Sex differences in 1,114,625 varicose vein surgeries: an 18-year cross-sectional analysis of the Brazilian public health system

BackgroundChronic venous disease (CVD) is a highly prevalent condition with significant morbidity. Although there is a well-documented predominance of CVD among women, the differences in surgical treatment based on sex, especially in low- and middle-income countries, are not well understood. This study aims to investigate these disparities within Brazils public healthcare system. MethodsThis nationwide cross-sectional study analyzed all varicose vein surgeries (n = 1,114,625) performed in the public sector from 2007 to 2024. Data were extracted from the national hospital information system (SIH/DATASUS). We compared demographics, procedural rates, age at surgery, length of hospital stay, and patterns of intercity and interstate travel for surgery between the sexes. ResultsWomen accounted for the majority of procedures, making up 80.5% of the total. Men underwent bilateral surgeries at a significantly older age than women, with a median age of 49 years for men compared to 47 years for women (p<0.01). Distinct travel patterns based on gender were observed: men were more likely to travel between cities for bilateral procedures (36.84%) compared to women (35.27%, p<0.01). On the other hand, women traveled more frequently between states (0.40% vs. 0.31%, p<0.01). The Southeastern region, which is home to 41.8% of the population, performed the highest volume of surgeries. ConclusionThis study reveals significant gender disparities in the surgical treatment of varicose veins in Brazil, extending beyond mere prevalence to include differences in the age at which intervention occur and geographic access patterns. The findings suggest that biological factors alone cannot account for these disparities, highlighting that healthcare-seeking behaviors, referral patterns, mortality rates, and structural inequities also play a crucial role. Further qualitative research is needed to elucidate the underlying motivations for these differences and to guide the development of more equitable healthcare policies.