[Should sex specific differences in venous diseases be explained by pregnancies and hormone intake?].
OBJECTIVE
Diseases of the venous system are among the most frequently occurring diseases in the German population. However, the last comprehensive population-based German data were obtained in 1979. Since then, diagnostic methods have improved substantially. Here, we examine the prevalence of venous diseases in women and their association with pregnancies and intake of hormones.


METHODS
We conducted a population-based cross-sectional study in Bonn and rural environments (Recruitment period: 11/2000 - 11/2001; response: 59 %; 3072 study participants (1350 men, 1722 women), 18 to 79 years of age; investigation: standardised medical history, physical examination, duplex sonography, photography and CEAP-classification of veins of the legs). The following definitions were used: 1) Varicosis: clinical classification C2-C6 (primary varicosis only, excluding those showing spider-bursts exclusively); 2) Chronic venous insufficiency (CVI): C3-C6. For women, the risk factors examined were the number of pregnancies (P) and intake of hormones. Odds ratios (OR) and 95 % confidence intervals (95 %-CI) were calculated by multiple logistic regression (adjusted for age, region of residence and socioeconomic status). In addition, never pregnant women and men were compared regarding the two outcome variables.


RESULTS
713 participants (23 %) had varicosis and 522 (17 %) CVI. The OR for women (reference group: men) was OR = 1.4, 95 %-CI: 1.25 - 1.79 (varicosis) and OR = 1.2, 95 %-CI: 0.93 - 1.42 (CVI). There was a positive dose-response relationship between the number of pregnancies and varicosis: 1 P: OR = 1.3 (95 %-CI: 0.89 - 1.96), 2 P: OR = 1.4 (95 %-CI: 1.00 - 2.07), 3 P: OR = 1.6 (95 %-CI: 1.05 - 2.41), 4 P: OR = 1.9 (95 %-CI: 1.18 - 3.20), > or = 5 P: OR = 2.2 (95 %-CI: 1.28 - 3.74) and this trend was similar for CVI. Never-pregnant women (n = 518) and men had a similar prevalence. We did not see a consistent effect of intake of hormones in varicosis (OR = 0.9 [95 %-CI: 0.68 - 1.22]), but a negative association with CVI (OR = 0.6 [95 %-CI: 0.47 - 0.89]).


CONCLUSIONS
Our results confirm the known association between diseases of the venous system and pregnancies, which seem to explain a big share of the sex-specific differences in the prevalence of these diseases.
Bromen
K
K
Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen. katja.bromen@cec.eu.int
Pannier-Fischer
F
F
Stang
A
A
Rabe
E
E
Bock
E
E
Jöckel
K-H
KH
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014648:Varicose Veins / Q000453:epidemiology*
D006728:Hormones