Venous thromboembolism mortality and trends in older US adults, 2011–2019

Abstract

Venous thromboembolism (VTE) affects 1.2 million people per year in the United States. With several clinical changes in diagnosis and treatment approaches in the past decade, we evaluated contemporary post‐VTE mortality risk profiles and trends. Incident VTE cases were identified from the 2011–2019 Medicare 20% Sample, which is representative of nearly all Americans aged 65 and older. The social deprivation index was linked from public data; race/ethnicity and sex were self‐reported. The all‐cause mortality risk 30 days and 1 year after incident VTE was calculated in demographic subgroups and by prevalent cancer diagnosis status using model‐based standardization. Risks for major cancer types, risk differences by age, sex, race/ethnicity, and socio‐economic status (SES), and trends over time are also reported. The all‐cause mortality risk among older US adults following incident VTE was 3.1% (95% CI 3.0–3.2) at 30 days and 19.6% (95% CI 19.2–20.1) at 1 year. For cancer‐related VTE events, the age‐sex‐race‐standardized risk was 6.0% at 30 days and 34.7% at 1 year. The standardized 30‐day and 1‐year risks were higher among non‐White beneficiaries and among those with low SES. One‐year mortality risk decreased 0.28 percentage points per year (95% CI 0.16–0.40) on average across the study period, with no trend observed for 30‐day mortality risk. In sum, all‐cause mortality risk following incident VTE has decreased slightly in the last decade, but racial and socio‐economic disparities persist. Understanding patterns of mortality among demographic subgroups and in cancer‐associated events is important for targeting efforts to improve VTE management.

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

“…[ 33 ] was based out of the Veterans Affairs health care system of which the authors acknowledge the robust access to healthcare for their cohort. When comparing our study to similar studies with disparities in access to health care, our results were consistent with the literature demonstrating worse mortality outcomes for non-White individuals [ 14 , 58 ]. Our study consisted of the highest proportion of Black individuals, helping to contribute primary literature to an underrepresented patient population.…”

“…Similar results were recently published by Giorgio et al. [ 58 ] investigating a large Medicare cohort of over 125,000 individuals from 2011 to 2019. Their study demonstrated an increased 30-day (7.0 % vs 5.8%) and 1-year (40.8% vs 33.8%) mortality in Black individuals compared with White individuals with CA-VTE [ 58 ].…”

“…[ 58 ] investigating a large Medicare cohort of over 125,000 individuals from 2011 to 2019. Their study demonstrated an increased 30-day (7.0 % vs 5.8%) and 1-year (40.8% vs 33.8%) mortality in Black individuals compared with White individuals with CA-VTE [ 58 ]. Interestingly, in a multivariable regression analysis done by Martens et al.…”

Symptom-related screening programme for early detection of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the SYSPPE study

“…When we analyse 1-year mortality rates in population-based studies or in other registries or databases, we observe how the 1- year mortality among PE patients varies from 19% to 52.3%. 30–32 Among the most relevant factors that could have contributed to higher mortality in our work, compared with other prospective studies that have addressed this issue, are cancer and age. The percentage of patients with cancer in previous studies ranged from 6.15% to 11%, 8 16 27 28 a figure that contrasts with the 26.7% in our series.…”

Venous Thromboembolism Management throughout the COVID-19 Era: Addressing Acute and Long-Term Challenges

“…Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), presents a considerable health challenge due to its multifactorial pathogenesis and potential short- and long-term complications. Despite its potential fatality, timely and appropriate anticoagulant therapy, along with vigilant patient monitoring, has led to a gradual reduction in mortality rates, highlighting the significance of comprehensive VTE management [ 1 ].…”