Health Inequities in Manitoba: Is the Socioeconomic Gap

Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
Amputations Among People with Diabetes
Definition
Prevalence of amputation was calculated for people with diabetes (aged 19 and older) who had a lower
limb amputation (below or including the knee) in a three–year period. See the previous indicator for the
definition of diabetes. Amputation was defined by ICD–9–CM procedure codes 84.1–84.17 (ICD–10–CCI
codes: 1.VC.93, 1.VG.93, 1.VQ.93, 1.WA.93, 1.WE.93, 1.WJ.93, 1.WL.93, 1.WM.93) in any procedure field.
Amputations associated with accidental injury were excluded (see below for codes).
Average annual rates of amputation per 1,000 residents with diabetes were calculated for eight
three–year periods, the first time period T1 being 1984/85–1986/87 to the last time period T8 being
2005/06–2007/08. Rates were age– and sex–adjusted to the Manitoba population age 19 and older in
the last time period. Exclusions for accidental injury included ICD–9–CM diagnosis codes 895, 896, 897
or ICD–10–CA codes S78, S88, S98, T05.3, T05.4, T05.5, T13.6.
Time Periods Average annual rate per 1,000 people with diabetes
T1: 1984/85–1986/87 15.37
T2: 1987/88–1989/90 14.83
T3: 1990/91–1992/93 14.52
T4: 1993/94–1995/96 16.78
T5: 1996/97–1998/99 16.55
T6: 1999/00–2001/02 14.12
T7: 2002/03–2004/05 12.61
T8: 2005/06–2007/08 11.58
Key Findings: Amputations Among People With Diabetes
Manitoba overall rates:
• From the first time period T1 (1984/85–1986/87) to the last time period T8 (2005/06–2007/08),
people with diabetes (aged 19 and older who had a lower limb amputation in a three–year period
decreased from 15.37 to 11.58 per 1,000. However, amputation rates first increased to the mid–1990s
(up to 16.78 in the mid–1990s), and then decreased to T8.
Rates by neighbourhood income quintile over time:
Rural:
• Comparing only T1 to T8, the rate of amputations among rural residents with diabetes remained
similar in most rural quintiles. However, rates in R1 increased substantially to the mid–1990s and
then decreased again.
• The disparity between R1 and R5 remained similar between the first time period and the last time
period. The rate ratio of R1 compared to R5 was 2.00 in the first time period and 3.38 in the last time
period, however this was not a statistically significantly increase. The absolute difference gap in
amputations among residents with diabetes comparing R1 to R5 was 13.85 more amputations per
1,000 people with diabetes in T1 and 18.32 more per 1,000 in T8 and these gaps over time were not
statistically significantly different (i.e., they are considered similar).
Manitoba Centre for Health Policy 89