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The bidirectional association between hemorrhoidal disease and varicose veins: a nationwide population-based cohort
Meng-Lin Lee1,2, Yi-Wei Kao3,4, Yu-Ting Yang4
1Division of Cardiovascular Surgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan.
Insights
Hemorrhoidal disease (HD) and varicose veins (VV) share a significant bidirectional association, increasing the risk of developing the other condition. This link suggests potential connective tissue issues and adverse outcomes when both diseases coexist.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Epidemiology
Background:
- Hemorrhoidal disease (HD) and varicose veins (VV) are prevalent vascular conditions.
- Understanding the relationship between HD and VV is crucial for comprehensive patient care.
Purpose of the Study:
- To investigate the association between hemorrhoidal disease and varicose veins.
- To determine if HD increases the risk of VV, and vice versa.
Main Methods:
- A nationwide cohort study utilizing the Taiwan National Health Insurance Research Database (2005-2021).
- Involved over 31 million beneficiaries, comparing HD patients to matched non-HD controls, and VV patients to matched non-VV controls.
- Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results:
- Hemorrhoidal disease was associated with a 1.52-fold increased risk of developing varicose veins (aHR, 1.52; 95% CI: 1.47-1.57).
- Varicose veins were associated with a 1.50-fold increased risk of developing hemorrhoidal disease (aHR, 1.50; 95% CI: 1.45-1.55).
- These associations were consistent across sexes and age groups, with comorbidities like mitral valve regurgitation, hernia, varicocele, and mortality observed in patients with both conditions.
Conclusions:
- A significant bidirectional association exists between hemorrhoidal disease and varicose veins.
- Physicians should consider the presence of one condition when evaluating patients for the other.
- Coexistence may indicate underlying connective tissue disorders and predict adverse long-term outcomes.
Purpose:
Hemorrhoidal disease (HD) and varicose veins (VV) are both common diseases. The aim was to investigate the association between them.
Methods:
A nationwide cohort study was conducted using the Taiwan National Health Insurance Research Database (NHIRD) from 2005 to 2021, which included information of over 31 million beneficiaries. To assess the risk of developing VV among HD patients, records of 832,310 patients with HD diagnoses (the HD cohort) and those of propensity score-matched patients without HD diagnoses (the non-HD cohort) were identified and compared. Hazard ratios (HRs) and 95% confidence intervals (CIs) derived from the Cox proportional hazards model were used to estimate the association risks. Similarly, an opposite direction was approached using records of 112,027 patients with VV diagnoses (the VV cohort) to assess the risk of developing HD among VV patients.
Results:
HD was associated with an increased risk of VV (adjusted HR, 1.52; 95% CI: 1.47-1.57). Similarly, VV were associated with an increased risk of HD (adjusted HR, 1.50; 95% CI: 1.45-1.55). The associations between the two diseases were evident in both sexes and all age groups. Patients with comorbid HD and VV had higher incidences of mitral valve regurgitation (P < 0.001), hernia (P < 0.001), varicocele (P = 0.008), and mortality (P = 0.006).
Conclusion:
This study revealed a significant bidirectional association between HD and VV. It is recommended that physicians be mindful of either condition in patients already diagnosed with the other, as their coexistence could imply the potential for additional associated connective tissue diseases and adverse long-term outcomes.
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