Incidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort

doi:10.1016/j.amjmed.2013.02.024

The American Journal of Medicine

Volume 126, Issue 9, September 2013, Pages 832.e13-832.e21

Material from this manuscript was presented at the 54^th American Society of Hematology Annual Meeting in Atlanta, Georgia on December 8, 2012.

https://doi.org/10.1016/j.amjmed.2013.02.024 Get rights and content

Abstract

Background

The public health burden of venous thromboembolism, which includes deep vein thrombosis and pulmonary embolism, is not fully known, and contemporary incidence and mortality estimates are needed. We determined the incidence and case fatality of venous thromboembolism in a general population.

Methods

Using the administrative health care databases of the Canadian province of Québec, we identified all incident cases of deep vein thrombosis or pulmonary embolism between 2000 and 2009 and classified them as definite or probable venous thromboembolism. We formed 2 patient cohorts, one with definite cases and the other including cases with definite or probable venous thromboembolism that were followed until December 31, 2009.

Results

We identified 67,354 definite and 35,123 probable cases of venous thromboembolism. The age- and sex-adjusted incidence rates of definite or probable venous thromboembolism, deep vein thrombosis, and pulmonary embolism were 1.22 (95% confidence interval [CI], 1.22-1.23), 0.78 (95% CI, 0.77-0.79), and 0.45 (95% CI, 0.44-0.45) per 1000 person-years, respectively, while for definite venous thromboembolism it was 0.90 (95% CI, 0.89-0.90) per 1000 person-years. The 30-day and 1-year case-fatality rates after definite or probable venous thromboembolism were 10.6% (95% CI, 10.4-10.8) and 23.0% (95% CI, 22.8-23.3), respectively, and were slightly higher among definite cases. The 1-year survival rate was 0.47 (95% CI, 0.46-0.48) for cases with definite or probable venous thromboembolism and cancer, 0.93 (95% CI, 0.93-0.94) for cases with unprovoked venous thromboembolism, and 0.84 (95% CI, 0.83-0.84) for cases with venous thromboembolism secondary to a major risk factor. Similar survival rates were seen for cases with definite venous thromboembolism.

Conclusion

The risk of venous thromboembolism in the general population remains high, and mortality, especially in cancer patients with venous thromboembolism, is substantial.

Section snippets

Study Design

This retrospective study used the linked administrative health care databases of the province of Québec, Canada to identify a cohort of Québec residents with an incident event of venous thromboembolism from January 1, 2000 to December 31, 2009.

Data Sources

Study data were obtained from the linked databases of the Maintenance et exploitation des données pour l'étude de la clientèle hospitalière (MED-ÉCHO) and the Régie de l'assurance maladie du Québec (RAMQ). MED-ÉCHO contains information on all Québec

Results

From the 245,452 patients in Québec between 2000 and 2009 with at least one venous thromboembolism diagnosis in RAMQ or MED-ÉCHO, we identified 67,354 cases with definite venous thromboembolism, and an additional 35,123 cases with probable venous thromboembolism. Figures 1 and 2 describe the identification of the definite and any venous thromboembolism cohorts, respectively. Table 1 shows baseline patient characteristics. In the any venous thromboembolism cohort, 56% of patients were women, 61%

Discussion

We found that the age- and sex-adjusted incidence rate of venous thromboembolism was 1.22 per 1000 person-years, and when a more robust definition of venous thromboembolism was used, the rate was 0.90 per 1000 person-years. These estimates compare with rates of venous thromboembolism from older population studies.3, 11, 12, 13 Similar to previous studies,1, 11 we did not observe a difference in the incidence of venous thromboembolism among men and women when adjusting for age. This confirms

References (40)

M. Cushman et al.
Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology
Am J Med
(2004)
G.E. Raskob et al.
Surveillance for deep vein thrombosis and pulmonary embolism: recommendations from a national workshop
Am J Prev Med
(2010)
H.K. Chew et al.
The incidence of venous thromboembolism among patients with primary lung cancer
J Thromb Haemost
(2008)
I.A. Naess et al.
Incidence and mortality of venous thrombosis: a population-based study
J Thromb Haemost
(2007)
V. Tagalakis et al.
Men had a higher risk of recurrent venous thromboembolism than women: a large population study
Gend Med
(2012)
T. Baglin et al.
High risk of recurrent venous thromboembolism in men
J Thromb Haemost
(2004)
H.J. Cohen et al.
Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly
Am J Med
(2003)
A. Rumley et al.
Effects of older age on fibrin D-dimer, C-reactive protein and other hemostatic and inflammatory variables in men aged 60-79 years
J Thromb Haemost
(2006)
G. Agnelli et al.
Nadroparin for the prevention of thromboembolic events in ambulatory patients with metastatic or locally advanced solid cancer receiving chemotherapy: a randomised, placebo-controlled, double-blind study
Lancet Oncol
(2009)
M.S. Rasmussen et al.
Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study
J Thromb Haemost
(2006)

A. Piccioli et al.

Epidemiologic characteristics, management, and outcome of deep venous thrombosis in a tertiary-care hospital: the Brigham and Women's Hospital DVT registry

Am Heart J

(1996)

S.Z. Goldhaber et al.

Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)

Lancet

(1999)

M.S. Andresen et al.

Mortality and recurrence after treatment of VTE: long term follow-up of patients with good life-expectancy

Thromb Res

(2011)

E. Garbe et al.

Selection of controls in database case-control studies: glucocorticoids and the risk of glaucoma

J Clin Epidemiol

(1998)

F.A. Anderson et al.

A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study

Arch Intern Med

(1991)

M.D. Silverstein et al.

Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study

Arch Intern Med

(1998)

F.A. Spencer et al.

A population-based study of the clinical epidemiology of venous thromboembolism

J Gen Intern Med

(2006)

F.A. Spencer et al.

Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study

J Thromb Thrombolysis

(2009)

Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures (CCP) (Catalogue 82-562E)

(1993)

Volume Three - Canadian Classification of Health Interventions (CCI) – Tabular List

(1992)

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: Funding: An infrastructure grant from the Canadian Foundation for Innovation (CFI), Ottawa, ON, Canada and an unrestricted grant from Bayer Pharma AG, Berlin, Germany.

: Conflict of Interest: None.

: Authorship: All authors had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors had a role in writing and revising the manuscript.

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AJM onlineClinical research studyIncidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Design

Data Sources

Results

Discussion

Am J Med

Am J Prev Med

J Thromb Haemost

J Thromb Haemost

Gend Med

J Thromb Haemost

Am J Med

J Thromb Haemost

Lancet Oncol

J Thromb Haemost

Am Heart J

Lancet

Thromb Res

J Clin Epidemiol

A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study

Arch Intern Med

Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study

Arch Intern Med

A population-based study of the clinical epidemiology of venous thromboembolism

J Gen Intern Med

Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study

J Thromb Thrombolysis

Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures (CCP) (Catalogue 82-562E)

Volume Three - Canadian Classification of Health Interventions (CCI) – Tabular List

AJM online
Clinical research study
Incidence of and Mortality from Venous Thromboembolism in a Real-world Population: The Q-VTE Study Cohort