Kate E |
| description | There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.
Using The Health Improvement Network (THIN) database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile). We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.
The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78). Documented provision of compression therapy did not vary with deprivation.
A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006) were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the inequalities experienced by leg ulcer patients may be exacerbated by reduced access to guideline-based management. |
| doi_str_mv | 10.1371/journal.pone.0058948 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_1330889300</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A478207778</galeid><doaj_id>oai_doaj_org_article_2c0dd5e3963b44adb34ca6c5a1abc7d2</doaj_id><sourcerecordid>A478207778</sourcerecordid><originalsourceid>FETCH-LOGICAL-c692t-2b2b8e4bdaad1ba1b89917180f450ca14a474d2248e375d266e2eb28855f00113</originalsourceid><addsrcrecordid>eNqNk01v1DAQhiMEomXhHyCIhITgsIu_kjgckKoK6EoVlaBwtSb2JJtV1t7GyYre-eE4u2m1QT2gHBJ7nnmdeccTRS8pWVCe0Q9r17cWmsXWWVwQkshcyEfRKc05m6eM8MdH3yfRM-_XAeIyTZ9GJ4wnLCOJOI3-LO0OfVdX0NXOxq6MuxXGWJaou2FlcNvWuzFo98Gibw3aGKyJN2Chwg3aPbtD63ofN1jFfaOx9R9jiLVbubaLfdeb27j3ta32ItcXy2-xgQ4K8Pg8elJC4_HF-J5FP798vj6_mF9efV2en13OdZqzbs4KVkgUhQEwtABayDynGZWkFAnRQAWITBjGhESeJYalKTIsmJRJUhJCKZ9Frw-628Z5NRroFeWcSJlzQgKxPBDGwVqF0jfQ3ioHtdpvuLZS0Ha1blAxTYxJkOcpL4QAU3ChIdUJUCh0ZljQ-jSe1hcbNDq41EIzEZ1GbL1SldspnhKWhl7NonejQOtu-tAltam9xqYBi8Ho8N80T2nG5FDZm3_Qh6sbqQpCAbUtXThXD6LqTGSSkSzLZKAWD1DhMbipdbhtZR32JwnvJwmB6fB3V0HvvVr--P7_7NWvKfv2iF0hNN3Ku6YfLqOfguIA6tZ532J5bzIlahiWOzfUMCxqHJaQ9uq4QfdJd9PB_wJAaA_i</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1330889300</pqid></control><display><type>article</type><title>Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Petherick, Emily S ; Cullum, Nicky A ; Pickett, Kate E</creator><contributor>Mendelson, John E.</contributor><creatorcontrib>Petherick, Emily S ; Cullum, Nicky A ; Pickett, Kate E ; Mendelson, John E.</creatorcontrib><description>There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.
Using The Health Improvement Network (THIN) database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile). We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.
The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78). Documented provision of compression therapy did not vary with deprivation.
A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006) were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the inequalities experienced by leg ulcer patients may be exacerbated by reduced access to guideline-based management.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0058948</identifier><identifier>PMID: 23527054</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analysis ; Cohort analysis ; Cohort Studies ; Compression ; Compression tests ; Compression therapy ; Computer programs ; Confidence intervals ; Data bases ; Databases, Factual ; Deprivation ; Diabetes ; Diagnostic systems ; Doppler effect ; Economic factors ; Economic indicators ; Economics ; Feasibility studies ; Female ; Health aspects ; Humans ; Identification methods ; Incidence ; Investigations ; Leg ; Leg Ulcer - diagnosis ; Leg Ulcer - epidemiology ; Leg Ulcer - therapy ; Leg ulcers ; Male ; Management ; Medical diagnosis ; Medical research ; Medicine ; Middle Aged ; Nursing ; Obesity ; Patients ; Prevalence ; Primary care ; Quality ; Risk analysis ; Risk assessment ; Risk factors ; Socioeconomic Factors ; Socioeconomics ; Statistical analysis ; Therapy ; Ulcers ; Ultrasound ; Varicose Ulcer - diagnosis ; Varicose Ulcer - epidemiology ; Varicose Ulcer - therapy ; Vascular diseases ; Wound healing ; Young Adult</subject><ispartof>PloS one, 2013-03, Vol.8 (3), p.e58948-e58948</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Petherick et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Petherick et al 2013 Petherick et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2b2b8e4bdaad1ba1b89917180f450ca14a474d2248e375d266e2eb28855f00113</citedby><cites>FETCH-LOGICAL-c692t-2b2b8e4bdaad1ba1b89917180f450ca14a474d2248e375d266e2eb28855f00113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602605/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602605/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23527054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Mendelson, John E.</contributor><creatorcontrib>Petherick, Emily S</creatorcontrib><creatorcontrib>Cullum, Nicky A</creatorcontrib><creatorcontrib>Pickett, Kate E</creatorcontrib><title>Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.
