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Epidemiology of Varicose veins

Malay Patel Ahmedabad, India drmalaypatel.com

Content

How Common is Venous Disease?

Methodological problems

Indian studies

Risk factors

References

Epidemiology of varicose veins

HOW COMMON IS VENOUS DISEASE IN THE POPULATION?

Venous disease is a common problem affecting humankind. Exactly how common, is difficult to determine, because relatively little epidemiological research has been conducted in this area [1].

This is perhaps because venous conditions have a very low public health priority.

Comparison of results from existing studies is difficult due to variations in methodologies and definitions employed and generalization of results is further hampered by a lack of data on samples.


METHODOLOGICAL PROBLEMS

• Epidemiological terms

(occurrence, frequency, incidence, prevalence)

• Population sampling

• Method of assessment

(simple questionnaire, detailed assessment)

• Definition of venous disease


EPIDEMIOLOGICAL TERMS

Prevalence and incidence are different measures of a disease's occurrence. The prevalence of a condition refers to the number of people who currently have the condition, whereas incidence refers to the annual number of people who have the condition. These two measures are very different.

Although many studies have reported a higher prevalence of varices in women than men, some of these differences may have resulted from methodological bias, and several recent studies do not support a higher prevalence in women.


POPULATION SAMPLING

There is always a practical limit to the number of people who can be assessed in an epidemiological study. Much of the available data relates to highly selected groups of patients or people who almost certainly do not accurately represent the general population.

It is essential that the relationship between the sample actually studied and the whole population is analysed before any conclusions are drawn [2].


METHOD OF ASSESSMENT

Some studies have relied on a simple questionnaire, completed either by the patient, a member of the household or the interviewer. Several authors have shown that this method of data collection is liable to gross error and is likely to underestimate the size of the problem.

Other reports have used more detailed assessment including full examination, vascular assessment and photography.

While these studies are likely to be more accurate they suffer from small sample size.



In a British study comparison of questionnaire with examination findings for a self-selected group of subjects revealed a sensitivity of 76 % and a specificity of 86 % for the questionnaire [3].



Sisto et al. [4] used a questionnaire to determine the prevalence of previous diagnosis of varicose veins by a physician, but no validation of this method of assessment was performed.



Only 56 % of women working in a department store in Czechoslovakia had themselves noticed the varicose veins which were diagnosed on examination [5].



In a study from Israel the sensitivity and specificity of interview was 47 % and 95 % in men and 67 % and 85 % in women respectively when the prevalence of varicose veins from interview data was compared with clinical examination data [6].


DEFINITION OF VENOUS DISEASE

The term venous insufficiency covers a wide range of conditions, from asymptomatic incompetence of venous valves, through varicose veins, to

chronic venous insufficiency and leg ulceration.

Definitions of venous dilation described by Porter et al. for reporting standards in venous disease [7] and definitions of varicose veins used by Widmer et al. in the Basle Study [8]


Auhor Term Definition

Porter [7]

Varicose veins Dilated, palpable subcutaneous veins generally larger than 4 mm

Reticular veins Dilated, non-palpable subdermal veins 4 mm in size or less

Telangiectases Dilated, intradermal venules less than 1 mm in size

Widmer [8]

Varicose veins Dilated, tortuous trunks of the long or short saphenous vein and their major branches of the first or second order

Reticular veins Dilated, tortuous subcutaneous veins, not belonging to the main trunk or its major branches

Hypenwebs Intradermal venectasis

PREVALENCE RATE OF VARICOSE VEIN


4,5 %

15-20%

3,7 %

4,5 %

http://www.rightdiagnosis.com/v/varicose_veins/stats-country.htm

3,91 %

4,49 %

4,49 %

3,96 %

PREVALENCE RATE OF VARICOSE DISEASE


Ref

eren

ce

yea

r

Co

un

try

M/F

p

rop

ort

ion

(%

)

Ag

e (

yea

rs)

Sam

ple

si

ze

C0 C1 C2 C3 C4 C5 C6

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

All (%)

M (%)

F (%)

Criqui [9] (2003)13*

US

A 35.3/64.7 40-79 2211 19.0 33.6 11.0 57.6 43.6 55.9 23.3 15.0 27.7 5.8 7.4 4.9† 6.2 7.8 5.3

including C4+C6

Jawien 2003)14*

Po

lan

d

16.0/84.0 16-97 40095 51.5 16.5 16.5

21.8

4.5

4.6

1.0 0.5

Rabe (2003)9*

Ger

man

y

43.9/56.0 19-79 3072 9.6 13.6 6.4 59.1 58.4 59.5 14.3 12.4 15.8 13.4 11.6 14.9 2.9 3.1 2.7 0.6 0.6 0.6 0.1 0.1

Carpentier (2004)10† F

ran

ce

67.72/32.3 - 409 18.7 (including C0+C1) 23.7 46.3 1.1 2.2 4.0 2.1 1.4 0.7 0.0

Chiesa (2005)12‡

Ital

y 14.1/85.9

18-90 5187 22.7 36.0 20.6 64.8 33.4 69.9 29.4

13.6

29.3

11.4

29.4¶

13.9§

13.6 11.4 13.9 3.4 5.2 3.1 8.6 11.6 8.1

including C4a only including C4b-C6

Table 10.1 Prevalence of C0-C6 (CEAP) in recent studies from Western countries

*Highest assigned clinical category; † edema in the whole population; ‡ all clinical category listed; ¶ non-saphenous varicose veins; § saphenous varicose veins

INDIAN STUDIES


1. SHIKSHA SHARMA & al, Certain Profession of Working as Risk Factors for Varicose Veins, IOSR Journal of Pharmacy and Biological Sciences, Volume 7, Issue 5 (Sep. – Oct. 2013), PP 56-59 www.iosrjournals.org

2. GANDHI, A Study to evaluate the effectiveness of self

instructional module on knowledge regarding varicose veins and its prevention among teachers in selected primary schools of Mangalore Taluk. 2009

3. MALHOTRA, S. L (Chief Medical Officer, South Eastern

Railway, Calcutta-43, India). An epidemiological study of varicose veins in Indian railroad workers from the south and north of India, with special reference to the causation and prevention of varicose veins. Int. J. Epid. 1972,1 : 177–183

The extrapolated prevalence rate of varicose vein in India providing warning is about 47,928,177 in statistics [10]. According to another estimate 15 to 20% of population in India is suffering vein disease [11].

