Racial and gender differences in the incidence of recurrent venous thromboembolism

Richard H. White; William E. Dager; Hong Zhou; Susan Murin

doi:10.1160/TH06-07-0365

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 96(03): 267-273
DOI: 10.1160/TH06-07-0365

Theme Issue Article

Schattauer GmbH

Racial and gender differences in the incidence of recurrent venous thromboembolism

Richard H. White

¹Department of Medicine, Davis, California, USA

,

William E. Dager

²Department of Pharmacy; UC Davis, Davis, California, USA

,

Hong Zhou

¹Department of Medicine, Davis, California, USA

,

Susan Murin

¹Department of Medicine, Davis, California, USA

› Author Affiliations

Abstract

Summary

Men have been reported to have a higher incidence of recurrent venous thromboembolism than women. However, it is not known if this gender effect holds among different racial/ethnic groups and for both venous thrombosis and pulmonary embolism. We conducteda retrospective analysis of 18-to 65-year-old Caucasian, African-American and Hispanic cases hospitalized in California with unprovoked venous thromboembolism. The principal outcome was recurrent venous thromboembolism 7–60 months after the index event. Among 11,514 cases that were followed for a mean of 3.0 years, men had a significantly higher rate (events/100 patient-years) of recurrent venous thromboembolism than women for both venous thrombosis [rate ratio (RR)=1.5, 95% confidence interval (CI):1.3–1.8] and pulmonary embolism [RR=1.3, 95%CI:1.0–1.6].Among men the recurrence rate did not vary significantly between the racial/ethnic groups (p>0.05). However, the recurrence rate among Hispanic women with venous thrombosis was significantly higher than in Caucasian women (p<0.001) and was comparable to the rate in men. Both Hispanic and African-American women with pulmonary embolism had a higher recurrence rate compared with Caucasian women (p<0.02) that was comparable to the rate in men. We conclude that women in California had a 40% lower risk of recurrent venous thromboembolism compared to men. Rates were comparable among men of different races, but there were significant inter-racial differences among women, which also varied with the type of initial event. The effect of gender on the risk of recurrent venous thromboembolism can not be generalized because it varies between racial/ethnic groups and with the type of index event.

Keywords

Race - ethnicity - gender - recurrent thromboembolism - epidemiology

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References

References
1 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.
2 Baglin T, Luddington R, Brown K. et al. High risk of recurrent venous thromboembolism in men. J Thromb Haemost 2004; 02: 2152-5.
3 Agnelli G, Becattini C, Prandoni P. Recurrent venous thromboembolism in men and women. N Engl J Med 2004; 351: 2015-8 author reply 2015-8.
4 Heit JA, Mohr DN, Silverstein MD. et al. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Archives of Internal Medicine 2000; 160: 761-8.
5 Eriksson H, Lundstrom T, Wahlander K. et al. Prognostic factors for recurrence of venous thromboembolism (VTE) or bleeding during long-term secondary prevention of VTE with ximelagatran. Thromb Haemost 2005; 94: 522-7.
6 Garcia-Fuster MJ, Forner MJ, Fernandez C. et al. Long-term prospective study of recurrent venous thromboembolism in patients younger than 50 years. Pathophysiol Haemost Thromb 2005; 34: 6-12.
7 Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Archives of Internal Medicine 2000; 160: 769-74.
8 White RH, Zhou H, Kim J. et al. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. Archives of Internal Medicine 2000; 160: 2033-41.
9 White RH, Zhou H, Murin S. et al. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 2005; 93: 298-305.
10 Office of Statewide Health Planning and Development. State of California. Inpatient hospital discharge data. 2006 Available at: http://www.oshpd.ca.gov/hqad/PatientLevel/index.htm Accessed June 10, 2006.
11 White RH, Chew HK, Zhou H. et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med 2005; 165: 1782-7.
12 Healthcare Cost and Utilization Project (HCUP). Comorbidity software, version 3.1. 2005 Available at: http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp Accessed June 10 , 2006.
13 Elixhauser A, Steiner C, Harris DR. et al. Comorbidity measures for use with administrative data. Med Care 1998; 36: 8-27.
14 Wilchesky M, Tamblyn RM, Huang A. Validation of diagnostic codes within medical services claims. J Clin Epidemiol 2004; 57: 131-41.
15 Southern DA, Quan H, Ghali WA. Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care 2004; 42: 355-60.
16 Ouellette JR, Small DG, Termuhlen PM. Evaluation of Charlson-Age Comorbidity Index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg 2004; 08: 1061-7.
17 White RH, Beyth RJ, Zhou H. et al. Major bleeding after hospitalization for deep-venous thrombosis. Am J Med 1999; 107: 414-24.
18 Open Source Epidemiologic Statistics for Public Health. Persontime2--comparing two person-time rates. 2005 Available at: http://www.openepi.com/Menu/OpenEpiMenu.htm Accessed May 10, 2006.
19 Hyers TM, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2001; 119 (Suppl. 01) 176S-193S.
20 Seeman TE, Crimmins E, Huang MH. et al. Cumulative biological risk and socio-economic differences in mortality:MacArthur studies of successful aging. Soc Sci Med 2004; 58: 1985-97.
21 Eichinger S, Weltermann A, Minar E. et al. Symptomatic pulmonary embolism and the risk of recurrent venous thromboembolism. Arch Intern Med 2004; 164: 92-6.