Using The Health Improvement Network (THIN) database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile). We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.
The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78). Documented provision of compression therapy did not vary with deprivation.
A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006) were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the inequalities experienced by leg ulcer patients may be exacerbated by reduced access to guideline-based management.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Compression</subject><subject>Compression tests</subject><subject>Compression therapy</subject><subject>Computer programs</subject><subject>Confidence intervals</subject><subject>Data bases</subject><subject>Databases, Factual</subject><subject>Deprivation</subject><subject>Diabetes</subject><subject>Diagnostic systems</subject><subject>Doppler effect</subject><subject>Economic factors</subject><subject>Economic indicators</subject><subject>Economics</subject><subject>Feasibility studies</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Incidence</subject><subject>Investigations</subject><subject>Leg</subject><subject>Leg Ulcer - diagnosis</subject><subject>Leg Ulcer - epidemiology</subject><subject>Leg Ulcer - therapy</subject><subject>Leg ulcers</subject><subject>Male</subject><subject>Management</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Nursing</subject><subject>Obesity</subject><subject>Patients</subject><subject>Prevalence</subject><subject>Primary care</subject><subject>Quality</subject><subject>Risk analysis</subject><subject>Risk assessment</subject><subject>Risk factors</subject><subject>Socioeconomic Factors</subject><subject>Socioeconomics</subject><subject>Statistical analysis</subject><subject>Therapy</subject><subject>Ulcers</subject><subject>Ultrasound</subject><subject>Varicose Ulcer - diagnosis</subject><subject>Varicose Ulcer - epidemiology</subject><subject>Varicose Ulcer - therapy</subject><subject>Vascular diseases</subject><subject>Wound healing</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk01v1DAQhiMEomXhHyCIhITgsIu_kjgckKoK6EoVlaBwtSb2JJtV1t7GyYre-eE4u2m1QT2gHBJ7nnmdeccTRS8pWVCe0Q9r17cWmsXWWVwQkshcyEfRKc05m6eM8MdH3yfRM-_XAeIyTZ9GJ4wnLCOJOI3-LO0OfVdX0NXOxq6MuxXGWJaou2FlcNvWuzFo98Gibw3aGKyJN2Chwg3aPbtD63ofN1jFfaOx9R9jiLVbubaLfdeb27j3ta32ItcXy2-xgQ4K8Pg8elJC4_HF-J5FP798vj6_mF9efV2en13OdZqzbs4KVkgUhQEwtABayDynGZWkFAnRQAWITBjGhESeJYalKTIsmJRJUhJCKZ9Frw-628Z5NRroFeWcSJlzQgKxPBDGwVqF0jfQ3ioHtdpvuLZS0Ha1blAxTYxJkOcpL4QAU3ChIdUJUCh0ZljQ-jSe1hcbNDq41EIzEZ1GbL1SldspnhKWhl7NonejQOtu-tAltam9xqYBi8Ho8N80T2nG5FDZm3_Qh6sbqQpCAbUtXThXD6LqTGSSkSzLZKAWD1DhMbipdbhtZR32JwnvJwmB6fB3V0HvvVr--P7_7NWvKfv2iF0hNN3Ku6YfLqOfguIA6tZ532J5bzIlahiWOzfUMCxqHJaQ9uq4QfdJd9PB_wJAaA_i</recordid><startdate>20130319</startdate><enddate>20130319</enddate><creator>Petherick, Emily S</creator><creator>Cullum, Nicky A</creator><creator>Pickett, Kate E</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20130319</creationdate><title>Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database</title><author>Petherick, Emily S ; Cullum, Nicky A ; Pickett, Kate E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-2b2b8e4bdaad1ba1b89917180f450ca14a474d2248e375d266e2eb28855f00113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Compression</topic><topic>Compression tests</topic><topic>Compression therapy</topic><topic>Computer programs</topic><topic>Confidence intervals</topic><topic>Data bases</topic><topic>Databases, Factual</topic><topic>Deprivation</topic><topic>Diabetes</topic><topic>Diagnostic systems</topic><topic>Doppler effect</topic><topic>Economic factors</topic><topic>Economic indicators</topic><topic>Economics</topic><topic>Feasibility studies</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Identification methods</topic><topic>Incidence</topic><topic>Investigations</topic><topic>Leg</topic><topic>Leg Ulcer - diagnosis</topic><topic>Leg Ulcer - epidemiology</topic><topic>Leg Ulcer - therapy</topic><topic>Leg ulcers</topic><topic>Male</topic><topic>Management</topic><topic>Medical diagnosis</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Nursing</topic><topic>Obesity</topic><topic>Patients</topic><topic>Prevalence</topic><topic>Primary care</topic><topic>Quality</topic><topic>Risk analysis</topic><topic>Risk assessment</topic><topic>Risk factors</topic><topic>Socioeconomic