The Effect of Health Literacy and Socio-Economic Deprivation on Outcomes After Lower Limb Revascularisation Surgery for Chronic Limb Threatening Ischaemia

Introduction

Low health literacy (HL) and social deprivation have been associated with poorer health outcomes. HL is the ability to obtain, process and understand health information needed to make health-related decisions. Research suggests many vascular patients have low HL. This is concerning as poorly managed chronic limb threatening ischaemia (CLTI) can cause limb-loss. This study aims to assess whether HL and social deprivation affect CLTI post-intervention outcomes.

Methods

All patients who had bypass graft surgery for CLTI between 2016-2019 at a tertiary vascular centre were retrospectively analysed. The HLS19-Q12 questionnaire categorised participant’s HL as inadequate, problematic, sufficient, or excellent. Social deprivation was measured using English Indices of Multiple Deprivation (IMD). Primary outcomes were major adverse cardiovascular and limb events, including amputation. Chi squared (X2) tests, Kaplan-Meier analysis and cox proportional regression analysis were performed.

Results

Fifty participants (mean age±SD: 70±8.7 years) were included. 28% of participants had inadequate HL, 38% had problematic HL, 24% had sufficient HL and 10% had excellent HL. Most participants lived in areas of highest deprivation (40%). HL groups were comparable for post-operative outcomes. HL was associated with IMD (0.308 (P=0.029)). IMD was a significant predictor of amputation (P=0.017).

Conclusion

High levels of social deprivation and low HL were found in this patient group. Low HL was associated with greater social deprivation. These results may help to direct post-operative support to socially deprived CLTI patients. As HL is a potentially modifiable factor, improving HL could have a mediating role in health inequalities created by social deprivation.