A Systematic Review of Gender and Ethnicity in Varicose Vein and Venous Leg Ulcer Management

BACKGROUND: Varicose veins (VVs) are a frequent manifestation of superficial venous insufficiency and can progress to venous leg ulcers (VLUs), a major cause of chronic morbidity. In the UK's National Health Service, up to 47% of VLUs remain unhealed after a year of treatment. As gender and ethnic differences in vascular disease outcomes gain recognition, this systematic review examines whether these demographic factors have been reported in major randomised control trials (RCTs) over the past 15 years and explores potential disparities in management outcomes. METHODS: This review included two independent systematic searches conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. VV studies were included if they enrolled over 200 adults with superficial venous insufficiency undergoing venous intervention which included great saphenous vein treatment; studies on recurrent disease and intervention or active ulceration were excluded. VLU studies were eligible if they enrolled over 50 patients treated with compression therapy or superficial venous interventions; those involving foot ulcers or adjunctive therapies were excluded. Two independent reviewers screened all abstracts and full texts, with discrepancies resolved by a third reviewer. Methodological quality was assessed according to Cochrane's risk of bias tool. RESULTS: From the VV search, of the 380 studies identified, 15 of these met the inclusion criteria and were included in this review. There was a total of 5355 participants across the 15 studies, with 68.2% reported as female (n=3652). Only two studies recorded patient ethnicity. From the VLU search, of the 399 studies identified, 14 RCTs underwent data extraction and were included in this review. There was a total of 2180 patients across the 14 studies with 51.1% being male participants (n=1076). Only 13 reported gender distributions and one reported ethnicity. From both reviews, no RCTs reported on outcome differences in relation to gender and ethnicity. CONCLUSIONS: Despite emerging evidence of gender- and ethnicity-related differences in VV and VLU outcomes, no recent RCTs have stratified results by these demographics, representing a critical gap impeding progress toward equitable, personalised venous care. While existing evidence is insufficient to justify differential treatment selection, it supports differential surveillance, counselling and informed consent strategies. Awaiting large-scale RCTs alone is insufficient; IPD meta-analyses, national registry linkage and mandated demographic reporting offer pragmatic solutions. Gender and ethnicity must be treated as analytic variables not demographic descriptors if venous research is to reflect the patients it serves.