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. 2023 May 4;20(9):3821–3839. doi: 10.1111/iwj.14222

What is the prevalence of chronic venous disease among health care workers? A scoping review

Sarah Benn 1, Zena Moore 2,3,4,5,6,7,8,9,10, Declan Patton 2,3,4,5,11, Tom O'Connor 2,3,4,5, Linda Nugent 12,4, Denis Harkin 13, Pinar Avsar 14,✉
PMCID: PMC10588334  PMID: 37139850

Abstract

Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain, swelling, varicose veins, and skin changes, with venous ulceration ultimately occurring in severe disease. To assess the prevalence of CVD among health care workers, a scoping review of existing publications exploring the prevalence of CVD among health care workers was conducted in July 2022. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were used. A total of 15 papers met the inclusion criteria and these formed the basis of the review. Among health care workers, the mean prevalence of CVD was 58.5% and the mean prevalence for varicose veins was 22.1%. There is an increased prevalence of CVD in health care workers when compared with the general population. Therefore, there is a need for early diagnosis and the use of preventative measures to protect health care workers from CVD and varicose vein development.

Keywords: chronic venous disease, health care workers, prevalence, varicose veins

1. INTRODUCTION

Chronic Venous Disease (CVD) is defined as a group of signs and symptoms occurring because of structural or functional outflow disturbances to the venous system of the limbs. 1 Malfunction of the venous system involving valvular incompetence or venous obstruction can arise in the deep and/or superficial veins of the limbs. 2 Early symptoms include; leg pain or discomfort, a believing of heaviness, and swelling which is often worse at the end of the day. 3 As disease severity increases clinical signs become visible. 4 These include telangiectasis, reticular veins and varicose veins, oedema, and skin changes; discolouration, darkening, and hardening of the skin, lipodermatosclerosis, with venous ulceration ultimately occurring in severe forms of CVD. 1

The CVD arises as a result of venous hypertension and inflammation. 3 Chronic hypertension actively damages the vessel wall and the endothelial layer of the vessel wall is disturbed because of distension. This triggers the activation and adherence of leucocytes and the initiation of the inflammatory cascade. Pathological changes occur because of increased permeability of the endothelium. Infiltration of red blood cells leads to oedema and tissue damage. 4 Chronic inflammation continues to weaken the walls of the vein and the function of its valves, contributing to the worsening condition of venous hypertension resulting in the pooling of blood in the lower limbs. 2

The prevalence of CVD in the general population varies depending on the geographical region studied. An international web‐based survey was carried out in 2020 to further understand the prevalence and characteristics of CVD across 8 countries in Europe and South America. 5 Based on patient self‐reporting, it was found that 22% of the general population suffers from signs and symptoms of CVD.

It is recognised that the incidence of varicose veins is higher in females than in males. 6 An important relationship is also thought to exist between the development of CVD and occupations which involve long periods of standing. 7 Indeed, studies have shown an increased prevalence of varicose veins in professionals that spend extended hours on their feet such as hairdressers, 8 hospital employees, 9 , 10 in particular nurses. 11 , 12

The CVD is a growing concern for both individuals and health care systems and it is expected that the number of CVD patients will increase substantially over the coming years because of the increasing incidence of obesity and the ever‐aging global population. 4 Varicose veins and chronic venous disease can impact negatively the patient. 4 The undesirable symptoms of swelling and pain, plus the visible effects of chronic venous disease can impact the patient psychologically, leading to a decrease in self‐esteem and an increased risk of depression. 11 , 13 Physically, tiredness and pain in the legs can interfere with the patient's ability to carry out normal activities and can lead to a loss of productivity at work. 14 Treatments of chronic venous disease can be difficult to tolerate, and surgery carries with it the added risk of complications. 5

The health of those who care for others is an important and under‐researched area and no scoping review was identified that explores the topic of CVD. Thus, this scoping review aimed to provide a synthesis of the available evidence that assessed the prevalence of chronic venous disease among health care workers.

2. REVIEW QUESTION

2.1. Primary question

What is the prevalence of chronic venous disease among health care workers?

2.2. Secondary questions

  1. What is the impact of chronic venous disease on the quality of life of health care workers?

  2. What is the incidence of adverse events among health care workers with CVD?

  3. What are the health care costs of chronic venous disease for health care workers?

3. METHODS

The methodology used was a scoping review. Scoping reviews are used to present a broad overview of the evidence pertaining to a topic, irrespective of study quality, and are useful when examining areas that are emerging, clarifying key concepts, and identifying gaps. 15 , 16 Scoping reviews are, therefore, particularly useful when a body of literature has not yet been comprehensively reviewed or exhibits a complex or heterogeneous nature not amenable to a precise systematic review of the evidence. 17 Scoping reviews also require rigorous and transparent methods in their conduct to ensure that the results are trustworthy 18 Therefore, using the PICO (population, intervention, control, and outcome) framework 19 as a guide, this scoping review appraised existing papers that explore the prevalence of the chronic venous disease among health care workers.

The components of the PEO were:

  • Population = Health care workers

  • Exposure = Chronic venous disease

  • Outcome = Primary—prevalence of the chronic venous disease; Secondary: quality of life, cost, and adverse events.

The author team used the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to guide the conduct and reporting of the scoping review (PRISMA 2021).

3.1. Search strategy

The search identified papers published in scientific journals with no limits applied initially on the type of methodology, jurisdiction, and any time of health care workers. Only English language papers were included. The following electronic databases were used to identify relevant literature: MEDLINE (Ovid), EBM Reviews, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Grey literature was explored using OpenGrey (www.opengrey.eu) and additional resources including Google Scholar were explored using reference lists of all identified studies.

