The territorial distribution of amputations in healthcare and social context in Hungary in 2016-2017

Introduction and aim: Peripheral artery disease and lower extremity artery disease occur in 4 to 6% of the population. In Hungary, the number of major amputations was 6798 in the observed period. With timely and appropriate treatment, the number of leg amputations (30-day mortality: 20%, 2-year mortality: 40-60%) can be effectively reduced. The purpose of this study is to identify the territorial differences within Hungary with regard to the care pathways of these diseases. Method: We performed a retrospective data analysis of the peripheral vascular treatment using 2015-2017 claim data of the National Health Insurance Fund of Hungary. Territorial differences in mortality rates were examined by descriptive statistics. Correlation analysis was performed to describe any relationship between mortality rates and other factors. Results: The subregional level analysis (n = 175) revealed 4 times differences across the country proving that high domestic amputation rates are partially due to the extreme amputation rates in 30 percent of the subregions. Multiple stratified regression analysis revealed that the proportion of districts where endovascular therapy is not available (n = 159), the university education level of the population (beta 1 = -0.13, 95% CI: -0.18 to -0.09) and the proportion of those over 65 years of age (beta 1 = 0.14, 95% CI: 0.03-0.24) were significantly associated with amputation rate. In districts with available endovascular therapy (n = 14), age distribution of population (beta 1 = 0.7, 95% CI: 0.42-0.98) was associated with the frequency of amputations. Conclusion: Regional and social disparities in incidence, prevalence and mortality rates significantly vary greatly across Hungary, but also provider capacities (with relevant competencies) influence strongly the development and progression of the disease.