Insurance Type and Area Deprivation Affect Venous Leg Ulcer Outcomes in Patients Undergoing GSV Ablation

Social determinants of health (SDH) can influence venous leg ulcer (VLU) healing and time to recurrence. The Area Deprivation Index (ADI) captures regional aspects of SDH-i.e., average household income, education, and housing-and has not been studied in relation to VLU recurrence after endovenous treatment. We hypothesize that a higher ADI (greater disparity) is associated with a longer time to treatment and a higher rate of VLU recurrence, particularly among those who receive Medicare or Medicaid.

A multi-center retrospective chart review was performed on VLUs from patients across four tertiary care centers who underwent ablation (radiofrequency, laser, chemical). Data were collected on the times from the initial visit to treatment, from treatment to healing, and from healing to recurrence. Demographics, insurance type, and national ADI percentiles were also collected. Kendall's Tau correlation was performed to identify relationships between ADI and times until initial treatment, healing, and recurrence. ANOVA assessed potential differences in time until initial treatment between patients of different insurance types.

260 patients treated from 2013-2024 were included, with 53.1% male, 56.2% BMI above 30kg/m2, average age of 70.3 ± 12.8 years, and average ADI of 37.8 ± 30.6. 66.2% of patients identified as White, 27.7% Black, 5.8% Hispanic, and 0.3% Asian. Of the 287 VLUs from these patients, 149 healed completely, 66 healed but recurred, and 72 did not heal by the last follow-up (average time to follow up 574±702 days). Higher ADI was significantly correlated with a shorter time from the index visit to initial treatment (p=0.033), with the correlation being stronger among Medicare patients (p=0.024). Among Medicare patients, higher ADI was also significantly associated with a shorter interval between wound healing and recurrence (p=0.023). Patients with recurrent VLU had a significantly higher median ADI than those whose ulcers completely healed without recurrence (p=0.016) CONCLUSIONS: ADI was associated with two important time points in VLU healing. First, greater deprivation was associated with faster time to initial intervention, particularly in Medicare recipients. However, higher ADI was also associated with a shorter time to recurrence. This study suggests that targeted post-procedure treatment algorithms for the most vulnerable populations should focus on patients with high ADI and their insurance type, particularly Medicare recipients.