The keywords and MeSH terms used in the search included:

  • #1 “chronic venous disease” OR “varicose veins” OR ‘varicose vein’ OR “chronic venous insufficiency” OR ‘venous insufficiency’

  • #2 “healthcare workers” OR ‘health care workers’ OR “physicians” OR “doctors” OR “nurses” OR “nursing” OR “dentists” OR “healthcare staff” OR “health personnel” OR “allied health personnel” OR “occupational diseases” OR “occupational health”

  • #3 “prevalence” OR “incidence” OR “frequency” OR “occurrence” OR “epidemiology”

  • #4: #1 AND #2 AND #3

3.2. Inclusion criteria

  • Published primary research articles, with no geographic restriction for study sites

  • Manuscripts written in English

  • Prevalence in the included studies could be a primary or secondary outcome

  • Any type of health care workers

3.3. Exclusion criteria

  • Population without health care workers

  • Non‐English reviews

3.4. Screening

The article titles were independently assessed by three different team members and the abstracts identified by the search strategy were screened for their eligibility, according to the inclusion and exclusion criteria. The full‐text version of potentially relevant studies was screened against the inclusion/exclusion criteria. Consensus between reviewers in relation to the studies and the data to be included was obtained.

3.5. Data extraction

Data were extracted onto a pre‐designed data extraction table recording the author, geographical site, study objectives, methodology, sample, data collection, and results (See Table 1).

TABLE 1.

Excluded studies with reasons.

Author Study title Reason for exclusion
Olynick and Foran (2021) “To stand or not to stand? Implications of prolonged standing for perioperative nurses: A discussion paper” No prevalence of CVD is discussed in this paper
Basic et al. (2014) “Orthostatic and Chronic Venous Insufficiency in Croatian Doctors of Dental Medicine” No mention of varicose veins
Falls, Nugent, and Wilson (2021) “Prevalence of lower limb venous disease in surgeons: a case study and results of a survey by the BAOMS Reconstruction Surgical Subspecialty Interest Group” It does not provide the information required
Hou Yung Kai (2021) “Lower limb venous and arterial peripheral diseases and work conditions: Systematic review”. A systematic review, not an original paper
Hannerz and Tuchsen (2002) “Hospitalisations among female home‐helpers in Denmark, 1981 to 1997”

Not clear in terms of percentage prevalence and it focuses on hospitalisation specifically.
Tuchsen et al. (2005) “Prolonged standing at work and hospitalisation because of varicose veins: a 12‐year prospective study of the Danish population” Does not have a specific date regarding health care workers.
Labropoulos, Delis, and Nicolaides (1995) “Venous reflux in symptom‐free vascular surgeons” No mention of varicose veins

Jin, Chi, and Ching (2008)

 “Perceived adverse occupational health effects in hospital personnel: An exploration of the effects of the workplace environment” No mention of varicose veins
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4. RESULTS

4.1. Overview of all included studies

Figure 1 outlines the flow of articles through the reviews. As can be seen, following reviews of titles & abstracts from a total of 417 hits, 392 were excluded. Then, following a review of the full papers of the remaining hits, 8 were rejected for the following reasons: non‐eligible study design and non‐eligible outcomes (see Table 1). Thus, 15 studies met the inclusion criteria and form the basis of this review. 9 , 10 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31

FIGURE 1.

FIGURE 1

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PRISMA flow diagram for study selection. 32

4.2. Study design

The studies were published between the years 2003 and 2022. A total of 14 used a cross‐sectional study design, 9 , 10 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 and one used a retrospective cohort study design. 31

4.3. Geographical location

The geographical location of the studies varied between China, 20 Turkey, 12 Taiwan, 31 Nepal, 21 USA, 10 Austria, 9 , 27 Italy, 23 Iran, 22 Egypt, 24 South Korea, 25 , 28 Bosnia and Herzegovina, 26 Thailand, 29 and India. 30

4.4. Study settings

The study settings also varied and included general hospitals, 20 , 22 , 23 university hospitals, 9 , 12 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 and a medical centre. 10 No specific study setting was stated by Huang et al. 31 as they used the Taiwan National Health Insurance Research Database to identify participants used in the study (see Figure 2).

FIGURE 2.

FIGURE 2

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Study settings.

4.5. Sample size

The total number of health care workers included in all the studies was 111 207, and the mean sample size was 7361 (SD: ±1798; min 71, 9 max 54 943 31 ).

4.6. Population

The participants studied were health care workers. The total cohort included nurses 9 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 physicians 9 , 27 , 31 and non‐physician health care providers; technicians, rehabilitation therapists, audiologists and social workers 31 and non‐specific health care workers 10 , 23 , 28 (see Figure 3).

FIGURE 3.

FIGURE 3

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Study population.

4.7. Studies characteristics

Table 2 provides a summary of the included studies.

TABLE 2.

Study characteristics.

Study number Authors & Country Design Study setting Study population Duration of CVD diagnosis Primary outcome result Secondary outcomes results
1.

Zhang, Ma 20

China

 Cross‐sectional study: using a self‐reported questionnaire

Multi‐centre:

Hospitals

 51, 406 nurses (97% female) The presence of varicose veins that had developed in the time they had begun working as a nurse was self‐reported.

  1. 37% of the nurses studied had developed varicose veins in their time working as a nurse.

  2. Female nurses tended to develop varicose veins when compared with male nurses.

  3. Nurses who worked >55 h per week and those who worked night shifts were more likely to suffer from occupational diseases

  1. Nurses who had occupational diseases were usually dissatisfied with their job.

  2. Multiple occupational diseases can lead to a decline in physical functions and decreased working efficiency, which can affect job satisfaction, career planning, and development of the nurse.

