Prevalence and Risk Factors of Varicose Veins among Female Hairdressers

Prevalence and Risk Factors of Varicose Veins
among Female Hairdressers: A Cross Sectional
Study in North-east of Iran

Introduction

• Varicose Veins Definition:Superficial veins that have become enlarged and twisted due to damaged valves in veins.
• It is one of the Occupational diseases.
• Women > Men
• Heriditaty
• Range from being asymptomatic to causing eczema,superficial thrombophlebitis,bleeding,venous ulcers.

Background

 
One of the most important pathogenic factors in western countries.
Affecting 1/3rd of Great Britain population and is a major cause of morbidity.In England,2% of health care budget is allocated to the control and treatment of these diseases.

Emerging problem in 21st century.

Estimated prevalence varies from 2% to 56% in Men and 1% to 73% in Women.

Several risk factors including age,sex,family history,obesity,diet and jobs that require prolonged standing are assumed to develop this disorder. Hair dressing is a kind of occupation that entails prolonged standing during work and consequently can increase the prevalence and severity of varicose veins.

Aims
• This study was conducted to determine the prevalence as well as demographic and occupational factors associated with Varicose Veins in female hairdressers in Shahroud,North of Iran in 2012.



 
Methods
 
• In this cross sectional study,197 female hairdressers licensed by the Health
Department of Shahroud University of Medical sciences,Iran were studied.
• This was a census study in that the entire population was completely included.
• Inclusion criteria included
-a license of hair dressers union
-being employed as a hairdresser for atleast one year at the time of the study
-no history of lower extremity venous disease before engaging in hairdressing.
• Demographic information included age,BMI,number of pregnancies,family history of varicose
veins,hypertension,Oral Contraceptive pill(OCP),constipation and physical conditions during the
day(duration of standing).
• Definition of Chronic Venous disease includes report by the participants based on their own
diagnosis,or recall of a diagnosis of another person,or a standard physical examination.
• In this study,standard physical examination was observational study.
• Then, the prominence of the lower limb veins were observed and classified as follows:
• None = 0: “None”
• Mild = 1: “Few, scattered, varicosities that are confined to branch veins or clusters. Includes ankle flare, defined as > 5 blue telangiectasia at the inner or sometimes the outer edge of the foot”
• Moderate = 2: “Multiple varicosities that are confined to the calf or the thigh”
• Severe = 3: “Multiple varicosities that involve both the calf and the thigh”

Statistical analysis

• Proportional odds model (POM) for ordinal logistic regression was used to assess the relationship between risk factors and status of varicose disease.
• Varicose veins were classified into four grades: none, mild, moderate and severe;
• Variables in this study included age, BMI, pregnancy, family history, blood pressure, OCP, defecation and duration of standing.
• Age was used as a continuous variable in the model. BMI was classified into four categories: underweight (<20), normal weight (20-24.9), overweight (25-29.9), and obese (>30).
• Pregnancy was defined as zero: for subjects without pregnancy, one: for subjects with one pregnancy, and two: for subjects with two or more pregnancies.
• Standing period was coded 1 if the subject stands on his foot less than 3 hours at work and coded 2 otherwise.
• Family history, blood pressure, OCP, and constipation were coded as one if the subject had the condition and zero otherwise. Ordinal logistic regression was used
to investigate the effect of possible risk factors on varicose veins on legs.
Variables age, BMI, pregnancy, family history, blood pressure, OCP, constipation and duration of standing were entered separately to the model, and crude odds ratio (OR) and 95% confidence interval
(CI) was estimated for each variable. Furthermore, adjusted OR and 95% confidence interval were estimated using multiple ordinal logistic regressions adjusting for all other risk factor in the model.
POM ordinal logistic regression was fitted using Minitab (version 16) and test of parallel line was performed by SPSS (version 18, Chicago, IL, USA) software.

Results

• The study was performed on 197 hairdressers, aged 18-68 year with mean age of 37.53 (SD=10.42) year and median age of 36 yr.
• The prevalence of varicose veins was 47.7%.
• Of 197 hairdressers in the study, 55 (27.9%) individuals had mild/moderate varicose, and 39 (19.8%) individuals had severe varicose.

Discussion

• This study was conducted to evaluate the prevalence and risk factors associated with varicose
veins in female hairdressers working in Shahroud, Iran.
• The prevalence of varicose veins in this study was 47.7% (27.9% mild/moderate varicose veins
and 19.8% severe varicose veins).
• In the study by Nassiri Foourg et al., the prevalence of varicose veins of the lower extremities in female nurses was reported 65.3% (43.5% mild varicose veins, 18.5% moderate varicose veins and 3.2% severe varicose veins).
• Sharifnia et al. reported the prevalence of varicose veins of nurses 73.9%, in that the prevalence
of varicose veins among female nurses was 78%.
• Estimated prevalence of varicose veins varies widely from 2% to 56% in men and from 1% to 73% in women. This variation in estimated prevalence may be due to the difference in the study
design, diagnostic criteria and population characteristics including age, gender and race.
• Beebe-Dimmer and his colleagues compared the estimated prevalence of varicose veins in
different countries and illustrated that the prevalence is higher in more developed countries.

Conclusion

• This study showed a high prevalence of varicose veins in the legs of female hairdressers. In addition, results of ordinal logistic regression model have found the significant association between varicose veins and some of the above risk factors such as age, blood pressure, family history and prolonged standing.

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Important References
Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The Epidemiology of Chronic
Venous Insufficiency and Varicose Veins. Ann Epidemiol. 2005;15(3):175-184.
Robertson L, Evans C, Fowkes FGR. Epidemiology of chronic venous disease. Phlebology. 2008;23(3):103-111.
Onida S, Davies AH. Varicose veins: diagnosis and management. Nurs Times. 2013;109(41):16-17.
London NJM, Nash R. ABC of arterial and venous disease. varicose veins. BMJ. 2000;320(7246):1391-1394.