(PC162) Higher Area Deprivation Index and Insurance Type Influence Venous Leg Ulcer Recurrence

Objectives: Social determinants of health (SDH) can influence venous leg ulcer (VLU) healing and time to recurrence. 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 indicating 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 endovenous ablation (radiofrequency, laser, chemical). Data was collected on times from initial visit to treatment, treatment to wound healing, and healing to recurrence. Patients’ 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 tests assessed potential differences in time until initial treatment between patients of different insurance types. Mann-Whitney U Tests were used to assess differences in ADI between patients with healed versus unhealed ulcers, as well as patients with recurrent versus non-recurrent ulcers.

Results: 260 patients treated from 2013-2024 were included from all four centers. 53.1% were male, 56.2% had BMI above 30, average age was 70.3 +/- 12.8, and average ADI was 37.8 +/- 30.6. 66.2% of patients identified as White, 27.7% Black, 5.8% Hispanic, and 0.3% Asian. Of the 287 lower extremity ulcers 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). Analysis demonstrated that patients with recurrent ulcers have a significantly higher median ADI than those whose ulcers completely healed (Figure 1; p=0.016). There was a significant negative correlation between 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).

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.