Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996

Richard H. White; Hong Zhou; Susan Murin; Danielle Harvey

doi:10.1160/TH04-08-0506

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 93(02): 298-305
DOI: 10.1160/TH04-08-0506

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996

Authors

Richard H. White

¹Division of General Medicine, University of California, Davis, California, USA
Hong Zhou

¹Division of General Medicine, University of California, Davis, California, USA
Susan Murin

²Division of Pulmonary and Critical Care Medicine, University of California, Davis, California, USA
Danielle Harvey

³Department of Public Health Sciences, University of California, Davis, California, USA

Abstract

Summary

There have been very few studies that have describe the epidemiology of first-time venous thromboembolism (VTE) in a large, ethnically diverse population. The California Discharge Data Set was used to identify a cohort of cases with incidentVTE in 1996. Cases associated with traditional provoking risk factors were identified and the remaining cases were labeled as idiopathicVTE. Direct standardization using census information was performed to compare incidence rates across races, gender, and gender within race. There were 21,002 cases with incident VTE in 1996, a crude incidence of 90 events per 100,000 adults. Thirty percent of all VTE events were pulmonary embolism. The directly standardized incidence per 100,000 California adults was 93 ± 1.7 ( ± 95% CI) in women, 85 ± 1.7 in men, 103 ± 2.1 in Caucasians, 138 ± 6.5 in African- Americans, 61 ± 2.8 in Hispanics and 29 ± 2.4 in Asian-Pacific Islanders (p<0.001 for all inter-group comparisons). After adjusting for misclassification of race, the incidence of VTE per 100,000 was 104 in Caucasians, 141 in African- Americans, 55 in Hispanics, and 21 in Asian/Pacific-Islanders. The incidence of idiopathic VTE was significantly lower among both Hispanics and Asian/Pacific-Islanders (p<0.001) than Caucasians or African-Americans. African-Americans were more likely, and Hispanics less likely, to be diagnosed with idiopathic pulmonary embolism compared to Caucasians. The 28 day case-fatality rate among cases with idiopathic VTE was 2%, and it was significantly higher among African-Americans (4.1%) compared to Caucasians (1.8%, p<0.001).There are important differences in the incidence of total and idiopathicVTE and in the proportion of events diagnosed as pulmonary embolism among each of the major racial/ethnic groups in California. Further research is needed to explain these observed differences among the different racial/ethnic group.

