ABSTRACT
Safa Salim, PhD, MBBS
Research Fellow
Imperial College London
London, England, United Kingdom
Previous epidemiological estimates for Chronic Venous Disease (CVD) suggest that 19% of the adult population have Varicose Veins (VV) and 0.4% experience Venous Leg Ulceration (VLU). However, since studies generated these estimates, there have been initiatives to improve venous care. This research aims to investigate changes in the population burden of venous disease in the UK.
Methods:
This is a retrospective, observational, cohort study evaluating routinely collected data from electronic healthcare records. Participants aged 18 years or over, with anonymised research quality data were eligible for inclusion. Electronic diagnostic codes were used to identify participants with the clinical manifestations of CVD, as described in the Clinical Etiology Anatomy Pathophysiology (CEAP) classification. Age, sex, and comorbidity matched controls were identified to perform a nested case-control study. During the 10-year study period (2008-2018), the number of eligible participants ranged from 2.3-4.2 million annually. Analyses included period prevalence, descriptive statistics, time series analyses, multivariate logistic regression models and hazard regression models, expressed using hazard ratios (HR), odds ratios (OR) and 95% confidence intervals (CI).
Results:
The annual period prevalence of active VLU reduced from 1.12% to 0.65% between 2008-2018. The annual period prevalence of symptomatic VV was relatively stagnant during the same time period (2.58% to 2.47%). VV were more prevalent in the summer months compared to VLU in the autumn. Factors associated with VV included a family history of CVD (OR: 2.1, CI: 1.95 – 2.27), personal history of superficial vein thrombosis (OR:2.41, CI: 1.31-4.41) and venous thromboembolism (VTE) (OR:1.61, CI: 1.2-2.15). Participants with VLU had an increased mortality risk compared to a matched control group [HR: 1.39 (CI: 1.23-1.58), p< 0.001].
During the study period, there were improvements in community care for venous disease with respect to an increased proportion of participants receiving compression (12.47%) and specialist referrals (up to 10.24%). However, there was an increase in wait times for endovenous/surgical venous procedures (median 75.85 to 95.88 days). There was significant regional heterogeneity with respect to disease frequency and clinical management.
Approximately 1-2% of patients presenting with symptomatic VV developed VLU at a median of 7.00 years (IQR: 5.88 – 8.63 years). Factors associated with progression to ulceration included previous VTE (OR: 2.04, CI: 1.67-2.48), male gender and white ethnicity (OR: 4.72, CI: 2.18-12.39). Ulcer recurrence occurs in approximately 23% of individuals at a median of 2.04 years (0.55 – 5.93 years).
Conclusions:
The management of CVD appears to have an impact on disease frequency over time. There are disparities in care across different regions and there appear to modifiable and non-modifiable factors affecting the natural history of CVD.