  3. Nurses suffering from various occupational diseases usually did not demonstrate a clear goal in their career development.
2.

Diken, Yalçınkaya 12

Turkey

 Cross‐sectional study: a doctor and nurse examined a patient using CEAP classification.

Single centre:

University Hospital

 294 nurses (79.3% females)
  1. 49.6% of subjects had a C0 status and no visible or palpable signs of venous disease, (no observable changes) according to CEAP classification.
  2. 51.4% had CVI signs. 39.2% C1, telangiectasis, or reticular veins.
  3. 0.9% C2, varicose veins.
  4. 62.9% had at least 1 symptom of Chronic venous Insufficiency.
  5. The average duration of hospital stay/work burden/workload was associated with an increased frequency of signs and symptoms of CVI.
  1. None of the nurses were previously diagnosed or has symptoms/findings of DVT
  2. 7.3% C3, oedema.
  3. 3% C4, pigmentation, or eczema.
  4. 0% C5, healed venous ulcer. 0% C5, active venous ulcer.
3.

Huang et al. 31

Taiwan

 Retrospective cohort study: the Taiwan National Health Insurance Research Database was used to identify subjects for the trial General population—Taiwan National Health Insurance Research Database

54 943 Health care workers in total

28 844 physicians

(86% male, 14% female)

26 099 non‐physician health care providers (technicians, rehabilitation therapists, audiologists, and social workers)

(30.59% male, 69.41% female)

 Duration of CVD was not stated in this study, but the subjects included in this study had physician‐made diagnoses
  1. Physicians and non‐physician health care providers had a cumulative varicose vein incidence of 0.12% and 0.13% respectively.
  2. The general population had a varicose vein incidence of 0.13%.
  3. Physician and non‐physician health care providers did not have a higher varicose vein risk than the general population.
  4. Varicose vein risk did not differ among physicians, non‐physician health care professionals, and the general population.
  5. Female physicians had a significantly lower varicose vein risk than female non‐physician health care providers 0.05% versus 0.17%.
  6. Surgeons had the highest incidence of varicose veins among physicians, with emergency medicine and paediatrics having the lowest incidence rate.
  7. In Taiwan physicians and non‐physician health care providers did not have a higher varicose vein risk than the general population.
  1. There was no significant difference in DVT history between physicians and the general population and non‐physician health care providers and the general population.
  2. C3 = 18.2%,
  3. C4a = 2.8%.
4.

Shakya, Karmacharya 21

Nepal

 Cross‐sectional study: Structured questionnaire to gather demographic, work‐related information, and medical history. Cardiovascular surgeon examined participants using CEAP classification and Doppler examination

Single centre:

University Hospital

181 nurses

(100% female)

 Duration of CVD diagnosis was not stated, participants in the study underwent a Doppler ultrasound for varicose vein confirmation. Participants who had varicose veins prior to entering the nursing profession were excluded from the study.
  1. Prevalence of varicose veins was 46%, with the highest prevalence among teaching faculty, with the lowest in the orthopaedic ward.
  2. Higher prevalence was also present in outpatient departments, surgery wards, and critical care units.
  3. The prevalence is increased in nurses with longer standing hours, with the highest prevalence of varicose veins among nurses who stand for 4 to 5 h per day.
  4. Sitting hours and walking hours were negatively associated with varicose veins.
  5. C0 = 72.4%,
  6. C1 = 2.8%,
  7. C2 = 3.9%
5.

Cires‐Drouet, Fangyang 10

United States

Cross‐sectional, observational single‐arm study:

Hospital‐wide screening of health care workers using a questionnaire to detail demographics and patient information. A physical exam for determination of CEAP classification of clinical disease by a nurse, deep ultrasound examination for reflux or obstruction by a vascular sonographer, and a self‐reported Caprini score to evaluate the risk of DVT

Single centre:

University Medical Centre

636 health care workers

(93% female)

 Not stated
  1. 30.8% demonstrated no evidence of CVI in either leg.
  2. 15.9% reported daily leg swelling,
  3. 65.2% self‐reporting varicose veins.
  4. In the remaining 69.1% of participants, Clinical evidence of CVI was present in at least 1 leg.
  5. CEAP:
    C1‐49%
    C2‐17.7%
  6. 17.8% of participants had no evidence of reflux.
  7. Venous reflux was present in at least 1 leg in 82.1%, with 71% occurring in the deep venous system of those with CVI.
  8. Female sex and white race were risk factors for venous reflux and CVI.
  1. Based on the Caprini score, 14.1% of participants were in the moderate risk category for DVT when experiencing a high‐risk situation.
  2. 2.2% had a history of DVT
  3. C3‐1.9%
  4. C4‐0.2%
  5. C5‐0.2%
6.

Ziegler, Eckhardt 9

Austria

Cross‐sectional study:

Physical examination CEAP and questionnaire to evaluate risk factors

 Single centre: University hospital 71 health care workers comprising of doctors and nurse Not stated

  1. 31% of nurses and medical doctors had an occurrence of CVD (C2‐C6)

  2. 69% had the absence of CVD

  3. 48% had the presence of CVD:

  4. C0: 52%

    C1 17%.

    C2 20%,
  1. 14.1% believe that the symptoms of CVD restricted their quality of life
  2. C3 10%
  3. C4 1%.
7.

