Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
J Vasc Surg Venous Lymphat Disord. 2023 Sep;11(5):897-903. doi: 10.1016/j.jvsv.2023.06.001. Epub 2023 Jun 19.
Superficial venous disease has a U.S. prevalence of nearly 30%, with advanced disease contributing to a significant healthcare burden. Although the risk factors for venous disease are well known, the correlation between race, sex, socioeconomic status, and disease severity on presentation is not well established. The area deprivation index (ADI) is a validated metric with respect to regional geography, social determinants of health, and degree of socioeconomic disadvantage. In the present study, we aimed to identify the disparities and the effect that the ADI, in addition to race and sex, has among patients associated with an advanced venous disease presentation.
A retrospective review between 2012 and 2022 was performed at four tertiary U.S. institutions to identify patients who underwent endovenous closure of their saphenous veins. Patient demographics, state ADI, comorbidities, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, and periprocedural outcomes were included. Pearson's correlation was performed between the CEAP classification and ADI. Poisson regression analysis was performed to identify factors predicting for an increasing CEAP classification at presentation. Variables with P < .05 were deemed significant.
A total of 2346 patients underwent endovenous saphenous vein closure during the study period, of whom 7 were excluded because of a lack of follow-up data. The mean age was 60.4 ± 14.9 years, 65.9% were women, and 55.4% were White. Of the 2339 patients, 73.3% presented with an advanced CEAP class (≥3). The mean state ADI for the entire cohort was 4.9 ± 3.1. The percent change in the CEAP classification is an increase of 2% and 1% for every level increase in the state ADI for unadjusted (incidence rate ratio [IRR] = 1.02; P < .001) and adjusted (IRR = 1.01; P < .001) models, respectively. Black race has a 12% increased risk of a higher CEAP class on presentation compared with White race (IRR = 1.12; P = .005). Female sex had a 16% lower risk of a higher CEAP presentation compared with male sex (IRR = 0.84; P < .01).
Low socioeconomic status, Black race, and male sex are predictive of an advanced CEAP classification on initial presentation. These findings highlight the opportunity for improved mechanisms for identification of venous disease and at-risk patients before advanced disease progression in known disadvantaged patient populations.
浅静脉疾病在美国的患病率接近 30%，晚期疾病会导致严重的医疗负担。尽管静脉疾病的危险因素众所周知，但种族、性别、社会经济地位与疾病严重程度之间的相关性尚不清楚。区域贫困指数（ADI）是一个经过验证的指标，可用于评估区域地理、健康决定因素和社会经济劣势程度。在本研究中，我们旨在确定 ADI 以及种族和性别对静脉疾病晚期表现患者的差异和影响。
在四家美国三级医疗机构进行了 2012 年至 2022 年的回顾性研究，以确定接受静脉内闭合术治疗大隐静脉的患者。患者人口统计学资料、州 ADI、合并症、CEAP（临床、病因、解剖、病理生理）分类和围手术期结局均包括在内。Pearson 相关系数用于评估 CEAP 分类与 ADI 之间的相关性。采用泊松回归分析来确定预测初始表现时 CEAP 分类增加的因素。P 值<.05 被认为具有统计学意义。
在研究期间，共有 2346 名患者接受了静脉内大隐静脉闭合术，其中 7 名因缺乏随访数据而被排除。平均年龄为 60.4±14.9 岁，65.9%为女性，55.4%为白人。在 2339 名患者中，73.3%的患者表现为晚期 CEAP 分级（≥3）。整个队列的平均州 ADI 为 4.9±3.1。未经调整（发病率比 [IRR] = 1.02；P<.001）和调整（IRR = 1.01；P<.001）模型中，州 ADI 每增加一个等级，CEAP 分类的变化百分比分别增加 2%和 1%。与白人相比，黑人种族在初次就诊时出现更高 CEAP 分级的风险增加 12%（IRR = 1.12；P=.005）。与男性相比，女性出现更高 CEAP 表现的风险降低 16%（IRR = 0.84；P<.01）。
社会经济地位低、黑人和男性是初始表现出高级 CEAP 分类的预测因素。这些发现强调了在已知处于不利地位的患者群体中，在疾病进展到晚期之前，需要改善识别静脉疾病和高危患者的机制。
