Secular Trends in Incidence and Mortality of Acute Venous Thromboembolism: The AB-VTE Population-Based Study
Secular Trends in Incidence and Mortality of Acute Venous Thromboembolism: The AB-VTE Population-Based Study
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DOI：
10.1016/j.amjmed.2016.01.041
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发表时间：
2016-08-01
影响因子：
5.9
通讯作者：
McMurtry, M. Sean
中科院分区：
文献类型：
--
作者：
Alotaibi, Ghazi S.;Wu, Cynthia;McMurtry, M. Sean
背景：静脉血栓栓塞症是发病率和死亡率的主要原因，需要对流行病学和卫生服务使用模式进行全面的研究。在这项研究中，我们提供了过去十年中静脉血栓栓塞症发病率和病死率的当代估计。方法：我们通过链接加拿大艾伯塔省2002年4月1日至2012年3月31日的6个行政健康数据库，开发了一个基于人群的静脉血栓栓塞症数据集。我们使用经过验证的算法定义急性症状性病例，并使用泊松回归对年度静脉血栓栓塞症计数进行建模。结果：我们在2002年4月1日至2012年3月31日期间发现了31,656例急性症状性静脉血栓栓塞症。经年龄和性别调整的静脉血栓栓塞率为每1000人年1.38(95%可信区间，1.37-1.40)。肺栓塞为0.38(95%CI，0.36~0.40)/1000人年，深静脉血栓为1.0(95%CI，0.99~1.1)/1000人年。调整后的模型显示，在研究期间，静脉血栓栓塞症的发生率没有显著变化。静脉血栓栓塞组30d病死率为2.0%(95%CI，1.89~2.21)，肺血栓栓塞组病死率增加近一倍：3.9%(95%CI，3.50~4.33)。静脉血栓栓塞组1年病死率为9.2%(95%CI，8.88~9.52)，肺栓塞组1年病死率为12.9%(95%CI，12.2~13.6)。病死率随年龄增长而升高。首次急性静脉血栓栓塞症后的1年和5年存活率在发生无故事件和诱发事件的患者中相似。而癌性血栓形成患者的1年和5年生存率分别为66%(95%CI，64.71%~67.29%)和46%(95%CI，43.28%~48.72%)。然而，静脉血栓栓塞症的病死率很高。(C)2016 Elsevier Inc.保留所有权利。
BACKGROUND: Venous thromboembolism is a major cause of morbidity and mortality, and comprehensive studies profiling the epidemiology and pattern of health services use are needed. In this study we provide contemporary estimates of venous thromboembolism incidence and case fatality over the past decade.METHODS: We developed a population-based venous thromboembolism dataset by linking 6 administrative health databases in Alberta, Canada from April 1, 2002 to March 31, 2012. We defined acute symptomatic cases using a validated algorithm and used Poisson regression to model annual venous thromboembolism counts.RESULTS: We identified 31,656 cases of acute symptomatic venous thromboembolism between April 1, 2002 and March 31, 2012. The age- and sex-adjusted incidence rate of venous thromboembolism was 1.38 (95% confidence interval [CI], 1.37-1.40) per 1000 person-years. For pulmonary embolism it was 0.38 (95% CI, 0.36-0.40) per 1000 person-years, and for deep vein thrombosis it was 1.0 (95% CI, 0.99-1.1) per 1000 person-years. The adjusted model showed no significant change in the incidence of venous thromboembolism during the study period. The 30-day case fatality rate of venous thromboembolism was 2.0% (95% CI, 1.89-2.21) and was almost doubled in patients with pulmonary embolism: 3.9% (95% CI, 3.50-4.33). The 1-year case fatality rate was 9.2% (95% CI, 8.88-9.52) for venous thromboembolism and 12.9% (95% CI, 12.2-13.6) for patients with pulmonary embolism. The case fatality rate increased with increasing subject age. The 1-year and 5-year survivals after first acute venous thromboembolism were similar in patients with unprovoked and provoked events. However, in patients with cancer-associated thrombosis, the 1-year and 5-year survival rate was 66% (95% CI, 64.71%-67.29%) and 46% (95% CI, 43.28%-48.72%), respectively.CONCLUSION: The incidence of acute venous thromboembolism remained unchanged over a 10-year period. However, the case fatality of venous thromboembolism is substantial. (C) 2016 Elsevier Inc. All rights reserved.