Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina

Abstract

Background: Venous thromboembolism (VTE) affects approximately 1-2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. Objective: To determine risk factors, incidence, treatments, and outcomes of VTE through a 2-year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). Patients/Methods: We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. Results: A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital-associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were youngerthan White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). Conclusions:Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospitalassociated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals.

Racial Distribution and Associated Outcomes for Patients With and Without Severe-Isolated Traumatic Brain Injuries Following Venous Thromboembolism Prophylaxis

“…In Saber et al, authors found that Black patients had a higher incidence of VTE and were noted to be younger than their White counterparts ( P < .0001). 7 Similarly, our study revealed that individuals who exhibited severe body injuries and received early VTE prophylaxis were predominantly from the Black demographic and were of a younger age group. This trend is further substantiated by Zebley et al, whose research demonstrated that Black patients had the highest rates of VTE prophylaxis utilization, coupled with the shortest time to administration (1.6 days) 3 .…”

An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county

“…We identified patients with a history of VTE at Duke University Hospital, Duke Regional Hospital, and the Durham Veterans’ Administration Medical Center within Durham County, North Carolina. Patients were included if they resided within Durham County at the time of diagnosis of VTE between April 1, 2012, and March 31, 2014 [ 6 ]. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were searched by International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes during the surveillance period.…”

“…All cases identified by electronic medical record screening were confirmed by review of imaging studies, autopsy reports, or clinical records by trained research staff and clinicians. Consistent with our previous paper, patients living outside Durham County at time of diagnosis, or at time of death for autopsy cases, were not included [ 6 ].…”

“…Cancer-associated venous thromboembolism (CA-VTE) is a common complication and an important cause of morbidity and mortality in patients with cancer. The annual incidence of venous thromboembolism (VTE) overall ranges between 1.37 and 2.47 individuals per 1000 each year [ [1] , [2] , [3] , [4] , [5] , [6] ]. When specifically looking at VTE in cancer cohorts, the annual incidence of VTE depends on the primary cancer type.…”

“…We investigated VTE rates, risk factors, treatment patterns, and outcomes in Durham County, North Carolina, between the years 2012 and 2014 [ 6 ]. Within this racially diverse cohort, we have expanded this analysis by evaluating clinical differences among patients with a history of VTE with and without active cancer.…”