Background: Venous leg ulcer is a disease most common in those aged 65 years and older. However, the incidence and prevalence have not been well established. Objective: Our purpose was to estimate the prevalence and incidence of venous leg ulcers in the elderly. Methods: We studied the General Practice Research Database, validated our case ascertainment strategy, and estimated the annual prevalence and incidence of venous leg ulcer. Results: The positive predictive value of our ascertainment strategy was 98.3% (95% confidence interval [CI], 90.0, 100.0). The annual prevalence of venous leg ulcer among the elderly was 1.69 (95% CI, 1.65, 1.74). The overall incidence rate was 0.76 (95% CI, 0.71, 0.83) for men and 1.42 (1.35, 1.48) per 100 person-years for women. Conclusion: Venous leg ulcer is a significant problem in those aged 65 years and older. As compared with previous studies, because we used medical records from a population of known size, our results are precise and less biased. (J Am Acad Dermatol 2002;46:381-6.)