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Postservice lower limb amputation in Scottish military veterans
  1. Beverly P Bergman,
  2. DF Mackay and
  3. JP Pell
  1. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Beverly P Bergman, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; Beverly.bergman{at}


Introduction Recent attention has focused on veterans who have lost limbs in conflict, but the number of UK veterans who lose limbs to disease is unknown. We used data from the Trends in Scottish Veterans’ Health study to explore postservice lower limb amputation.

Methods We carried out a retrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence. We used survival analysis to examine the risk of amputation in veterans compared with non-veterans, and explored associations with antecedent disease.

Results We found no difference between veterans and non-veterans in the risk of lower limb amputation, which was recorded in 145 (0.19%) veterans and 464 (0.18%) non-veterans (Cox proportional hazard ratio (HR) 1.00, 95% CIs 0.82 to 1.20, p=0.961). Peripheral arterial disease was recorded in two-thirds of both veteran and non-veteran amputees, and type 2 diabetes in 41% of veterans and 33% of non-veterans, with a dual diagnosis in 32% of veterans and 26% of non-veterans. Trauma was an infrequent cause of amputation.

Conclusions Although in later life veterans are no more likely to lose a limb to disease than non-veterans, the number so affected greatly outweighs those who have lost limbs in conflict. The high public profile of conflict-related limb loss risks eclipsing the needs of veterans with disease-related loss. Support for ageing veterans who have lost limbs due to disease will require planning with the same care as that afforded to the victims of conflict if inequalities are to be avoided.

  • epidemiology
  • vascular medicine
  • general diabetes

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  • Contributors BPB conceived the idea and designed the study, with advice from JPP and DFM. BPB carried out the data analysis, which was overseen by DFM, and interpreted the findings. BPB wrote the first draft of the report, which was critically reviewed and edited by all authors. All authors approved the final article. BPB revised the article following review, which was approved by all authors.

  • Funding This study was supported by a Forces in Mind Trust grant (FiMT17/1101UG).

  • Competing interests BPB is a military veteran and Honorary Civilian Consultant Advisor (Army) in Veterans’ Health and Epidemiology. Neither the Army nor the Ministry of Defence had any input to this paper, and the views and opinions expressed are solely those of the authors.

  • Patient consent for publication Not required.

  • Ethics approval The data extract was pseudo-anonymised and approval for the study was granted by the Public Benefit and Privacy Panel of the Information Services Division of NHS Scotland. Use of anonymised extracts of Scottish routine data for health research is covered by generic NHS ethics approval (East of Scotland Research Ethics Committee; reference 16/ES/0112). As this was a secondary data study, individual consent was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The study remains in progress and the data are not currently available for sharing.