The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.
The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.
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DOI：
10.1001/archinte.1994.00420080053005
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发表时间：
1994-04
影响因子：
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通讯作者：
W. Kniffin;J. Baron;J. Barrett;J. Birkmeyer;F. Anderson
中科院分区：
文献类型：
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作者：
W. Kniffin;J. Baron;J. Barrett;J. Birkmeyer;F. Anderson
背景：目前还没有研究确定老年人肺栓塞（PE）和深静脉血栓形成（DVT）的基本流行病学。开展本项目就是为了提供这方面的信息。方法：我们从1986年至1989年期间随机抽取5%的美国医疗保险登记者样本，获得所有医疗保险索赔。通过选择用于诊断和治疗的代码，我们确定了7174例PE和8923例DVT。对这些队列进行分析，以提供年龄、种族、性别和地理位置的发病率;侵入性治疗的频率; DVT治疗后PE的频率; PE复发的频率;以及诊断后的生存率。结果65 ~ 69岁人群PE和DVT的年发病率分别为1.3/1000和1.8/1000。这两个比率随着年龄的增长而稳步上升，到85至89岁时分别为2.8和3.1。对于PE，女性的发生率低于男性（校正的相对风险为0.86; 95%置信区间为0.82至0.90），黑人的发生率高于白人（校正的相对风险为1.25; 95%置信区间为1.15至1.36）。对于DVT，与性别和种族的关联较弱，并且方向相反。0.2%的PE病例进行了肺栓塞切除术; 4.4%的PE病例和2%的DVT病例进行了腔静脉阻断。所有病例中有0.3%进行了血栓切除术。1.7%的DVT患者在出院接受初始治疗后1年内发生肺栓塞。PE的1年复发率为8.0%。与PE和DVT相关的住院死亡率分别为21%和3%。一年死亡率分别为39%和21%。结论肺栓塞和DVT是老年人的常见病。两者都随着年龄的增长而增加，但种族和性别的影响很小。目前的治疗模式似乎可以有效预防DVT后PE和PE复发。两者均与1年死亡率相关，提示需要了解相关疾病的作用以及预防和治疗方法的适应症。
BACKGROUND There are no studies that define the basic epidemiology of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the elderly. This project was undertaken to provide that information. METHODS We obtained all Medicare claims during the period 1986 through 1989 from a random 5% sample of US Medicare enrollees. By selecting codes used for diagnoses and treatment, we identified 7174 cases of PE and 8923 cases of DVT. These cohorts were analyzed to provide incidence by age, race, sex, and geographic location; frequency of invasive treatment; frequency of PE after treatment for DVT; frequency of recurrence of PE; and survival after diagnosis. RESULTS Annual incidence rates per 1000 at age 65 to 69 years for PE and DVT were 1.3 and 1.8, respectively. Both rates increased steadily with age to 2.8 and 3.1 by age 85 to 89 years. For PE, women had lower rates than men (adjusted relative risk, 0.86; 95% confidence interval, 0.82 to 0.90), and blacks had higher rates than whites (adjusted relative risk, 1.25; 95% confidence interval, 1.15 to 1.36). For DVT, the associations with gender and race were weaker and in the opposite direction. Pulmonary embolectomy was done in 0.2% of cases of PE; interruption of the vena cava was done in 4.4% of cases of PE and in 2% of cases of DVT. Thrombectomy was done in 0.3% of all cases. Pulmonary embolism occurred in 1.7% of patients with DVT within 1 year of hospital discharge for initial treatment. The 1-year recurrence rate for PE was 8.0%. In-hospital mortality associated with PE and DVT was 21% and 3%, respectively. One-year mortality was 39% and 21%, respectively. CONCLUSIONS Pulmonary embolism and DVT are common problems in the elderly. Both increase with age, but the effects of race and sex are small. Current treatment patterns appear to be effective in preventing both PE after DVT and recurrence of PE. Both are associated with substantial 1-year mortality, suggesting the need to understand the role of associated conditions as well as the indications for prophylaxis and the methods of treatment.