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Background: Varicose vein (VV) is a common problem that mostly occurs in legs. This medical condition can influence the quality of life and working condition of nurses.
Aim of the study: To estimate the prevalence of lower limbs varicosity and its associated risk factors among nurses. Methods: This a cross-sectional descriptive study was carried out among 100 nurses working Baghdad Teaching Hospital, Surgical Specialties Hospital, and Al- Kidney Teaching Hospital, Baghdad, Iraq from January 1st to May 10th, 2022. The participants were recruited in the study using systematic random sampling. The Occupational Sitting and Physical Activity and Aberdeen Varicose Vein Questionnaires were used for data gathering. Results: The prevalence of varicose veins was estimated to be (48%) of the sample. There are a significant association between (age, prolonged standing, body mass index and varicose vein. Conclusion: The prevalence of VV among the nurses working in Baghdad teaching hospitals was high, and many factors showed a significant relation with this problem. Nurses should be informed about preventive measures and treatments for this medical condition.
Varicose veins (VV) are caused by incompetent venous valves which are abnormally dilated and tortuous in nature. The risk factors like prolonged standing, overweight, ageing, smoking, overweight, heavy lifting and pregnancy in females increases the possibility of developing VV. An increase in straining bowel movement, low fiber intake, genetic weakness in vein walls, increasing age, menopause increases the chances of developing VV [1].
The prevalence of varicose vein was reported in 72.4% (95% CI 65.7-78.4), with women having a higher prevalence compared with men (77.9% vs. 56.9%, P = 0.004) [2]. Prevention can be done by elevating legs above the level of heart for several minutes throughout a day, walking every day to build calf muscle helps to relieve symptoms, maintaining body weight by eating healthy foods, keeping legs moving, flexing ankles timely while sitting at desk to keep the blood pumping, wearing compression stockings will support and aid the valves to keep the blood pumping out of legs etc [3]. Nursing profession is perceived as a high-risk occupation; in which positions such as long-time standing and sitting and grueling physical states are inevitable during the work [4].
Various studies revealed the strong positive co-relations between prolonged standing at different work sector with prevalence of varicose veins. A survey analysis shows that prevalence of varicose veins in nursing officers was estimated to be 16.18% in worldwide and in ICU nursing officers it is estimated to be 52.5% among other nursing officers working in various sector [5]. Nurses are critical components of healthcare systems, and lower leg varicose veins may result in performance instabilities and increased economic expenditures by people and society to remedy the imposed damage. The issue is essential, as it may imperil work production, health in old age, various underlying thrombotic events, and other grave consequences [6]. The current study aims to assess the prevalence of lower limbs varicosity and its associated risk factors among nurses.
This cross-sectional descriptive study was carried out in Baghdad Teaching Hospital, Surgical Specialties Hospital, and Al- Kidney Teaching Hospital during the period from January 1st to May 10th, 2022. The total number of nurses on duty at the time of study was 100. A systematic random sample was selected from the list of nurses (every 4th). The selected nurses (100) were approached and requested to participate in the study. The study was approved by University of Baghdad Faculty of nursing Institutional Research Board. Nurses gave informed consent to participate voluntarily in the study, before the interview, with a full right to withdraw and with assurance of confidentiality and anonymity of the data. The occupational sitting and physical activity and aberdeen varicose vein questionnaires were used for data gathering. The ethical permission (Ethics committee permission number: 25/11/2021-2105) from the relevant University of Baghdad/ College of nursing, clinical research ethics committee, institutional permission from the Faculty of nursing, and written informed consent from the participants were obtained for the study. The content validity of the questionnaire was verified by 10 experts of faculty of nursing. The data was collected through distribution of self -administered questionnaire. The data was analyzed by using SPSS (V. 25) package which include descriptive statistical approach (frequency, percentage and mean of score) and inferential statistical approach. P \(\leq\) 0.05 was considered to be statistically significant.
