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Faster Intervention With Faster Recurrence: Insurance Type And Area Deprivation Affect Venous Leg Ulcer Outcomes
Alex Rothstein, BA, BM1, Deeptha Bejugam
2, Christian Campat, DO
3, Leigh Ann O'Banion, MD
3, Niyati Bhatt
2, Juan Carlos Jimenez, MD
4, Misaki Kiguchi, MD, MBA
2, Ulka Sachdev, MD
1.
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,
2MedStar Washington Hospital Center, Washington, DC, USA,
3University of San Francisco California-Fresno, Fresno, CA, USA,
4David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
OBJECTIVES:Social determinants of health (SDH) can influence venous leg ulcer (VLU) healing and recurrence time. Area Deprivation Index (ADI) captures regional aspects of SDH—i.e. average household income, education, and housing—and has not been studied regarding VLU recurrence after endovenous treatment. We hypothesize that a higher ADI (greater disparity) is associated with prolonged time to treatment and faster VLU recurrence.
METHODS:A multi-center retrospective chart review was performed on VLUs from patients across four tertiary care centers who underwent ablation (radiofrequency, laser, chemical). Data was collected on times from initial visit to treatment, treatment to healing, and 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.
RESULTS:260 patients treated from 2013-2024 were included, with 53.1% male, 56.2% BMI above 30, average age of 70.3 ± 12.8, 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 last follow up (average time to follow up 574±702 days). There was a significant negative correlation between 1) time from index visit to initial treatment and ADI (Table 1; p=0.033) with the correlation being stronger in Medicare patients (p=0.024) and 2) time from wound healing to recurrence and ADI in Medicare patients (p=0.023).
CONCLUSIONS:ADI negatively correlated with two important time points in VLU healing. First, greater deprivation was negatively associated with the initial time to intervention, particularly in Medicare recipients. One interpretation is that patients with Medicare who also have significant socioeconomic burden may be expedited for needed treatment. However, higher ADI also correlated with a faster time to recurrence, suggesting that maintenance therapy needs to be improved for Medicare patients with socioeconomic risks. Optimizing the ability of patients with high ADI to maintain office visits and/or wound care may help reduce recurrence.
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