Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation

Aims To assess the combined impact of socio‐economic status and gender on the risk of diabetes‐related lower extremity amputation within a universal healthcare system. Methods We conducted a population‐based cohort study using administrative health databases from Ontario, Canada. Adults with pre‐existing or newly diagnosed diabetes (N = 606 494) were included and the incidence of lower extremity amputation was assessed for the period 1 April 2002 to 31 March 2009. Socio‐economic status was based on neighbourhood‐level income groups, assigned to individuals using the Canadian Census and their postal code of residence. Results Low socio‐economic status was associated with a significantly higher incidence of lower extremity amputation (27.0 vs 19.3 per 10,000 person‐years in the lowest (Q1) vs the highest (Q5) socio‐economic status quintile. This relationship persisted after adjusting for primary care use, region of residence and comorbidity, and was greater among men (adjusted Q1:Q5 hazard ratio 1.41, 95% CI 1.30–1.54; P