Impact of Area Deprivation Index on the Outcomes of Venous Leg Ulcer Healing and Recurrence

Chronic venous disease (CVD) remains a very common problem, with up to 40% of the population showing symptoms and 1% presenting with venous leg ulcer (VLU). Social drivers of health (SDOH) influence outcomes. This study aimed to analyze the impact of area deprivation index among patients undergoing interventions for venous ulceration.

Between 2012 and 2022, all patients presenting with a primary VLU to an urban medical center were analyzed. Inclusion criteria were all patients with a primary active VLU with superficial truncal venous incompetence and without total deep venous incompetence on duplex imaging or an abnormal ankle-brachial or toe-brachial index. Demographics and interventions to affect healing were recorded. Patient zip codes were correlated with an Area Deprivation Index (ADI) quintile, defined as quintile 1 (Q1) to quintile 5 (Q5), from least to most disadvantaged. Patients without ADI were excluded. Low-risk ADI was composed of Q1 to Q4 groups, while high-risk ADI was considered to be composed of Q5 group. All patients underwent maximal therapy, which consisted of venous ablation, compression, and wound care. Preoperative, perioperative, and postoperative outcomes considering ADI were analyzed. The primary outcomes of VLU healing at 24 weeks and recurrence within 1 year were analyzed.

354 patients (61% female, age 68 ± 10 years, mean ± standard deviation [SD]) presented with an active VLU. Patient distribution by ADI quintile was as follows: Q1 (10%), Q2 (12%), Q3 (19%), Q4 (23%), and Q5 (36%). The proportion of patients considered high risk by the Charlson Comorbidity Index also increased significantly as the ADI quintile increased. The size of the VLU at presentation and wound bed scores (WBSs) worsened as the ADI worsened. There was no significant difference in the medical and surgical therapy offered across the quintiles. Initial VLU healing was 30 ± 1%, 29 ± 2%, 17 ± 2%, 22 ± 3%, and 17 ± 3% at 12 weeks for Q1, Q2, Q3, Q4, and Q5, respectively, (mean ± standard error of the mean [SEM]; P = 0.01). At 1 year, freedom from ulcer recurrence was 67 ± 1%, 64 ± 2%, 60 ± 2%, 56 ± 3%, and 45 ± 2% at for Q1, Q2, Q3, Q4, and Q5, respectively (mean ± SEM; P = 0.01).

Patients presenting with a VLU are more likely to be identified as socially disadvantaged by ADI. Increasing severity of social disadvantage as determined by ADI is associated with a slower time to VLU initial healing and early VLU recurrence. Assessing and addressing SDOH, as measured by ADI, will improve outcomes of VLU management.