The majority of the study were female who accounted for (64%) of the total participants while male constituted (36%). Most of the study participants (35%) were ages between 30 and 40 years old. Nearly to half of study sample (48%) were diagnosis have Varicose vein. According to body mass index most of them (64%) within normal body weight. Related smoking most of nurses (62%) were no smoker. More than one third of nurse’s spent (4-6) hours daily standing and finally half of study participants spent (1-2) hours daily sitting.
In this study, the composition of intensive care nurses (n=100) is outlined concerning their demographic characteristics, as summarized in Table 1. The detailed distribution of the clinical classification of varicose veins (CEAP) among the 100 participants is provided in Table 2. An analysis of the relationship between various variables (age, standing time, sitting time, BMI) and varicose veins (VV) is presented in Table 3. Furthermore, the exploration of the association between variables (Gender, Smoking, Exercise, Family history) and the occurrence of varicose veins is elucidated in Table 4.
| Variables | Years | Frequency | Percent |
|---|---|---|---|
| Age group | 20-26 | 19 | 19% |
| 27-33 | 27 | 27% | |
| 34-40 | 35 | 35% | |
| 41-47 | 11 | 11% | |
| 48-54 | 8 | 8% | |
| Gander | Male | 36 | 36% |
| Female | 64 | 64% | |
| Varicose vein diagnosis | Yes | 48 | 48% |
| No | 52 | 52% | |
| BMI | $\leq$ 25 | 61 | 61% |
| $\geq$ 25 | 39 | 39% | |
| Smoke | Yes | 38 | 38% |
| No | 62 | 62% | |
| Exercise | Yes | 17 | 17% |
| No | 83 | 83% | |
| Time spends standing | 1-2 | 18 | 18% |
| 2-4 | 29 | 29% | |
| 4-6 | 41 | 41% | |
| 6-8 | 12 | 12% | |
| Time spends sitting | 1-2 | 53 | 53% |
| 2-4 | 32 | 32% | |
| 4-6 | 15 | 15% | |
| Family history of varicose veins | Yes | 47 | 47% |
| No | 53 | 53\% |
| Clinical classification of CEAP | Frequency | Percent |
|---|---|---|
| C0: No visible veins 131 (72.4%) | 58 | 58% |
| C1: Reticular veins 5 (2.8%) | 15 | 13% |
| C2: Varicose veins 7 (3.9%) | 22 | 22% |
| C3: Edema 33 (18.2%) | 5 | 5% |
| C4a: Pigmentation or eczema 5 (2.8%) | 0 | 05 |
| C4b: Lipodermatosclerosis 0 (0%) | 0 | 0% |
| C5: Healed venous ulcer 0 (0%) | 0 | 0% |
| C6: Active venous ulcer | 0 | 0% |
| Variable | With VV | Without VV | p-value | ||
|---|---|---|---|---|---|
| Mean | S | Mean | S | ||
| Age | 43 | 1 | 32 | 7 | 0.21 |
| Standing time | 5.2 | 1 | 2.1 | 6 | 0.02 |
| Sitting time | 3.1 | 4 | 3.6 | 1 | 0.17 |
| BMI | 25.13 | 2 | 22.1 | 8 | 0.031 |
| Variables | With VV | Without VV | P value | |||
|---|---|---|---|---|---|---|
| Frequency | Percent | Frequency | Percent | |||
| Gender | Female | 36 | 30% | 28 | 28% | 0.21 |
| Male | 12 | 12% | 15 | 15% | ||
| Exercise | Yes | 5 | 5% | 11 | 11% | 0.22 |
| No | 43 | 43% | 47 | 47% | ||
| Family history | No | 20 | 20% | 27 | 27% | 0.21 |
| Yes | 22 | 22% | 31 | 31% | ||
The findings of our study reveal that approximately half of the participating nurses exhibited symptoms of varicose veins (VV). Notably, our investigation indicates a higher likelihood of varicose veins among nurses who are required to stand for prolonged periods at work. The prevalence of varicose veins was particularly elevated among those nurses who stood for 4-6 hours daily. Furthermore, within the nursing profession, the teaching faculty demonstrated the highest prevalence of varicose veins.
