Sociodemographic factors in chronic leg ulceration.
BACKGROUND
While there is a commonly held belief that leg ulceration is associated with social factors, the evidence to support this is mainly anecdotal.


OBJECTIVE
To determine deficits in sociodemographic status in patients with chronic leg ulceration. In a matched case-control study carried out in community leg ulcer clinics and participants' homes within Wandsworth Primary Care Trust, patients with chronic leg ulceration were compared with age- and sex-matched community controls drawn from general practitioner registers. Main outcome measures were the prevalence of social class, ethnicity, marital status, living status and social support. Data were analysed by conditional logistic regression.


RESULTS
In all, 113 patients were identified and matched to controls. Patients had a mean age of 75 years (range 31-94), with 72 (64%) being women. The ulcer had been present for a median of 8 months (range 0.8-144), and 29% of patients had an area of ulceration >10 cm(2) (range 0.5-171.5). Being Afro-Caribbean increased the risk of leg ulceration eightfold (95% confidence interval, CI 1.83-34.75; P < 0.001) compared with the white population. There was a gradient with social class, with patients with leg ulcers being more likely to come from social class IV and V (odds ratio, OR 2.82, 95% CI 1.19-6.74; P = 0.015). Never having married (OR 2.98, 95% CI 1.15-7.74; P = 0.025), living in rented housing (P < 0.001) and having a mobility deficit (P < 0.001) more often occurred in the ulcer patients, while living with a spouse was protective (OR 0.46, 95% CI 0.21-0.99; P = 0.048). Patients with ulceration experienced significantly poorer social support than their controls for most subscales of the medical outcomes study social support questionnaire (all P < 0.05).


CONCLUSIONS
Chronic leg ulceration is associated with poorer socioeconomic status, and factors which relate to social isolation. At present it is not possible to determine whether these associations are causative or are a consequence of the ulceration.
Moffatt
C J
CJ
Centre for Research and Implementation of Clinical Practice, Thames Valley University, 32-38 Uxbridge Road, London W5 2BS, UK.
Franks
P J
PJ
Doherty
D C
DC
Smithdale
R
R
Martin
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006798:Housing; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology / Q000209:etiology*; D008131:London / Q000453:epidemiology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D012307:Risk Factors; D012923:Social Class; D012944:Social Support; D016138:Walking