RISK FACTORS


Risk factors associated with CVI and varicose veins have been well described. A strong familial relationship for varicose veins has been demonstrated in multiple studies [12]. However, with the exception of a few congenital disorders associated with varicose veins (e.g., Klippel–Trenaunay syndrome and Chuvash polycythemia), no specific gene has been identified with the development of varicose veins [13].

RISK FACTORS


Increased age and female gender have also been demonstrated to be linked to the development of varicose veins in large epidemiological studies [14,15]. Furthermore, multiparous women have been shown to have a higher risk of developing varicose veins over time, independent of pregnancy-associated weight gain [16].

RISK FACTORS


However, obese women are three-times more likely than non-overweight women to develop and report varicose veins while no such relationship has been shown for men [17]. Finally, occupations that require long periods of standing have been associated with the development of varicose veins [18].

RISK FACTORS


• Age: Incidence increases with age • Sex: More common in females. Pregnancy may be the most important

stress leading to varicose veins • Genetics: Individual with a genetic predisposition may develop

varicose veins when exposed to stress like obesity and pregnancy • Occupation: It conflicts reports. But incidence is definitely higher in

standing occupations like barbers • Parity: Women with multiple pregnancies may be at risk • Diet: Constipating diet may lead to straining, raised intra-abdominal

pressure and this leads to varicose veins • Other factors include obesity and heavy weight lifting.

Note: These are co-relational studies and may not stand to scientific scrutiny.

CONCLUSION


Epidemiology studies have given us a good idea of the incidence and prevalence of varicose veins yet there are many indicators that new studies are required. The last word has not been said on the epidemiology of varicose veins and it is still evolving.

References


1. Charles V. Ruckley, Francis G.R. Fowkes, Andrew W. Bradbury, Venous Disease: Epidemiology, Management and Delivery of Care, Springer Science & Business Media, 2012.

2. Callam J., Epidemiology of varicose veins, British Journal of Surgery, 1994, 81, 167-173.

3. Franks PJ, Wright DDI, Moffatt CJ, et al. Prevalence of venous disease: a community study in West London. Eur J Surg 1992;158:143–147.

4. Sisto T, Reunanen A, Laurikka J, et al. Prevalence and risk factors of varicose veins in lower extremities: Mini-Finland Health Survey. Eur J Surg 1995;161:405–414.

5. Stvrtinova V, Kolesar J, Wimmer G. Prevalence of varicose veins of the lower limbs in the women working at a department store. Int Angiol 1991;10:2–5.

6. Abramson JH, Hopp C, Epstein LM. The epidemiology of varicose veins: a survey of western Jerusalem. J Epidemiol Community Health 1981;35:213–217.

.

References


7. Widmer LK, ed. Peripheral venous disorders: prevalence and socio-medical importance. Bern: Hans Huber, 1978:1–90.

8. Arnoldi CC. The aetiology of primary varicose veins. Dan Med Bull 1957;4:102–107.

9. Criqui MH, Jamosmos M. Fronck A, Denenberg JO, Langer RD, Bergen J et al. Chronic venous disease in an ethnically diverse population: The San Diego Population Study, Am J Epidemiol. 2003, 158:448-456.

10. Prevalence and incidence of varicose veins. Available from: http://www.cureresearch.com/v/varicose-veins/stats.htm. Accessed 2009.

11. Dr. Pradeep Muley M. D. Treating varicose veins without surgery. Available from:http://www.indianinterventionalradiology.in. Accessed on May 03 2008.

12. Hirai M, Naiki K, Nakayama R. Prevalence and risk factors of varicose veins in Japanese women. Angiology 41(3), 228–232 (1990).

13. Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br. J. Surg. 96(11), 1231–1242 (2009).

http://www.cureresearch.com/v/varicose-veins/stats.htm











References


14. Brand FN, Dannenberg AL, Abbott RD, Kannel WB. The epidemiology of varicose veins: the Framingham Study.Am. J. Prev. Med. 4(2), 96–101 (1988).

15. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J. Epidemiol. Community Health 53(3), 149–153 (1999).

16. Dindelli M, Parazzini F, Basellini A, Rabaiotti E, Corsi G, Ferrari A. Risk factors for varicose disease before and during pregnancy. Angiology 44(5), 361–367 (1993).

17. Seidell JC, Bakx KC, Deurenberg P, van den Hoogen HJ, Hautvast JG, Stijnen T. Overweight and chronic illness – a retrospective cohort study, with a follow-up of 6–17 years, in men and women of initially 20–50 years of age. J. Chronic Dis. 39(8), 585–593 (1986).

18. Tuchsen F, Krause N, Hannerz H, Burr H, Kristensen TS. Standing at work and varicose veins. Scand. J. Work Environ. Health 26(5), 414–420 (2000).

Thank you for you attention!

Malay Patel Ahmedabad, India drmalaypatel.com

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