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Risk Factors for Leg Ulceration in People Who Inject Drugs: A Cross-Sectional Study

Coull, Alison F.; Kyle, Richard G.; Hanson, Coral L.; Watterson, Andrew


Alison F. Coull

Richard G. Kyle

Andrew Watterson


Aims and Objectives
The aim of this study was to assess, for the first time in a hard-to-reach population, the risk factors for leg ulceration among PWID, with the objective of making improvements to prevention and care.
An estimated 4.8 million people globally inject drugs with potential for injecting related harm. Skin and vein damage associated with drug injecting is increasing. Leg ulceration is a chronic condition which in the UK has a prevalence of 15% amongst people who have injected drugs (PWID) compared to 1% in the general population. Glasgow has the highest rate of problematic drug use in Scotland with approximately 13,900 individuals, about 50% of whom are thought to inject. However, the reasons for high prevalence of leg ulceration among PWID are unknown. To support improvements in prevention and care, the dearth of evidence around risk factors for leg ulceration in PWID needs to be addressed.
A cross-sectional survey of 200 current and former injectors recruited from drugs services in Glasgow, Scotland, to measure skin problems, leg ulceration and injecting habits is reported following STROBE guidelines. Logistic regression modelling examined whether demographics and injecting habits predicted leg ulceration.
Results: The likelihood of leg ulceration was increased for those who injected in the groin and the leg. Additionally, injecting in the groin and leg were associated with having a DVT.
The primary risk factors for leg ulceration in PWID are injecting in the groin and the legs and these are clinically linked to deep vein thrombosis. Injecting into the femoral vein is increasingly common practice for PWID and healthcare practitioners should advise injectors of the increased risk of leg ulceration and DVT and discourage injecting into these areas.


Coull, A. F., Kyle, R. G., Hanson, C. L., & Watterson, A. (2021). Risk Factors for Leg Ulceration in People Who Inject Drugs: A Cross-Sectional Study. Journal of Clinical Nursing, 30(11-12), 1623-1632.

Journal Article Type Article
Acceptance Date Feb 5, 2021
Online Publication Date Feb 15, 2021
Publication Date 2021-06
Deposit Date Feb 10, 2021
Publicly Available Date Feb 16, 2022
Journal Journal of Clinical Nursing
Print ISSN 0962-1067
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 30
Issue 11-12
Pages 1623-1632
Keywords Risk factors; Drug user; Leg Ulcer; Venous insufficiency; Venous thromboembolism; Groin or femoral injecting; Leg injecting; PWID; Skin; Nursing
Public URL


Risk Factors For Leg Ulceration In People Who Inject Drugs: A Cross-Sectional Study (accepted version) (450 Kb)

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