F. Alanazi1, A. Baothman1, W. Qu1, M. Osman1, K. Bauer1, J. Ortiz1, F. C. Brunicardi1, M. Nazzal1 1University Of Toledo Medical Center,Department Of Surgery,Toledo, OH, USA
Introduction:
Chronic venous disease (CVD) and venous leg ulcers (VLU) are common medical problems that cause loss of work hours and require lengthy medical treatment. In this study we analyzed the social determinants of health associated with factors that contribute to both CVD and VLU.
Methods:
National Inpatient Sample (NIS) database (2008-2014) of the Healthcare Cost and Utilization Project (HCUP) was used to select adult (≥18 years) CVD and VLU patients in the study. All diagnoses and procedures were identified with ICD-9-CM code. Statistical analyses were done with IBM SPSS statistical software ver. 24. Type I error level was set at 0.05.
Results:
Total number of patients with CVD and VLU in the study was 2,418,709 and 610,895, respectively. While the decrease in general hospital admission rate in the period from 2008 to 2014, the prevalence of CVD increased by 51.1% (from 0.87% to 1.32%, coeff=0.07, P<.001), and the prevalence of VLU increased by 57% (from 0.22% to 0.34%, coeff=0.02, P<.001). The prevalence of VLU in CVD patients increased by 3.9% in the same period (from 24.8% to 25.7%, coeff=0.135, p=.012).
Prevalence of CVD increased with age (from 0.3% in 18-24 years group to 1.7% in ≥65 years group, Cochran–Armitage test p<.001). Other risks for CVD included: male gender (1.37% vs 0.94%, P<.001 ), Caucasian (CA) vs. African American (AA) and Hispanics (HIS, 1.29% vs. 0.85% and 0.65%, both P<.001), patients in the 26th-50thpercentile (IT2) and 51st-75thpercentile of the income scale (IT3, 1.15 and 1.13%, respectively) compared to those in 0-25thpercentile (IT1, 1.08%) or76th-100thpercentile of the income scale (IT4, 1.11%)(all P<.001), and patients with BMI ≥ 40 compared to those with BMI<40 (5.5% vs. 0.90%,P<.001).
The prevalence of VLU in CVD patients was highest in patients of age 45-64 years (28.5%), gradually decreased to 25.8% (age 25-44 years), 23.8% (age ≥65 years), and 19.2% (age 18-24years, all P<.01). Other risk factors for VLU were: male gender (28.1% vs 22.7%, P<.001), AA and HIS compared to CA (36.2% and 27.4% vs. 23.7%, both P<.001), IT1 compared to IT2 -IT4 (27.6% vs. 24.8%, 24.6%, and 23.6%, all P<.001); patients with BMI ≥ 40 compared to those with BMI<40 (26.9% vs. 24.9%,P<.001).
Conclusion:
This paper reflects demographic and social status variations in patients with CVD and VLU. The prevalence of both CVD and VLU increased over the years of the study. Prevalence of CVD is higher in elders, in CA compared to HIS and AA, in patients in intermediate household incomes compared to higher and lower household income groups, and morbidly obese patients. The prevalence of VLU is higher in the middle age group, in men, in AA and HIS, in low income patients and morbidly obese patients. Analysis of the NIS data indicates an increasing burden of chronic venous disease and venous leg ulcers, particularly among populations at risk for poor social determinants of health.