Elsevier

Mayo Clinic Proceedings

Volume 76, Issue 11, November 2001, Pages 1102-1110
Mayo Clinic Proceedings

Original Article
Incidence of Venous Thromboembolism in Hospitalized Patients vs Community Residents

https://doi.org/10.4065/76.11.1102Get rights and content

Objective

To estimate the incidence rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients and to compare these with incidence rates in community residents.

Patients and Methods

We performed a retrospective review of the complete medical records from a population-based inception cohort of patients who resided in Olmsted County, Minnesota, and had an incident DVT or PE from 1980 through 1990.

Results

From 1980 through 1990, 911 Olmsted County residents experienced their first lifetime event of definite, probable, or possible venous thromboembolism. Of these residents, 253 had been hospitalized for some reason other than a diagnosis of DVT or PE (in-hospital cases), and 658 were not hospitalized at onset of venous thromboembolism (community residents). The average annual age- and sex-adjusted incidence of in-hospital venous thromboembolism was 960.5 (95% confidence interval, 795.1–1125.9) per 10,000 person-years and was more than 100 times greater than the incidence among community residents at 7.1 (95% confidence interval, 6.5-7.6) per 10,000 person-years. The incidence of venous thromboembolism rose markedly with increasing age for both groups, with PE accounting for most of the age-related increase among in-hospital cases. Incidence rates in the 2 groups changed little over time despite a reduction in the average length of hospital stay between 1980 and 1990.

Conclusions

Venous thromboembolism is a major national health problem, especially among elderly hospitalized patients. This finding emphasizes the need for accurate identification of hospitalized patients at risk for venous thromboembolism and a better understanding of the mechanisms involved so that safe and effective prophylaxis can be implemented.

Section snippets

PATIENTS AND METHODS

Using data resources of the Rochester Epidemiology Project,10 we reviewed a master list of 9046 potential cases to identify the inception cohort of 2218 Olmsted County residents with a first lifetime venous thromboembolism (DVT or PE) during the 25-year period from 1966 through 1990, as described in detail elsewhere.11 We had access to a mean ± SD of 30.5±19.2 years (median, 30 years) of documented medical history before the first diagnosis of venous thromboembolism in these patients. Diagnosis

RESULTS

From 1980 through 1990, the time frame covered in the current analysis, 911 Olmsted County residents experienced their first lifetime event of definite, probable, or possible venous thromboembolism. Of these residents, 253 (28%) had been hospitalized for some reason other than a diagnosis of DVT or PE. This number represents fewer than half of the 658 cases observed among Olmsted County residents who were not hospitalized at onset of thromboembolism. However, the population of hospitalized

DISCUSSION

Our study demonstrates that the overall age- and sex-adjusted incidence of venous thromboembolism is more than 100-fold higher among hospitalized patients compared with community residents; if cases occurring in recently hospitalized community residents and community nursing home residents are excluded, the in-hospital incidence is more than 260-fold higher compared with the incidence among community residents. Based on National Hospital Discharge Survey hospitalization rates, we estimate that

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    This study was supported in part by grants HL46974 and AR30582 from the National Institutes of Health.

    1

    Dr Silverstein is now at the Center for Health Care Research, Medical University of South Carolina, Charleston.

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