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.

Keywords: Compression treatment; Leg ulcers; Regional variations; Statutory health insurance; Wound care, health care research.

Figure 1

Sampling frame.

Figure 2

Proportion (%) of at least one compression therapy per patient with venous leg ulcer in Germany, 2010–2012 (n = 24 735 – not additive, multiple prescription per patient were observed).

Figure 3

Regional differences of patients with venous leg ulcers receiving at least one compression therapy in Germany, 2009–2012 (n = 24 703).