Rosati, Sacco 23

Italy

Cross‐sectional study:

Clinical examination: observation, palpation, specific tests (no ultrasound performed) using CEAP classification and questionnaire to determine risk factors

Single centre:

General Hospital

 91 nurses, out of a total of 173 hospital workers—31 support staff/auxiliary and 51 employees) Not stated
  1. Upright standing is a major risk factor for CVD, with the prevalence of venous pathology greater among nurses than administrative staff.
  2. It is significantly higher in female workers than in males.
  3. Prevalence of venous pathology seems to be greater among nurses and auxiliaries (54%).
  4. Prevalence of the total venous pathology was significantly higher among female workers (46.8%).
  5. Among nurses, there was a significantly higher prevalence of major diseases compared with the support staff and other hospital employees.
  6. The nursing group showed a significantly higher prevalence in the case of venous pathology.
8.

Sharif Nia, Chan 22

Iran

 Cross‐sectional study: Self‐filled questionnaire (demographics and personal info, nursing duties) and physical examination using CEAP classification clinical findings Multi‐centre study: 3 general hospitals used

203 nurses

(71.4% women)

 Not stated

  1. Prevalence of Varicose veins was 73.9%

  2. Women had a higher prevalence when compared with men (77.9% vs. 56.9%).

  3. Varicose veins risk increases with the increase in the hours of work in a standing position (>4 h).
9.

Abou‐ElWafa, El‐Metwaly 24

Egypt

 Cross‐sectional descriptive study: Questionnaire to collect data and Doppler Ultrasound Examination to assess for varicose veins.

Single centre study:

University Hospital

201 nurses

(81.4% female)

 Not stated

  1. 18.4% of nurses have lower limb varicosities.

  2. Varicose veins are significantly more prevalent among nurses aged >25 years, married, not exercising, and obese.

  3. The prevalence of varicose veins is significantly higher among nurses in emergency and ICU/operative rooms, working for 5 > years, with more than 6 daily working hours, and with static standing posture.

  4. The significant independent predictors of varicose veins among nurses are being >25 years old, working in emergency rooms and ICU/operative rooms, and using oral contraceptives and adjusted odds ratio.
10.

Yun, Kim 25

Republic of South Korea

 Cross‐sectional study; Survey and diagnostic testing: Doppler ultrasonography

Single centre:

University Hospital

414 nurses

(98.3% women)

 Not stated

  1. The prevalence of varicose veins in nurses was estimated at 16.2%. (16.2% prevalence in female nurses, 14.3% in male nurses).

  2. Highest prevalence was demonstrated by working in the operating room (36.4%)followed by the outpatient clinic (26.9%), intensive care unit (19.4%) emergency (18.2%), and ward (10.2%).

  3. Standing for more than 4 h showed significantly more pathological reflux compared with the less than 4 h standing group.
11.

Ljevak, Vasilj 26

Bosnia and Herzegovina

 Comparative cross‐sectional study: Standard shift work index (SSI) and health‐related questionnaire was used to collect data on the subjects.

Single centre:

University Hospital

157 nurses

(86% female, 14% male)

 Not stated

  1. There was a significantly higher number of nursing staff experiencing varicose veins in the shift work group 26.3% (specific shifts 12‐hr day shift/24‐hrs off/12‐hr night shift/48‐hrs off) in comparison with those working the daily schedule 13% (7 working hour day)
12.

Ziegler 27

Austria

 Cross‐sectional study: physical examination CEAP, a questionnaire to evaluate endogenous risk factors, to evaluate restriction of QOL subjects were asked about symptoms and were graded, days absent from work in relation to CVD recorded

Single centre:

University Hospital

71 doctors and nurses

(72%being females).

 Not stated

  1. Out of the doctors and nurses' group:

    C0‐52%,

    C1‐17%,

    C2‐20%,
  1. 14% of the doctors and nurses group stated believing temporarily restricted, predominantly in the evening in their QOL because of diverse symptoms of CVD, including cramps, oedema, pruritus, and restless legs.
  2. 1% stated that they suffered permanently from these symptoms.
  3. 3. No doctors or nurses had stayed absent from work during the past last year because of complaints of CVD
  4. 1.4% history of DVT
  5. C3‐10%,
  6. C4‐1%
13.

Kwon 28

South Korea

 Cross‐sectional Study: Retrospective analysis using a questionnaire, the self‐reported VEINES‐QOL/Sym questionnaire was used to evaluate symptoms and QOL of leg‐related venous disease. Patients were classified into CEAP by their own response—self‐reported.

Single centre:

University Hospital

1166 health care workers

(21.2% male, 78.8% female)

 Not stated

  1. The prevalence of CVD based on clinical manifestation and symptoms was 79.7%.

  2. 20.3% had no disease,

  3. 47.3% had mild disease (C1, C2),

  4. Higher prevalence of

    CVD in females is 89.8% and males 41.7%.

  5. The prevalence of varicose veins was 21.8% in women and 9.5% in males.

  6. Higher prevalence of CVD in females 89.8% than in males 41.7%.
  1. The mean VEINES‐QOL/Sym score was 67.2 for all participants. 64.6 for patients ages <30, 64.9 for patients 31 to 40, 71.4 for patients 41 to 50, and 74.1 for patients >50.
  2. The total score of the nurse/nurse assistant group was 63.1.
  3. The active group of workers was 77.6, the mid group was 70.7, sedentary group 76.3.
  4. Participants with a working period of >15 had the highest scores, those with a working period of 0 to 5 years had 66.7, 6 to 10 years 64.2, 11 to 15 years 67.2, and > 15 years 72.8.
  5. 32.3% had moderate to severe disease (C3, C4, C5, C6).
14.

