AIMS/HYPOTHESIS Our aim was to investigate the geospatial distribution of diabetic foot ulceration (DFU), lower extremity amputation (LEA) and mortality rates in people with diabetes in small geographical areas with varying levels of multiple deprivation. METHODS We undertook a population cohort study to extract the health records of 112,231 people with diabetes from the Scottish Care Information - Diabetes Collaboration (SCI-Diabetes) database. We linked this to health records to identify death, LEA and DFU events. These events were geospatially mapped using multiple deprivation maps for the geographical area of National Health Service (NHS) Greater Glasgow and Clyde. Tests of spatial autocorrelation and association were conducted to evaluate geographical variation and patterning, and the association between prevalence-adjusted outcome rates and multiple deprivation by quintile. RESULTS Within our health board region, people with diabetes had crude prevalence-adjusted rates for DFU of 4.6% and for LEA of 1.3%, and an incidence rate of mortality preceded by either a DFU or LEA of 10.5 per 10,000 per year. Spatial autocorrelation identified statistically significant hot spot (high prevalence) and cold spot (low prevalence) clusters for all outcomes. Small-area maps effectively displayed near neighbour clustering across the health board geography. Disproportionately high numbers of hot spots within the most deprived quintile for DFU (p < 0.001), LEA (p < 0.001) and mortality (p < 0.001) rates were found. Conversely, a disproportionately higher number of cold spots was found within the least deprived quintile for LEA (p < 0.001). CONCLUSIONS/INTERPRETATION In people with diabetes, DFU, LEA and mortality rates are associated with multiple deprivation and form geographical neighbourhood clusters.

中文翻译：

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地理空间映射和数据链接揭示了根据多种剥夺导致的足部疾病结局的可变性：一项针对糖尿病患者的人群队列研究。

目的/假设我们的目的是研究在小范围不同剥夺程度的小地理区域的糖尿病患者的糖尿病足溃疡（DFU），下肢截肢（LEA）和死亡率的地理空间分布。方法我们进行了一项人群队列研究，以从苏格兰护理信息-糖尿病合作组织（SCI-Diabetes）数据库中提取112,231名糖尿病患者的健康记录。我们将此链接到健康记录，以识别死亡，LEA和DFU事件。这些事件是使用多个剥夺地图在国家卫生局（NHS）大格拉斯哥和克莱德地区的地理分布图上进行的。进行了空间自相关和关联性测试，以评估地理变化和格局，患病率调整后的结局发生率与五分位数的多次剥夺之间的关系。结果在我们的卫生局区域内，糖尿病患者的DFU患病率调整率为4.6％，LEA率为1.3％，死亡率先于DFU或LEA为每10,000人每年10.5。空间自相关确定了所有结果的统计学显着热点（高患病率）和冷点（低患病率）聚类。小面积地图有效地显示了跨卫生局地理区域的邻居群集附近。发现在最贫困的五分位数中，DFU（p <0.001），LEA（p <0.001）和死亡率（p <0.001）的发生率异常高。反过来，在LEA最少被剥夺的五分之一人口中，发现的冷点数量成比例增加（p <0.001）。结论/解释在糖尿病患者中，DFU，LEA和死亡率与多重剥夺有关，并形成地理邻域簇。