Q J Med 2004; 97: 431-437
QJM vol. 97 no. 7 © Association of Physicians 2004; all rights reserved.
Prevalence of leg ulceration in a London population
From the 1Centre for Research & Implementation of Clinical Practice, Thames Valley University, London, 2Wandsworth Primary Care NHS Trust, St Johns Therapy Centre, London, and 3Nursing Research Unit, King's College London, London, UK
Received 7 January 2004 and in revised form 6 April 2004
Background: Current prevalence estimates of chronic leg ulceration are frequently based on studies from the 1980s. During the last decade, major changes have occurred in the application of evidence-based practice to this condition.
Aim: To determine the prevalence and cause of leg ulceration in a defined geographical population after 8 years of providing standardized evidence based protocols of care.
Design: Prospective survey.
Methods: Patients with leg ulceration of >4 weeks duration) within an integrated acute and community leg ulcer service were ascertained, interviewed and clinically assessed, using a standardized questionnaire on medical history, ulcer details and non-invasive vascular investigation to describe causes. Ulcers were classified by aetiology.
Results: We identified 113 patients in a population of 252 000, giving a crude prevalence of 0.45/1000 (95%CI 0.37–0.54/1000): 0.34/1000 in men, 0.54/1000 in women. Rates were highly dependent on age, increasing to 8.29 (men) and 8.06/1000 (women) in those aged >85 years. Of the responders, 62/113 (55%) had their ulcer for >1 year. Uncomplicated venous ulceration was observed in only 59/138 (43%) ulcerated limbs; a further 21 had ulceration primarily due to arterial disease. Complex causes were present in 48 (35%) limbs, mostly venous disease in combination with diabetes (35%), lymphoedema (42%) and rheumatoid arthritis (26%).
Discussion: Our prevalence of chronic leg ulceration is approximately one-third of that predicted by previous studies using similar methodologies in the 1980s. Patients with ulceration have more complex aetiologies than previously recognized, which may be a consequence of both increasing ulcer chronicity and age.
Address correspondence to Professor P.J. Franks, Centre for Research & Implementation of Clinical Practice, Thames Valley University, 32–38 Uxbridge Road, London W5 2BS. e-mail: peter.franks{at}tvu.ac.uk
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