Kaima, Reanpang 29

Thailand

 Cross‐sectional study: 2‐part questionnaire— 1. to collect data on individual characteristics, risk factors, and history of CVD. 2. quality of life by using Chronic Venous Insufficiency Quality of Life Questionaire‐14 (CIVIQ‐14). Physical examination using CEAP classification

Single centre:

University Hospital

222 nurses

(94.1% female)

 Not stated

  1. Across all nurses C0‐20.8%,

    C1‐66.5%,

    C2‐12.7%.

  2. The prevalence of C0‐C2 was notably different between the two groups, OR nurses and non‐OR nurses. The prevalence of C1 in OR nurses—was 59.6% and in non‐OR nurses—72.1%.

  3. Prevalence of C2 in OR nurses 8.1%, non‐OR nurses 16.4%.

  4. Prevalence of C2 and C1 in non‐OR nurses was significantly higher than in OR nurses. C2 in non‐OR nurses was 2 times more frequent than in OR nurses.

  5. However, the standing time per day in the study is not different between the two groups of nurses. The mean standing time per day of OR nurses is 5.6 h and non‐OR nurses are 6.14 h. Non‐OR nurses had more CVD (C1 & C2).
  1. Quality of life was not remarkably different between OR nurses and non‐OR nurses.
15.

Mishra, Solanki 30

India

 Cross‐sectional study: Self‐filled questionnaire and physical examination based on CEAP.

Muti‐centre:

General hospitals

364 nurses

(82.97% female)

 Not stated

  1. Varicose vein prevalence of 24.17%, with prevalence among female nurses at 24.5% and males slightly lower at 22.58%.
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4.8. Results for the primary outcome

The primary outcome of interest was the prevalence of CVD among health care workers. The methods and tools used to estimate the prevalence of chronic venous disease varied throughout the studies and included self‐reporting questionnaires, physician‐made diagnoses, clinical and physical examinations using the CEAP classification system, and Doppler ultrasonography. Some studies used a combination of tools such as questionnaire and Doppler ultrasonography, questionnaire and physical exam and questionnaire, physical exam and Doppler ultrasonography (see Figure 4).

FIGURE 4.

FIGURE 4

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Methods and tools used to estimate the prevalence of chronic venous disease.

The mean prevalence of CVD was 58.4% and the mean (overall) prevalence for varicose veins was 22.1%. The mean prevalence for self‐reported varicose veins was reported as 29.4%. Whereas the mean prevalence of C2‐classified varicose veins on physical exam or Doppler ultra‐sonography was 18.81% (see Figure 5).

FIGURE 5.

FIGURE 5

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The mean prevalence of chronic venous disease among health care workers.

As a variety of methods were used to estimate the prevalence of CVD (a CEAP classification of C1‐C6) and varicose veins (self‐reported or CEAP classification of C2), the minimum findings are individually reported based on the methods used and conditions described. The minimum prevalence of CVD reported using physical examination and CEAP classification was 48%. 9 , 27 The minimum prevalence of CVD reported using Doppler ultrasonography and CEAP classification was 27.7%. 21 The minimum prevalence of varicose veins reported using a physician‐made diagnosis was 0.12% of physicians and 0.13% of non‐physician health care workers. 31 The minimum prevalence of varicose veins in using a self‐completed questionnaire was 19%. 26 In the same study, it was specifically stated that a lower prevalence of varicose veins was found in a sub‐group of non‐shift working nurses, at 13%. The minimum prevalence of varicose veins reported using a self‐completed questionnaire and physical exam with CEAP classification (C2) was 12.7%. 29 In the same study, it was specifically stated that a lower prevalence of varicose veins was found in a sub‐group of OR nurses, at 8.1%. The minimum prevalence of varicose veins reported in which Doppler ultra‐sonography and CEAP classification (C2) were used was 3.9%. 21

The maximum prevalence of CVD reported using a self‐completed questionnaire was 79.7%. 28 The maximum prevalence of CVD reported using a self‐completed questionnaire and physical exam with CEAP classification was 79.2%. 29 The maximum prevalence of varicose veins reported in which Doppler ultra‐sonography and CEAP classification were used was 69.2%. 10 The maximum prevalence of varicose veins reported using a self‐completed questionnaire was reported at 46%. 21 The maximum prevalence of varicose veins reported using a self‐completed questionnaire and physical exam with CEAP classification (C2) was 24.17%. 30 The maximum prevalence of varicose veins reported in which Doppler ultra‐sonography and CEAP classification (C2) were used was 18.4%. 24 The CEAP classification has been a universally accepted classification system and reporting standard for CVD and continues to be an important contributor to progress in the field of CVD. 33

The prevalence rates varied across the countries (see Figure 6). However, one study reported incidence rates. In Taiwan Huang et al. 31 reported that according to the National Health Insurance research database physicians and nonphysician health care providers had a culminating, physician‐diagnosed varicose vein incidence of 0.12% and 0.13% respectively. Surgeons had the highest incidence of varicose veins among physicians whereas physicians working in emergency medicine and paediatrics had the lowest incidence rate.

FIGURE 6.

FIGURE 6

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Percentage prevalence by country.

4.9. Results for the secondary outcome

The secondary outcomes of interest were the impact of chronic venous disease on quality of life, the cost for health care workers, and the incidence of adverse events related to CVD. The cost of chronic venous disease was not discussed in any of the papers included in this review.

4.9.1. Quality of life

Among the included studies, three papers evaluated the impact of chronic venous disease on quality of life. 20 , 27 , 28

In Ziegler 27 14% of the participants stated believing temporarily restricted in their quality of life, predominantly in the evening, because of a diverse range of CVD symptoms including cramps, oedema, pruritus, and restless legs. Furthermore, 1% of the group studied stated that they suffered permanently from these symptoms.

