Journal article
Venous thromboembolism incidence, recurrence, and mortality based on Women's Health Initiative data and Medicare claims
Thrombosis research, Vol.150, pp.78-85
02/2017
DOI: 10.1016/j.thromres.2016.11.015
PMID: 28063368
Abstract
Our objective was to compare Medicare claims to physician review and adjudication of medical records for identifying venous thromboembolism (VTE), and to assess VTE incidence, recurrence, and mortality in a large national cohort of post-menopausal women followed up to 19years.
We used detailed clinical data from the Women's Health Initiative (WHI) linked to Medicare claims. Agreement between data sources was evaluated among 16,003 women during 1993–2010. A claims-based definition was selected to analyze VTE occurrence and impact among 71,267 women during 1993–2012.
Our VTE definition had 83% sensitivity. Positive predictive value was 69% when all records were included, and 94% after limiting Medicare records to those with a WHI hospitalization adjudicated. Annualized VTE incidence was 4.06/1000person-years (PY), recurrence was 5.30/100PY, and both rates varied by race/ethnicity. Post-VTE mortality within 1year was 22.49% from all causes, including 1.01% from pulmonary embolism, 10.40% from cancer, and 11.08% from other causes. Cancer-related VTE compared to non-cancer VTE had significantly (p<0.001) higher recurrence (9.86/100PY vs. 4.43/100PY) and mortality from all causes (45.89% vs. 12.28%), but not from pulmonary embolism (0.40% vs. 1.27%).
Medicare claims compared reasonably well to physician adjudication. The combined data sources provided new insights about VTE burden and prognosis in older women.
•Medicare claims compared reasonably well to medical record adjudication for VTE.•In a national cohort of older women, VTE incidence varied by race/ethnicity.•Incidence was highest in African-Americans and lowest in Asians/Pacific Islanders.•VTE recurrence and all-cause mortality were high, especially in women with cancer.•High post-VTE mortality in cancer patients appears due to cancer rather than VTE.
Details
- Title: Subtitle
- Venous thromboembolism incidence, recurrence, and mortality based on Women's Health Initiative data and Medicare claims
- Creators
- Dale R. Burwen - National Heart Lung and Blood InstituteChunyuan Wu - Fred Hutch Cancer CenterDominic Cirillo - University of Rochester Medical CenterJacques E. Rossouw - National Heart Lung and Blood InstituteKaren L. Margolis - HealthPartnersMarian Limacher - University of FloridaRobert Wallace - University of IowaMatthew Allison - University of California San DiegoCharles B. Eaton - Memorial Hospital of Rhode IslandMonika Safford - University of AlabamaMatthew Freiberg - Vanderbilt University
- Resource Type
- Journal article
- Publication Details
- Thrombosis research, Vol.150, pp.78-85
- DOI
- 10.1016/j.thromres.2016.11.015
- PMID
- 28063368
- NLM abbreviation
- Thromb Res
- ISSN
- 0049-3848
- eISSN
- 1879-2472
- Publisher
- Elsevier Ltd
- Grant note
- DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute; DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100000016, name: U.S. Department of Health and Human Services, award: HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C
- Language
- English
- Date published
- 02/2017
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984363580102771
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