Comparison of characteristics from White‐ and Black‐Americans with venous thromboembolism: A cross‐sectional study

Abstract

When compared with Whites, Black-Americans may have a 40% higher incidence venous thromboembolism (VTE) incidence. However, whether other VTE characteristics and risk factors vary by race is uncertain. To compare demographic and baseline characteristics among White-and Black-Americans with VTE, we used data prospectively collected from consecutive consenting adults enrolled in seven Centers for Disease Control (CDC) Thrombosis and Hemostasis Centers from August 2003 to March 2009. These characteristics were compared among Whites (n 5 2002) and Blacks (n 5 395) with objectively diagnosed VTE, both overall, and by age and gender. When compared with Whites, Blacks had a significantly higher proportion with pulmonary embolism (PE), including idiopathic PE among Black women, and a significantly higher proportion of Blacks were women. Blacks had a significantly higher mean BMI and a significantly lower proportion with recent surgery, trauma or infection, family history of VTE, and documented thrombophilia (solely from reduced factor V Leiden and prothrombin G20210A prevalence). Conversely, Blacks had a significantly higher proportion with hypertension, diabetes mellitus, chronic renal disease and dialysis, HIV, and sickle cell disease. When compared with White women, Black women had a significantly lower proportion with recent oral contraceptive use or hormone therapy. We conclude that Whites and Blacks differ significantly regarding demographic and baseline characteristics that may be risk factors for VTE. The prevalence of transient VTE risk factors and idiopathic VTE among Blacks appears to be lower and higher, respectively, suggesting that heritability may be important in the etiology of VTE among Black-Americans. Am. J. Hematol. 85:467-471, 2010. V V C 2010 Wiley-Liss, Inc. IntroductionMost epidemiologic studies of venous thromboembolism (VTE) risk factors have been conducted within White-American and -European populations [1][2][3][4]. However, when compared with Whites, Black-Americans appear to have a higher risk for [5,6] and incidence of VTE [7][8][9][10]. Two single-nucleotide polymorphisms, factor V Leiden (G1691A) and prothrombin G20210A, have been identified as risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) in Europeans and White-Americans, [11][12][13][14][15][16] but not Black-Americans [6,17,18]. We hypothesized that the apparent higher VTE incidence among Blacks might be due to an increased prevalence of known VTE risk factors. To test this hypothesis, we compared demographic and baseline clinical characteristics from White-and Black-Americans with objectively diagnosed VTE who were seen in one of the seven CDC Thrombosis and Hemostasis Research and Prevention Network centers.

Sickle Cell Trait: Is There an Increased VTE Risk in Pregnancy and the Postpartum?

“…Several studies have described a higher rate of VTE in blacks and some have investigated the association of SCT with thromboembolic disease [6]–[11], [16]–[18]. In support of the hypercoagulability hypothesis, Westerman noted increased levels of prothrombotic markers such as D-dimers, TAT (thrombin-antithrombin complexes) and the prothrombin cleavage fragment F1.2 in patients with SCT compared to HbAA controls [27].…”

Emergency department visits by patients with venous thromboembolism, 1998-2009

“…More research is needed related to racial/ethnic disparities in occurrence as well as causes and outcomes of VTE. Available information indicates that the prevalence of a number of hereditary conditions, such as factor V Leiden, that increases the risk of thrombosis, is lower among African Americans [22,23] . However, several other risk factors, such as hypertension and diabetes, have been found in higher rates among African-Americans with VTE compared to whites [11,22,23] .…”

Relationship Between African-American Race and Delirium in the ICU

“…[13–15] Recently, racial differences have been elucidated in critical illness with African-Americans having a higher prevalence of sepsis compared to whites,[16] higher rates of cardiac arrest,[17, 18] noncardiogenic acute respiratory failure,[19] and venous thromboembolism. [20] Race not only affects disease prevalence but also clinical manifestations, severity, and mortality. [12–14, 21] Although access to care has been the presumed default factor responsible for such disparities, recent evidence has shown that the relationship between race and disease is complicated with race modifying the disease through multiple mechanisms including genetic susceptibility, presence of comorbid conditions, socioeconomic status, and access to care.…”