Factors</topic><topic>Socioeconomics</topic><topic>Statistical analysis</topic><topic>Therapy</topic><topic>Ulcers</topic><topic>Ultrasound</topic><topic>Varicose Ulcer - diagnosis</topic><topic>Varicose Ulcer - epidemiology</topic><topic>Varicose Ulcer - therapy</topic><topic>Vascular diseases</topic><topic>Wound healing</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Petherick, Emily S</creatorcontrib><creatorcontrib>Cullum, Nicky A</creatorcontrib><creatorcontrib>Pickett, Kate E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Petherick, Emily S</au><au>Cullum, Nicky A</au><au>Pickett, Kate E</au><au>Mendelson, John E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-03-19</date><risdate>2013</risdate><volume>8</volume><issue>3</issue><spage>e58948</spage><epage>e58948</epage><pages>e58948-e58948</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. No previous studies were found that examined social patterns in the quality of treatment received by patients with leg ulcers.
Using The Health Improvement Network (THIN) database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile). We assessed socio-economic differences in the incidence and prevalence of leg ulcers using negative binomial regression. Socio-economic differences in two key areas of guideline recommended leg ulcer management, arterial Doppler assessment and compression bandaging, were assessed using multilevel regression.
The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. Overall reported rates of Doppler assessment and provision of compression therapy were low, with less than sixteen per cent of patients having a database record of receiving these recommended diagnostic and treatment options. Patients diagnosed with incident venous leg ulcers living in the most deprived areas were less likely to receive the recommended Doppler-aided assessment for peripheral vascular disease than patients living in the least deprived areas (odds ratio 0.43, 95% confidence interval 0.24-0.78). Documented provision of compression therapy did not vary with deprivation.
A socio-economic gradient in venous leg ulcer disease was observed. The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006) were low. Reported use of Doppler ultrasound assessment was negatively associated with socio-economic status. These findings suggest that the inequalities experienced by leg ulcer patients may be exacerbated by reduced access to guideline-based management.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23527054</pmid><doi>10.1371/journal.pone.0058948</doi><tpages>e58948</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2013-03, Vol.8 (3), p.e58948-e58948 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1330889300 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Aged Aged, 80 and over Analysis Cohort analysis Cohort Studies Compression Compression tests Compression therapy Computer programs Confidence intervals Data bases Databases, Factual Deprivation Diabetes Diagnostic systems Doppler effect Economic factors Economic indicators Economics Feasibility studies Female Health aspects Humans Identification methods Incidence Investigations Leg Leg Ulcer - diagnosis Leg Ulcer - epidemiology Leg Ulcer - therapy Leg ulcers Male Management Medical diagnosis Medical research Medicine Middle Aged Nursing Obesity Patients Prevalence Primary care Quality Risk analysis Risk assessment Risk factors Socioeconomic Factors Socioeconomics Statistical analysis Therapy Ulcers Ultrasound Varicose Ulcer - diagnosis Varicose Ulcer - epidemiology Varicose Ulcer - therapy Vascular diseases Wound healing Young Adult |
| title | Investigation of the effect of deprivation on the burden and management of venous leg ulcers: a cohort study using the THIN database |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T13%3A03%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Investigation%20of%20the%20effect%20of%20deprivation%20on%20the%20burden%20and%20management%20of%20venous%20leg%20ulcers:%20a%20cohort%20study%20using%20the%20THIN%20database&rft.jtitle=PloS%20one&rft.au=Petherick,%20Emily%20S&rft.date=2013-03-19&rft.volume=8&rft.issue=3&rft.spage=e58948&rft.epage=e58948&rft.pages=e58948-e58948&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0058948&rft_dat=%3Cgale_plos_%3EA478207778%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1330889300&rft_id=info:pmid/23527054&rft_galeid=A478207778&rft_doaj_id=oai_doaj_org_article_2c0dd5e3963b44adb34ca6c5a1abc7d2&rfr_iscdi=true |