A Cross-sectional Evaluation of the Association Between Lower Extremity Venous Ulceration and Predictive Risk Factors

Objective. This study sought to identify the association between a history of venous ulceration and demographic, vascular, and nonvascular risk factors in a healthy cohort of older adults.

All patients older than 60 years impanelled within a primary care practice residing in Olmsted County, Minnesota on January 1, 2005 were enrolled.

This was a cross-sectional study utilizing administrative data from an outpatient practice. The primary outcome was a previous history of venous ulceration. The predictor risk variables included demographic risk factors and comorbid health conditions. Data analysis involved univariable comparison between venous ulceration and the risk variables. The significant variables were placed in a final multivariable model.

The authors reviewed the records of 12,650 patients and identified 581 (4.6%) who had a history of venous ulceration. Venous insufficiency had the highest association with venous ulceration with an odds ratio of more than 900. Decubitus ulceration also had a high association with an odds ratio of 2.66 [95% CI: 1.74-4.07]. Older age, female gender, previous hospitalization, diabetes, renal insufficiency, peripheral vascular disease, congestive heart failure, depression, degenerative arthritis, peripheral neuropathy, hypothyroidism, and falls were associated with venous ulceration. Marital status, hyperlipidemia, hip fracture, chronic obstructive pulmonary disease, cancer, and dementia were not associated with venous ulceration.

The relationship between venous insufficiency and venous ulceration appears to be very strong, as expected, given the etiology of disease. Conditions such as vascular disease and vascular risk factors were also highly associated with ulceration. Interestingly, decubitus ulceration as a risk was a novel finding.