Racial disparities in superficial venous disease management: A comparative study of interventions and patient-related outcomes

TL;DR

This study finds racial disparities in venous disease treatment and outcomes, showing Black patients have more severe disease but significant improvement after treatment.

Contribution

The study is one of the first to comprehensively analyze racial disparities in venous disease management and outcomes using a national database.

Findings

Non-Hispanic Black patients had more severe baseline chronic venous insufficiency compared to other groups.

Black patients showed the largest improvement in quality-of-life scores after treatment despite fewer procedures.

Hispanic/Latino patients had the highest preoperative symptom scores but also the greatest symptom reduction post-treatment.

Abstract

Chronic venous insufficiency (CVI) resulting in venous hypertension can cause lifestyle-limiting debilitation. Studies have identified racial and ethnic disparities in CVI presentation and clinical severity; however, there is limited literature examining disparities in CVI management and procedural outcomes among different racial and ethnic groups. The aim of this study was to characterize differences in endovenous treatment paradigms between racial and ethnic groups and to assess how this affected patient outcomes.

The national Vascular Quality Initiative Varicose Vein Registry database was queried for superficial venous interventions, including endovenous radiofrequency ablation, endovenous laser ablation, high ligation, stripping, and microphlebectomy, performed from April 2014 to March 2024. We categorized patients as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino, Asian, and Other (including American Indian, Alaskan Native, Native Hawaiian, other Pacific Islander, more than one race, and unknown/other). Baseline demographics, clinical and treatment characteristics, complication rates, and changes in quality-of-life endpoints (ie, revised Venous Clinical Severity Score [rVCSS] and Heaviness, Achiness, Swelling, Throbbing, Itching [HASTI] score) were compared between racial/ethnic groups with NHW as the reference category. Linear regression and logistic regression/χ2 tests were used to compare continuous/ordinal and categorical variables, respectively.

A total of 65,090 superficial venous procedures encompassing endovenous thermal ablations, stripping/high ligation, and microphlebectomy were included. NHW patients underwent interventions for less severe baseline CVI based on CEAP class and had more superficial venous interventions (2.45 ± 1.95; P < .001) and repeat thermal ablations (1.66 ± 1.14; P < .001) than other groups. NHB had more severe baseline CVI based on higher prevalence of severe CEAP (ie, C5, C6, and C6r disease: 5.8%, 11.8%, and 0.9%, respectively; P < .05). NHB patients were less likely to have concomitant microphlebectomy than NHW (odds ratio, 0.79; 95% confidence interval, 0.73-0.87; P < .001). NHB had the highest rVCSS score preoperatively (8.17 ± 4.02; P < .001) with the largest improvement at ≤3 (−4.40 ± 5.23; P < .001) and >3 months (−7.00 ± 5.00; P < .001) following intervention. Hispanic/Latinos had the highest preoperative HASTI score (10.34 ± 5.40; P < .001) and the largest score reduction at ≤3 months (−6.62 ± 6.51; P < .001). Post procedure, Hispanics and other study groups were more likely to experience blistering and medication induced ulcer (P < .05). The other group was less likely to experience hematoma postoperatively (P < .05).

This study highlights significant differences across racial/ethnic groups in the presentation, treatment and outcomes of patients with treated for CVI. Black patients undergo fewer ablations and superficial venous procedures overall; however, once treated, they exhibit significant symptomatic improvement.