Our results align with previous studies, such as that conducted by Shakya et al. [4], which reported a higher relative risk for varicose veins in occupations involving a greater proportion of standing compared to sitting work. Prolonged standing emerged as a significant contributing factor to varicose veins. A study by Ali et al. [6], focusing on nurses in various departments, reported a varicose vein prevalence of 15.8%. Additionally, the prevalence of varicose veins has varied widely in previous research, ranging from 2% to 56% in males and 1% to 73% in females [6].
Gender-specific variations were observed, with female nurses exhibiting a higher prevalence compared to their male counterparts. Notably, our study, conducted within a specific geographical area, deviates from the prevalence reported in other regions, emphasizing the significance of regional variations in healthcare research.
Numerous international studies have identified nurses as a high-risk group for varicose veins, with prevalence rates varying across different nations. Our findings support this trend, with a significant proportion of nurses engaged in moderate to strenuous physical activities, such as agriculturists, small-scale business workers, and factory workers, showing an increased risk of varicose veins.
Regarding risk factors, our study highlights a strong association between age and varicose veins, consistent with previous research [7, 8, 9]. The influence of gender on varicose veins is also evident, with females experiencing varicose veins more frequently, possibly attributed to factors such as pregnancy.
Notably, our study emphasizes the significant association between prolonged standing hours and varicose veins in the nursing profession. The heightened risk faced by nurses, who predominantly stand for extended periods, underscores the need for preventive measures. Prolonged standing negatively affects venous return, weakening or compromising the function of one-way valves, leading to varicose veins.
While our findings did not show a significant association between sitting periods and varicose veins, the literature offers varying perspectives. Shakya et al. [4] suggested a potential beneficial effect of increased sitting and walking time on varicose veins. However, further research is required to establish definitive conclusions.
Concerning Body Mass Index (BMI), our study identified an association between increased BMI and varicose veins. This aligns with existing evidence indicating rising rates of lower extremity venous disease in individuals with higher BMI.
Surprisingly, our study did not find a significant association between exercise, smoking, family history, and varicose veins. Contrastingly, other studies have reported obesity, pregnancy, and family history as major risk factors for varicose veins [10, 11].
The statistical analysis conducted in our study further solidifies the link between prolonged standing time and varicose veins. Adjusting for various factors, the odds of developing varicose veins increased significantly with each additional hour of standing time.
In conclusion, our study underscores the prominence of varicose veins among nurses, particularly those engaged in prolonged standing, and emphasizes the need for preventive strategies in occupational settings. Future research should delve deeper into the multifaceted nature of risk factors to inform targeted interventions for this occupational group.
Varicose veins were predominantly present with a prevalence of 48% among the nurses at Baghdad teaching Hospitals. Prolonged standing, age, and BMI were found to be a significant risk factor for varicose veins. The nurses should try to avoid unnecessary prolonged standing at work and use sitting or walking whenever possible and maintain healthy body weight, walking and regular exercise can have a protective effect against VV. This change in clinical practice could ultimately reduce the risk for vascular disease. High prevalence in intensive care unit might necessitate raising awareness and prevention strategies. For subsequent studies, we recommend combining the survey with physical examination and appropriate imaging modalities to confirm the diagnosis and assess the intensity, increasing the number of intensive care units, and including and comparing more than one hospital.
The authors would like to thank the study participants and data collectors for their fully participation.
This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.
The authors declared no conflict of interest.
Ethical approval for this study was obtained from the University of Baghdad Faculty of nursing Institutional Research Board (Code:25/11/2021-2105).
All authors equally contributed to preparing this article.
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