Keywords

Thrombosis - epidemiology - population - statistics

Full Text

References

References
1 Silverstein MD, Heit JA, Mohr DN. et al Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.. Arch Intern Med 1998; 158: 585-93.
2 Heit JA, Silverstein MD, Mohr DN. et al The epidemiology of venous thromboembolism in the community.. Thromb Haemost 2001; 86: 452-63.
3 Anderson Jr. FA, Wheeler HB, Goldberg RJ. 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; 151: 933-8.
4 Kniffin Jr. WD, Baron JA, Barrett J. et al The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.. Arch Intern Med 1994; 154: 861-6.
5 White RH. The epidemiology of venous thromboembolism.. Circulation 2003; 107 (23) (Suppl. 01) 4-8.
6 White RH, Zhou H, Romano PS. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California.. Ann Intern Med 1998; 128: 737-40.
7 Stein PD, Kayali F, Olson RE. et al Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census.. Am J Med 2004; 116: 435-42.
8 Stein PD, Hull RD, Patel KC. et al Venous thromboembolic disease: comparison of the diagnostic process in blacks and whites.. Arch Intern Med 2003; 163: 1843-48.
9 Stein PD, Hull RD, Patel KC. et al Venous thromboembolic disease: comparison of the diagnostic process in men and women.. Arch Intern Med 2003; 163: 1689-94.
10 Levine M, Gent M, Hirsh J. et al A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis.. N Engl J Med 1996; 334: 677-81.
11 Koopman MM, Prandoni P, Piovella F. et al Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group.. N Engl J Med 1996; 334: 682-7.
12 Cushman M, Tsai AW, White RH. et al Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology.. Am J Med 2004; 117: 19-25.
13 Harenberg J, Riess H, Buller HR. et al Comparison of six-month outcome of patients initially treated for acute deep vein thrombosis with a low molecular weight heparin Certoparin at a fixed, body-weight-independent dosage or unfractionated heparin.. Haematologica 2003; 88: 1157-62.
14 Juul K, Tybjaerg-Hansen A, Schnohr P. et al Factor V Leiden and the risk for venous thromboembolism in the adult Danish population.. Ann Intern Med 2004; 140: 330-7.
15 Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans.. Am J Cardiol 2000; 85: 1334-7.
16 Liu HS, Kho BC, Chan JC. et al Venous thromboembolism in the Chinese population--experience in a regional hospital in Hong Kong.. Hong Kong Med J 2002; 8: 400-5.
17 Ho CH, Chau WK, Hsu HC. et al Prevalence of factor V Leiden in the Chinese population.. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62: 875-8.
18 Ho CH, Chau WK, Hsu HC. et al Causes of venous thrombosis in fifty Chinese patients.. Am J Hematol 2000; 63: 74-8.
19 Shen MC, Lin JS, Tsay W. Protein C and protein S deficiencies are the most important risk factors associated with thrombosis in Chinese venous thrombophilic patients in Taiwan.. Thromb Res 2000; 99: 447-52.
20 Mokdad AH, Ford ES, Bowman BA. et al Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.. JAMA 2003; 289: 76-9.
21 Dowling NF, Austin H, Dilley A. et al The epidemiology of venous thromboembolism in Caucasians and African-Americans: the GATE Study.. J Thromb Haemost 2003; 1: 80-7.
22 Patel RK, Ford E, Thumpston J. et al Risk factors for venous thrombosis in the black population. The epidemiology of venous thromboembolism in Caucasians and African-Americans: the GATE Study.. Thromb Haemost 2003; 90: 835-88.
23 Lilienfeld DE, Godbold JH, Burke GL. et al Hospitalization and case fatality for pulmonary embolism in the twin cities: 1979–1984.. Am Heart J 1990; 120: 392-5.
24 Nordstrom M, Lindblad B, Bergqvist D. et al A prospective study of the incidence of deep-vein thrombosis within a defined urban population.. J Intern Med 1992; 232: 155-60.
25 Oger E. Incidence of venous thromboembolism: a community-based study in Western France. EPIGETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale.. Thromb Haemost 2000; 83: 657-60.
26 Arrighi HM, Hertz-Picciotto I. The evolving concept of the healthy worker survivor effect.. Epidemiology 1994; 5: 189-96.
27 Siddique RM, Siddique MI, Connors Jr. AF. et al Thirty-day case-fatality rates for pulmonary embolism in the elderly.. Arch Intern Med 1996; 156: 2343-47.
28 Stein PD, Kayali F, Olson RE. Estimated case fatality rate of pulmonary embolism, 1979 to 1998.. Am J Cardiol 2004; 93: 1197-9.
29 Kyrle PA, Minar E, Bialonczyk C. et al The risk of recurrent venous thromboembolism in men and women.. N Engl J Med 2004; 350: 2558-63.
30 Prewitt K.. (US Bureau of the Census.). Accuracy and Coverage Evaluation: Statement on the Feasibility of Using Statistical Methods to Improve the Accuracy to the 2000 Census June. 2000
31 White RH, Gettner S, Newman JM. et al Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty.. N Engl J Med 2000; 343: 1758-64.
32 White RH, Romano PHZ. A population-based comparison of the 3-month incidence of thromboembolism after major elective/urgent surgery.. Thromb Haemost 2003; 90: 446-55.
33 White R, Brickner L, Scannell K. ICD-9-CM codes poorly indentified venous thromboembolism during pregnancy.. J Clin Epidemiol 2004; 57: 985-8.
34 Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective, case-control study.. J Clin Epidemiol 2001; 54: 810-16.