In Kwon 28 a disease‐specific quality of life instrument, The VEINES‐QOL/Sym questionnaire, was used to measure the quality of life of the participants. This tool is specifically used in patients with chronic venous disorders of the leg. As described by Bland et al. (2015) the VEINES‐QOL/Sym questionnaire consists of 26 items and includes questions about symptoms, limitations in daily activities, and psychological impact. It also asks questions regarding the change in the person's leg condition in the previous 1‐year period and the time of day that the symptoms experienced are most intense. Higher scores indicate better outcomes and a better quality of life. In their study, Kwon 28 adapted the tool by removing the psychological impact questions. They found that the mean VEINES‐QOL/Sym score for all health care workers studied was 67.2. When the participants were analysed according to age the mean VEINES‐QOL/Sym score was 64.6 for participants ages <30, 64.9 for participants aged 31 to 40, 71.4 for participants aged 41 to 50, and 74.1 for participants aged >50. The mean score of the nurse/nurse assistant group was 63.1. Participants with a working period of >15 years had the highest scores of 72.8. Those with a working period of 0 to 5 years had a score of 66.7, 6 to 10 years 64.2, and 11 to 15 years 67.2. According to these scores, the impact of CVD on younger health care workers resulted in them having a poorer quality of life than older participants studied. Nurses also experienced a reduced quality of life because of CVD symptoms.

With regard to the quality of working life, Zhang, Ma 20 found that nurses who had occupational diseases, such as varicose veins, were usually dissatisfied with their job. If a nurse suffered from multiple occupational diseases, such as varicose veins with insomnia and/or a musculoskeletal‐related disorder, this lead to a decline in physical function and thus a decreased working efficiency. This further impacted job satisfaction and had a knock‐on negative effect on the career planning and development of the nurse. Nurses who were suffering from occupational diseases were found to not have clear goals in relation to their career development.

4.9.2. Adverse events

The adverse events, DVT or VTE experienced by health care workers with chronic venous disease, were presented in 4 papers. 10 , 12 , 27 , 31

Diken, Yalçınkaya 12 found that none of the nurses included in the study had previously been diagnosed with, or had findings of DVT, similarly, Huang et al. 31 found that there was no significant difference in DVT history between physicians and non‐physician health care providers and the general population. Conversely, Ziegler 27 found that 1.4% of participants had a history of DVT, and Cires‐Drouet, Fangyang. 10

found that 2.2% of the participants had a history of DVT. Furthermore, Cires‐Drouet, Fangyang 10 also evaluated participants using the Cipriani score for Venous Thromboembolism, a risk assessment tool for the occurrence of venous thromboembolism (VTE) among surgical patients. A score of greater than 9 is considered to be high risk, a score between 5 and 8 is considered moderate risk and a score of less than 4 is considered low risk. On the basis of the Cipriani score, 14.1% of health care workers studied were in the moderate risk category, indicating ≤6% DVT risk when experiencing a high‐risk situation.

Additionally, stages C3 to C6 according to the CEAP classification were considered complications in this study. Six studies reported C3 and upper stages prevalence rates. 9 , 10 , 12 , 27 , 28 , 31 The mean prevalence rates were 9.48 ± 5.8% (C3) 9 , 10 , 12 , 27 , 31 ; 1.6 ± 1.23% (C4) 9 , 10 , 12 , 27 , 31 respectively. One study reported a C5 prevalence rate of 0.2%. 10 Kwon 28 showed that 32.3% of the health workers had moderate to severe disease (C3, C4, C5, C6) (see Table 2).

5. DISCUSSION

In this scoping review, 15 research studies were analysed in order to answer our primary research aim of assessing the prevalence of CVD among health care workers. The international health care worker population which formed the basis of our review came from 12 different countries across Asia, Europe, and America, with 65% of this population being nurses, and 15% being physicians. We found the mean prevalence of CVD in health care workers to be 58%. This result is considerably higher than that of the 22% rate of CVD estimated among the general population. 5 Our data suggest that CVD has a higher prevalence among health care workers than that among the general population. Prior to the outset of this review, the prevalence of CVD in health care workers was expected to be greater than that of the general population. The factors which supported this thinking are the prolonged standing times associated with the nursing and health care profession 7 and the dominance of female staff within the global health and social care workforce. 6 The World Health Organisation (2022) estimates that women account for 70% of the workforce.

With regard to our secondary research aims, analysing the impact of CVD on quality of life, the health care costs of CVD, and the adverse events occurring because of CVD, we were unable to answer these questions effectively. There was little discussion on the impact of CVD on quality of life, cost, and associated adverse events in the papers included in this review. These topics were in the main, beyond the scope of the majority of the quantitative papers we analysed. Thus, in this regard, the health of those who care for others remains an under‐researched area. The undesirable symptoms of swelling and pain, plus the visible effects of CVD can negatively impact the individual's quality of life, leading to a decrease in self‐esteem and an increased risk of depression. 11 Tiredness and pain in the legs can interfere with the ability to carry out normal activities and can lead to a loss of productivity at work. 14 Health systems worldwide are already under pressure. The looming burden of the high prevalence of CVD in health care workers in particular is worrying, 60% is a sizeable number of the workforce. Disease awareness and appropriate treatment are needed for the management and prevention of CVD to avoid complications and reduced quality of life. 4

To support the findings of this review we recommend greater emphasis within health care systems in the area of CVD prevention, in particular, the implementation of preventative strategies in the workplace to reduce the high rates of CVD in health care workers.

