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Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients.

Methods

A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was defined using governmental population data and SEDS was defined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses.

Results

There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18 years) was 18.75/100,000 per year (range 16.56–23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35–1.89; p < 0.001).

When adjusting for confounding factors, least deprived patients were more likely to be > 50 years old (OR 1.97; 95%CI 1.24–3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11–2.67; p = 0.02) and in the spring (OR 1.65, 95%CI  1.01–2.70; p = 0.045) and to give a history of preceding tendinitis (OR  4.04, 95%CI 1.49–10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23–0.87; p = 0.02) and to be obese (OR 0.25–0.41, 95%CI  0.07–0.90; p ≤ 0.03).

Conclusions

The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Significant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries.

Level of Evidence

Prognostic Study Level III.

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Abbreviations

ATR:

Achilles tendon rupture

SEDS:

Socioeconomic deprivation status

LD:

Least deprived

MD:

Most deprived

NHS:

National health service

REC:

Regional ethics committee

NRS:

National records of Scotland

SIMD:

Scottish index of multiple deprivation

IQR:

Inter-quartile range

FET:

Fisher’s exact test

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Funding

None received.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, Msida, Malta

    J. F. Maempel

  2. Faculty of Medicine and Surgery, University of Malta Medical School, Msida, Malta

    J. F. Maempel

  3. Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

    N. D. Clement, S. P. Mackenzie, C. McCann & T. O. White

  4. University of Edinburgh Medical School, Edinburgh, United Kingdom

    T. O. White

Authors
  1. J. F. Maempel
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  2. N. D. Clement
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  3. S. P. Mackenzie
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  4. C. McCann
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  5. T. O. White
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Contributions

JM: concept/idea for study, data collection, review and analysis, drafting of manuscript, and editing of manuscript; NDC: guidance with study design, assistance with statistical analysis, and editing of manuscript; SPM: data collection and manuscript editing; CMcC data collection and manuscript editing; TOW: guidance with study design and manuscript editing.

Corresponding author

Correspondence to J. F. Maempel.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

This study was part of a departmentally approved service review of ATR which was reviewed by the scientific officer for the regional ethics committee (REC) who advised that REC review was not necessary.

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Appendix

Appendix

See Fig. 6.

Fig. 6
figure 6

Month of injury for sporting and non-sporting injuries.

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Maempel, J.F., Clement, N.D., Mackenzie, S.P. et al. Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 31, 691–700 (2023). https://doi.org/10.1007/s00167-022-07103-2

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