CVR Physician Dr. Pappas Presents Study Findings on Racial Disparity in Vein Treatment

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A Center for Vein Restoration physician advances the study of vascular disease with research presented at a European conference.

The physicians who work at the 87 Center for Vein Restoration locations across the country strive not only to help patients overcome the discomfort of varicose veins and other venous disorders with state-of-the-art treatments, but to advance the study of vascular medicine, as well. Many of our doctors have conducted extensive clinical research to further our understanding of venous disease treatment outcomes and expand the expertise of all doctors in the field.

In 2019, a Center for Vein Restoration physician, Dr. Peter J. Pappas, presented his research at the European Venous Forum in Zurich, Switzerland. His research focused on differences in vein treatment outcomes between racial groups in the U.S. Specifically, he studied treatment outcomes after vein interventions in African Americans, Hispanics, Asians, Others (race not designated), and Whites.

The study reported the prevalence of chronic venous insufficiency (percentage of patients in the population with the disease) was highest among white women. However, when comparing various racial groups, Dr. Pappas found the incidence and prevalence (which takes into account newly diagnosed patients plus those diagnosed in the past) of disease severity differed among African-Americans, Asians, and Hispanics when compared to Whites. At the same time, African-Americans required more superficial vein treatments to achieve results similar to other racial groups.

“If you look at the prevalence of disease by age and by race, most of the studies that have been published in the past have indicated that with increases in age, the prevalence also increases,” Dr. Pappas explained. By contrast, Dr. Pappas’s research group reported that for African-Americans, Hispanics, or Asians, the prevalence of disease either stayed the same or declined with age. “To my knowledge,” Dr. Pappas said, “this is the first time that the prevalane of disease is reported to decrease as patients get older.” In addition to disparities in diagnosis, the study reported differences in patient outcomes based on race.

African-Americans Receive a Lower Recommendation Rate for Varicose Vein Treatments

Dr. Pappas noted that the recommendation rates for ablation, ultrasound-guided sclerotherapy, and phlebectomy were the lowest for African-American patients. He noted that a large proportion of African Americans that presented for a venous evaluation had no evidence of chronic venous insufficiency. As a result, they are less likely to receive a recommendation for a venous procedure compared to other racial groups. Dr. Pappas surmised that the cause of leg pain and swelling in African Americans was related to a high incidence of osteoarthritis and morbid obesity, and they are often misdiagnosed with venous disease. When African Amerians are positive for venous disease, they are more likely to present with severe forms of the disease, like swelling, skin damage, and open wounds. As a result, African Americans are more likely to require more procedures in order to address their symptoms.

The study was based on a review of more than 60,000 patients who presented for a venous evaluation at one of 78 Center for Vein Restoration centers in the U.S. Patients were classified into five racial groups: African-American, Asian, Hispanic, White, and Other (race not recorded). Of that group, 77 percent were female and 23 percent male. Breaking it down by racial group, 17 percent were African-American, 3 percent were Asian, 18 percent Hispanic, 55 percent White, and 8 percent Other.

The highest prevalence of venous insufficiency was reported among white patients, with the “vast majority” of the disease seen in women across all race classes. Among Hispanic patients, a higher percentage were males.

The study found the incidence of the disease decreased between 2015-2017 for African-Americans and Asians, but increased in the Other group and remained stable for Hispanics. Commenting on the prevalence, Pappas said it was “similar between African-Americans and Hispanics. Although Asians demonstrated the lowest prevalence of disease, they were more likely to present with severe skin damage and below-knee varicose veins. As expected, Whites had the highest incidence of chronic venous insufficiency.” Dr. Pappas added that Hispanics were more likely to seek treatment for chronic venous insufficiency and spider veins due to socioeconomic and cultural reasons. Hispanics and Asians also demonstrated the greatest degree of improvement after an ablation with or without a phlebectomy. African Americans demonstrated similar outcomes but required more procedures to achieve these results.

New Jersey-based CVR Doctor Also Distinguished Researcher

In addition to his extensive research efforts, Dr. Pappas works at two Center for Vein Restoration branches in Union and Morristown, New Jersey. A graduate of UMDNJ-New Jersey Medical School (NJMS), he has more than 20 years experience treating vein disorders as well as conducting clinical research into vascular disease. He is a reviewer for the Journal of Vascular Surgery, and has authored 80 peer reviewed publications and 30 book chapters.

Because of his extensive knowledge and research, Dr. Pappas received a five-year NIH grant to investigate the pathophysiology of venous ulceration. He was also the first recipient of the JOBST Research Fellowship in Venous and Lymphatic Disease of the American Venous Forum Foundation. In addition, Dr. Pappas is a past president of the American Venous Forum, the premier academic venous society nationally and internationally.

Dr. Pappas and his research partners have previously published outcomes data for Medicare and non-Medicare beneficiaries, demonstrating differences in diagnosis and number of procedures needed in patients older than 65 years of age, as opposed to younger patients. Furthermore, “we determined that progressive increases in BMI are associated with worse outcomes after endothermal ablations, phlebectomies and ultrasound-guided foam sclerotherapy,” Dr. Pappas concluded.

Serving All Populations

The physicians at Center for Vein Restoration locations are dedicated to serving our community, treating every patient thoroughly regardless of their race or ethic group. In addition, our talented physicians are dedicated to advancing the field of venous medicine and helping to eliminate racial disparities in medicine. Contact us today to find a location near you and make an appointment.

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