title: Epidemiology and use of compression treatment in venous leg ulcers: nationwide claims data analysis in Germany.
abstract: Chronic venous diseases are the most common causes of leg ulcers. Compression treatment (CT) is a central component of venous leg ulcer (VLU) therapy along with prevention based on guidelines and clinical evidence. However, large-scale data on the use of CT are rare. In particular, there have not yet been published nationwide data for Germany. We analysed data from a large German statutory health insurance (SHI) on incident VLU between 2010 and 2012. VLUs were identified by ICD-10 diagnoses. The status of active disease was defined by wound-specific treatments. Compression stockings and bandages were identified by SHI medical device codes. The overall estimated incident rate of active VLU of all insured persons was 0·34% from 2010 to 2012. Adapted to the overall German population, n = 229 369 persons nationwide had an incident VLU in 2010-2012. Among all VLU patients, only 40·6% received CT within 1 year, including 83·3% stockings, 31·8% bandages and 3·1% multi-component compression systems. Compression rates showed significant differences by gender and age. Large regional variations were observed. Validity of data is suggested by high concordance with a primary cohort study. Although recommended by guidelines, there is still a marked under-provision of care, with CT in incident VLUs in Germany requiring active measures.
authors.affiliation: German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Heyer
authors.affiliation: German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Protz
authors.affiliation: Centre for Social Policy Research, University of Bremen, Bremen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.affiliation: German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Augustin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D053828:Stockings, Compression; D014647:Varicose Ulcer / Q000453:epidemiology / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology*
keywords: Compression treatment; Leg ulcers; Regional variations; Statutory health insurance; Wound care, health care research