Race, Gender, And Socioeconomic Disparities Affect The Clinical Stage Of Patients Presenting For Treatment Of Chronic Venous Disease
Misaki M. Kiguchi, MD, MBA, FACS1, Joshua Fallentine, BS2, Jae Hak Oh, BS2, Bianca Cutler, MSN, FNP-C1, Yueqi Yan, PhD3, Harik R. Patel, BS4, Michael Y. Shao, MD5, Nishant Agrawal, BS6, Emely Carmona, BS6, Eric S. Hager, MD6, Amna Ali, MD7, Mariya Kochubey, MD7, Leigh Ann O'Banion, MD7.
1MedStar Washington Hospital Center, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA, 3UC Merced, Merced, CA, USA, 4St. George's University of London, London, United Kingdom, 5Northshore University Health System, Chicago, IL, USA, 6University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 7UCSF Fresno, Fresno, CA, USA.
OBJECTIVES: Superficial venous disease has a US prevalence of nearly 30% with advanced disease contributing to a significant healthcare burden. Limited evidence exists correlating socioeconomic disparities and presentation of venous disease. This study aimed to identify specific disparities among patients associated with advanced disease presentation.
METHODS: A retrospective review between 2012-2022 was performed at four tertiary US institutions to identify patients who underwent endovenous closure of their saphenous veins. Patient demographics, co-morbidities, CEAP classification, and peri-procedural outcomes were included. State area deprivation index (ADI), an established value correlated with socioeconomic disadvantage (increasing ADI, worse socioeconomic state), was also collected. Pearson's correlation was performed between CEAP classification and ADI index. Poisson regression analysis was performed to identify factors predicting increasing CEAP classification at presentation. Variables with a p<0.05 were deemed significant.
RESULTS: 2339 patients presented for evaluation and underwent endovenous saphenous vein closure during the study period. Mean age was 60.4±14.9 years, 65.9% were female, and 55.4% were white. CEAP classification was distributed as follows: 26.6% CEAP 2, 37.5% CEAP 3, 17.8% CEAP 4, 3.2% CEAP 5, and 14.8% CEAP 6. Mean state ADI for the entire cohort was 4.9 ± 3.1. On multivariate regression, African Americans (IRR=1.12, p=0.005) and increasing state ADI (IRR=1.01, p<0.01) were significantly associated with advanced CEAP classification while female sex presented at earlier CEAP stages (IRR=0.84, p<0.01). (Figure 1)
CONCLUSIONS: This multicentered US study identified both low socioeconomic status and black race as predictive of advanced CEAP classification on initial presentation. These findings highlight the opportunity for improved mechanisms for identification of venous disease and at-risk patients prior to advanced disease progression in a known disadvantaged patient population. 
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