EPIDEMIOLOGY AND RISK FACTORS OF VARICOSE VEIN DISEASE IN TAJIKISTAN

Abstract

Objective: To analyze the prevalence of varicose vein disease (VVD) and its risk factors (RFs) among the population of Tajikistan in the pilot project involving the two regions of the country. Methods: From the general population permanently residing in D. Balkhi and Dusti districts of the Republic of Tajikistan 3,084 people were screened for VVD and its RFs, including 1,521 from the Dusti district (376 men and 1,145 women), and 1,563 from the D. Balkhi district (352 men and 1211 women). There were 728 men (23.6%), and 2,356 women (76.4%) enrolled in the study. The age of the screened cohort ranged from 11 to 83 years, with a mean age of 41.1±3.5 years. The study included analysis of complaints and anamnesis of the disease, a detailed study and identification of all possible RFs, angiological examination of the participants in order to identify the signs of VVC, as well as Doppler ultrasound examination (DUE) in case of dilatation of the main subcutaneous veins. Results: Clinical signs of VVD were detected in 1,469 (47.6%) people of the examined cohort, which were significantly less common in men (280 cases, 38.5%) than in women (1,189; 50.5%) (p<0.001). The most common manifestations were reticular varices and telangiectases (59.6%) with significantly higher frequency in females (p<0.001). The share of C2-C6 classes of VVC was 40.4% of cases, including decompensated forms of the disease with symptoms of induration, healed or active ulcers, which occurred in 4.9% of cases. Most often different forms of VVD were found in females (n=1189;80.9%) compared to males (n=280; 19.1%) (p<0.001). However, among male patients mild forms of VVD, such as reticular varices and telangiectases, were significantly less common (48.9%) compared to the females (62.2%; p<0.001). The main subcutaneous veins’ dilation and complicated forms of VVD (C2-C6) were observed in 51.1% of men and 37.8% of women, the difference between them being significant (p<0.001). Most commonly VVD was seen in the age of 31-40 and 41-50 years (83.2% and 69.7%, respectively). Significant RFs for VVD among the examined cohort were hereditary predisposition (OR 2.322; 95% CI: 1.247-3.421), pregnancy and number of deliveries (OR 3.041; 95% CI: 1.033-4.051), obesity (OR 1.338; 95% CI: 0.838- 2.481), regular static activity (OR 11.262; 95% CI: 7.452-17.019), prolonged standing or sedentary work (OR 3.627; 95% CI: 1.464-4.848), age over 18 years (OR 1.506; 95% CI: 0.839-2.702) and a combination of RFs (OR 8.096; 95% CI: 6.072-12.129). Conclusion: Almost half (47.6%) of the surveyed population suffers from VVD of varying severity, most of patients are young and middle-aged people, mainly women. Significant RFs for VVD among the examined cohort were hereditary predisposition, pregnancy and childbirths, obesity, regular heavy physical activity, prolonged sedentary or standing work, age, as well as a combination of these factors. Keywords: Chronic venous disease, varicose veins, epidemiology, risk factors.