Large studies that examine risk factors for first occurrence of venous leg ulcerations are needed to guide management.
To investigate factors associated with development of first occurrence of venous leg ulcerations.
A retrospective cohort study using a validated national commercial claims database of patients with venous insufficiency. Subjects were followed to determine whether they developed first occurrence of venous leg ulcerations, and risk and protective factors were analyzed.
Adjusted hazard ratio (AHR) for comorbidities demonstrated an increased risk in men (AHR 1.838; 95% confidence interval [CI] 1.798-1.880), older age (45-54 years: AHR 1.316, 95% CI 1.276-1.358; 55-64 years, AHR 1.596, 95% CI 1.546-1.648), history of nonvenous leg ulceration (AHR 3.923; 95% CI 3.699-4.161), anticoagulant use (AHR 1.199; 95% CI 1.152-1.249), antihypertensive use (AHR 1.067; 95% CI 1.040-1.093), and preexisting venous insufficiency including chronic venous insufficiency (AHR 1.244; 95% CI 1.193-1.298), edema (AHR 1.224; 95% CI 1.193-1.256), and chronic venous hypertension (AHR 1.671; 95% CI 1.440-1.939). Possible protective factors were having venous surgery (AHR 0.454; 95% CI 0.442-0.467), using compression stockings (AHR 0.728; 95% CI 0.705-0.753), using prescribed statin medications (AHR 0.721; 95% CI 0.700-0.743), and using pain medications (AHR 0.779; 95% CI 0.757-0.777).
Risk of misclassification, given the use of International Classification of Diseases, Ninth Revision codes. Possible confounding factors such as body mass index could not be adequately controlled with these codes.
The new evidence presented supports a paradigm shift toward venous leg ulceration prevention.Le texte complet de cet article est disponible en PDF.
Key words : venous leg ulcer, prevention, venous insufficiency, chronic venous insufficiency, venous surgery, wounds, chronic wounds, first venous leg ulcer
Abbreviations used : AHR, CI, fVLU, ICD-9, SD, VI, VLU
| Funding sources: Supported by a Dermatology Foundation and University of Miami award to Dr Lev-Tov.
| Conflicts of interest: None disclosed.
| The sponsors had no role in the study design.
| IRB approval status: Not applicable.