Practical action can be taken by both health systems and health care workers alike. For example, Hughes et al. 34 investigated the use of antifatigue mats, sit/stand stools, and limited standing times to overcome prolonged standing faced by health care workers in the perioperative setting. We suggest such measures be considered by hospital management. Furthermore, individual behaviour change, for example, toward weight management should be encouraged among health care workers as obesity is a known risk factor in the development and progression of CVD and varicose veins. 4

Venous screening programs can be used for the early detection and appropriate management of CVD. Screening programs allow for disease identification prior to the onset of symptoms, thus allowing early diagnosis and effective, timely treatment to take place. Thus, venous screening programs will ultimately act to improve the health and quality of life of our health care workers. 35 , 36

5.1. Recommendations

It was noted in the outcomes of the literature search that there was no data available on the prevalence of CVD in health care workers in some countries. Additional studies should be designed to identify the global rate of CVD to enable a comparison of regional outcomes. Another possible area of future research would be to investigate the impact of increasing awareness about CVD and the implementation of educational and preventive measures among this high‐risk cohort.

5.2. Limitations

An unanticipated challenge that emerged in the review process was the variety of methods used to estimate the prevalence of CVD (CEAP classification of C1‐C6) and varicose veins (self‐reported or CEAP classification of C2) across the papers included in this study, with some authors using multiple methods in their individual studies. 9 , 21 , 23 , 25 , 27 , 28 , 30 Because of lack of heterogeneity in the methods used bias may be present potentially leading to an inaccurate reporting of the prevalence rate of CVD in health care workers as not one singular clinical‐diagnostic protocol was followed by all studies. This limitation impacts our prevalence rate, which can be interpreted as a generalised figure. Nonetheless, the findings were appropriate for the purpose of answering our research question.

6. CONCLUSION

The main goal of this scoping review was to determine the prevalence of CVD among health care workers. Despite the methods and tools used to estimate the prevalence of chronic venous disease varied throughout the studies, this review has found that 58% of health care workers suffer from CVD. Thus, from these findings, we can conclude that health care workers have a much higher prevalence of CVD than that of the general population. To avoid late consequences of CVD, such as venous ulcers or DVT, following exposure to a high‐risk environment, it is essential to conduct educational and preventive measures in this high‐risk group. However, more research is required to determine the efficacy of the implementation of educational and preventive measures for CVD in this cohort.

FUNDING INFORMATION

This research did not receive any funding.

CONFLICT OF INTEREST STATEMENT

No conflict of interest is declared by the authors.

ACKNOWLEDGEMENT

Open access funding provided by IReL.

Benn S, Moore Z, Patton D, et al. What is the prevalence of chronic venous disease among health care workers? A scoping review. Int Wound J. 2023;20(9):3821‐3839. doi: 10.1111/iwj.14222

DATA AVAILABILITY STATEMENT

Data sharing not applicable ‐ no new data generated, or the article describes entirely theoretical research

