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Varicose Veins

One Korean nurse in six had varicose veins on ultrasound. Standing four hours a day nearly tripled the odds

Most studies of standing work and varicose veins ask people whether they have them. This one scanned 414 nurses instead, which is why its answer carries more weight than its size suggests.

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In short

In a study that combined a questionnaire with Doppler ultrasonography in 414 nurses at a Korean university hospital, the prevalence of varicose veins was 16.18 percent, and working four hours or more a day in a standing position was independently associated with venous reflux after adjustment for sociodemographic factors (odds ratio 2.80, 95% CI 1.08 to 7.25), alongside increasing age (1.06 per year), pregnancy (2.15) and delivery (2.02).

Key takeaways

  • 414 nurses at a Korean university hospital were surveyed and examined with Doppler ultrasonography between March and August 2014.
  • The prevalence of varicose veins was 16.18 percent — roughly one in six.
  • Working four hours or more a day in a standing position was associated with venous reflux after adjustment, with an odds ratio of 2.80 (95% CI 1.08 to 7.25).
  • Age was a significant factor at an odds ratio of 1.06 per year, as were pregnancy (2.15) and delivery (2.02).
  • The diagnosis was made by ultrasound rather than by self-report, which is what separates this study from most occupational surveys of varicose veins.
  • In a separate national survey, most Korean adults recognised chronic venous disease only as a name, and awareness was lower in men, younger people, and those with less education or income.
  • Of Korean patients with chronic venous disease, about 60 percent said physical symptoms rather than appearance were what harmed their quality of life.

That standing all day causes varicose veins is one of the most widely repeated claims in occupational health and one of the least well evidenced, because almost every study asking the question has relied on people reporting their own legs. A Korean study did it the harder way.

What was done differently

Published in Safety and Health at Work, the study surveyed nurses at a Korean university hospital between March and August 2014 — and then scanned them. Every participant had Doppler ultrasonography, so venous reflux was measured rather than reported. 414 nurses completed both.

16.18%

prevalence of varicose veins among 414 Korean hospital nurses, diagnosed by Doppler ultrasonographyYun MJ et al., Safety and Health at Work, 2018

The distinction between measured and reported matters more here than in most fields. Varicose veins are visible, so people form an opinion about whether they have them, and that opinion tracks what they look for, what they have been told, and how much the appearance bothers them. Reflux on ultrasound tracks none of those things.

What predicted reflux

Factors significantly associated with venous reflux in Korean nurses
FactorOdds ratio (95% CI)
Age, per year1.06 (1.03–1.10)
Pregnancy2.15 (1.17–3.94)
Delivery2.02 (1.08–3.78)
Standing ≥4 hours a day, adjusted2.80 (1.08–7.25)

The standing result survived adjustment for sociodemographic factors, which is the finding the authors set out to test. The confidence interval is worth reading alongside it: from 1.08 to 7.25. The lower bound only just clears 1, so the study establishes that an effect exists more confidently than it establishes how large it is.

The parts of the risk nobody chooses

Three of the four significant factors are not about work at all. Age raised the odds by 6 percent per year. Pregnancy roughly doubled them, and so did delivery. A nurse in her forties who has had children carries most of her risk from things that have nothing to do with her shift pattern.

That is the honest frame for occupational advice here. Standing hours are the modifiable part of a risk that is mostly not modifiable, which makes them worth addressing precisely because the rest is not — and makes it misleading to present varicose veins as a condition somebody brought on themselves by choosing the wrong job.

And most people do not know what they have

A national survey of 900 Korean adults found awareness of chronic venous disease low, with most respondents recognising it only as a name. Awareness was higher in women, in people over 29, and in those with more education and higher income.

The same survey found that of Korean patients who did have chronic venous disease, about 60 percent said physical symptoms — heaviness, aching, swelling — damaged their quality of life more than appearance or emotion did. A condition widely discussed as cosmetic is not experienced as one by the people who have it.

Put beside the nurses' 16.18 percent, that gap is the practical finding. In an occupational group at elevated risk, roughly one in six had ultrasound-confirmed varicose veins, in a country where most adults could not say what the disease is.

Sources

  1. 1

    Yun MJ, Kim YK, Kang DM, Kim JE, Ha WC, Jung KY, Choi HW

    A study on prevalence and risk factors for varicose veins in nurses at a university hospital

    Safety and Health at Work 2018;9(1):79-83

    doi:10.1016/j.shaw.2017.08.005 · PMID:30363079

    https://doi.org/10.1016/j.shaw.2017.08.005
  2. 2

    Kim H, Lee SH, Park JK, Kang JM, Hong KP, Yu YS, Choi HZ, Joh JH

    Public awareness of chronic venous disease in Korea

    Journal of Vascular Surgery: Venous and Lymphatic Disorders 2023;11(3):477-482

    doi:10.1016/j.jvsv.2022.12.005 · PMID:36580999

    https://doi.org/10.1016/j.jvsv.2022.12.005
  3. 3

    Shon S, Kim H, Kim HC, Cho S, Lee SH, Joh JH

    National trend of the treatment for chronic venous diseases in Korea between 2010 and 2020

    Annals of Surgical Treatment and Research 2023;104(1):27-33

    doi:10.4174/astr.2023.104.1.27 · PMID:36685771

    https://doi.org/10.4174/astr.2023.104.1.27