REFERENCES

  • 1. Ortega MA, Fraile‐Martínez O, García‐Montero C, et al. Understanding chronic venous disease: a critical overview of its pathophysiology and medical management. J Clin Med. 2021;10:20210722. doi: 10.3390/jcm10153239 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Kasperczak J, Ropacka‐Lesiak M, Breborowicz HG. Definition, classification and diagnosis of chronic venous insufficiency ‐ part II. Ginekol Pol. 2013;84:51‐55. doi: 10.17772/gp/1540 [DOI] [PubMed] [Google Scholar]
  • 3. Nicolaides AN, Labropoulos N. Burden and suffering in chronic venous disease. Adv Ther. 2019;36(1–4):20190213. doi: 10.1007/s12325-019-0882-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Davies AH. The seriousness of chronic venous disease: a review of real‐world evidence. Adv Ther. 2019;36(5–12):20190213. doi: 10.1007/s12325-019-0881-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Rabe E, Régnier C, Goron F, Salmat G, Pannier F. The prevalence, disease characteristics and treatment of chronic venous disease: an international web‐based survey. J Comp Eff Res. 2020;9(1205–1218):20201020. doi: 10.2217/cer-2020-0158 [DOI] [PubMed] [Google Scholar]
  • 6. Alsaigh T, Fukaya E. Varicose veins and chronic venous disease. Cardiol Clin. 2021;39:567‐581. doi: 10.1016/j.ccl.2021.06.009 [DOI] [PubMed] [Google Scholar]
  • 7. Sudoł‐Szopińska I, Bogdan A, Szopiński T, Panorska AK, Kołodziejczak M. Prevalence of chronic venous disorders among employees working in prolonged sitting and standing postures. Int J Occup Saf Ergon. 2011;17:165‐173. doi: 10.1080/10803548.2011.11076887 [DOI] [PubMed] [Google Scholar]
  • 8. Chen CL, Guo HR. Varicose veins in hairdressers and associated risk factors: a cross‐sectional study. BMC Public Health. 2014;14(885):20140828. doi: 10.1186/1471-2458-14-885 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Ziegler S, Eckhardt G, Stöger R, Machula J, Rüdiger HW. High prevalence of chronic venous disease in hospital employees. Wien Klin Wochenschr. 2003;115:575‐579. doi: 10.1007/bf03040451 [DOI] [PubMed] [Google Scholar]
  • 10. Cires‐Drouet RS, Fangyang L, Rosenberger S, et al. High prevalence of chronic venous disease among health care workers in the United States. J Vasc Surg Venous Lymphat Disord. 2020;8:224‐230. doi: 10.1016/j.jvsv.2019.10.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. AlBader B, Sallam A, Moukaddem A, et al. Prevalence of varicose veins among nurses at different departments in a single tertiary Care Center in Riyadh. Cureus. 2020;12:e12319. doi: 10.7759/cureus.12319 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Diken AI, Yalçınkaya A, Aksoy E, et al. Prevalence, presentation and occupational risk factors of chronic venous disease in nurses. Phlebology. 2016;31(111–117):20150110. doi: 10.1177/0268355514567491 [DOI] [PubMed] [Google Scholar]
  • 13. Sritharan K, Lane TR, Davies AH. The burden of depression in patients with symptomatic varicose veins. Eur J Vasc Endovasc Surg. 2012;43(480–484):20120129. doi: 10.1016/j.ejvs.2012.01.008 [DOI] [PubMed] [Google Scholar]
  • 14. Franz A, Wann‐Hansson C. Patients' experiences of living with varicose veins and management of the disease in daily life. J Clin Nurs. 2016;25(733–741):20151028. doi: 10.1111/jocn.13023 [DOI] [PubMed] [Google Scholar]
  • 15. Peters MD, Godfrey CM, Khalil H, et al. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13:141‐146. doi: 10.1097/xeb.0000000000000050 [DOI] [PubMed] [Google Scholar]
  • 16. Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16(15):20160209. doi: 10.1186/s12874-016-0116-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Moher D. Reporting guidelines: doing better for readers. BMC Med. 2018;16(233):20181214. doi: 10.1186/s12916-018-1226-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(143):20181119. doi: 10.1186/s12874-018-0611-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16. doi: 10.1186/1472-6947-7-16 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Zhang W, Ma X, Xiao Q, Yu S, Zhang M, Wang X. Career development and occupational disease in Chinese nurses: a cross‐sectional study. Inquiry. 2022;59:469580221092819. doi: 10.1177/00469580221092819 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Shakya R, Karmacharya RM, Shrestha R, Shrestha A. Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study. BMC Nurs. 2020;19(8):20200203. doi: 10.1186/s12912-020-0401-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Sharif Nia H, Chan YH, Haghdoost AA, Soleimani MA, Beheshti Z, Bahrami N. Varicose veins of the legs among nurses: occupational and demographic characteristics. Int J Nurs Pract. 2015;21(313–320):20140401. doi: 10.1111/ijn.12268 [DOI] [PubMed] [Google Scholar]
  • 23. Rosati MV, Sacco C, Mastrantonio A, et al. Prevalence of chronic venous pathology in healthcare workers and the role of upright standing. Int Angiol. 2019;38(201–210):20190516. doi: 10.23736/s0392-9590.19.04040-9 [DOI] [PubMed] [Google Scholar]
  • 24. Abou‐ElWafa HS, El‐Metwaly AAM, El‐Gilany AH. Lower limb varicose veins among nurses: a single center cross‐sectional study in Mansoura, Egypt. Ind J Occup Environ Med. 2020;24(172–177):20201214. doi: 10.4103/ijoem.IJOEM_264_19 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Yun M‐J, Kim Y‐K, Kang DM, et al. A study on the prevalence and risk factors for varicose veins in nurses at a university hospital. Saf Health Work. 2017;9:9‐83. doi: 10.1016/j.shaw.2017.08.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Ljevak I, Vasilj I, Neuberg M, Tomić J, Meštrović T. The effect of shift work on the overall health status of hospital‐employed nursing staff in Bosnia and Herzegovina: a cross‐sectional study. Psychiatr Danub. 2021;33:771‐777. [PubMed] [Google Scholar]
  • 27. Ziegler S. Chronic venous disease is highly prevalent in hospital employees. Phlebolymphology. 2006;13:150‐155. [Google Scholar]
  • 28. Kwon SK. Prevalence of chronic disease in healthcare workers. Ann Phlebol. 2020;18:45‐50. [Google Scholar]
  • 29. Kaima P, Reanpang T, Kulprachakarn K, Pongtam S, Rerkasem K. Chronic venous disease among nurses in operating room and outside operating room. Vessel Plus. 2020;4:37. doi: 10.20517/2574-1209.2020.50 [DOI] [Google Scholar]
  • 30. Mishra N, Solanki SL, Mishra S. Lower limb varicose veins among nurses: a cross sectional study IN UDAIPUR. Int J Curr Res Rev. 2015;7:51‐55. [Google Scholar]
  • 31. Huang HK, Weng SF, Su SB, et al. Standing posture at work does not increase the risk of varicose veins among health care providers in Taiwan. Med Princ Pract. 2017;26(266–272):20170228‐20170272. doi: 10.1159/000466696 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed). 2021;372:n71. doi: 10.1136/bmj.n71 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(342–352):20200227. doi: 10.1016/j.jvsv.2019.12.075 [DOI] [PubMed] [Google Scholar]
  • 34. Hughes L, Fethke N, Hagemann T. Antifatigue mats, sit/stand stools, and the effects on leg discomfort and fatigue. AAOHN J. 2001;49(7):321‐326.11760638 [Google Scholar]
  • 35. McLafferty RB, Digman C, Currens K. Effectiveness of a venous screening and compression stocking education program for nurses. J Vasc Nurs. 2007;25(2):39‐44.17531938 [Google Scholar]
  • 36. Speechley M, Kwiecien S, Teasell R, Loh E. Effectiveness of a compression stocking program to reduce venous symptoms and improve quality of life in nurses. J Occup Health. 2017;59(4):338‐345. [Google Scholar]

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Data Availability Statement

Data sharing not applicable ‐ no new data generated, or the article describes entirely theoretical research

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