Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
PLoS One. 2013 Jul 29;8(7):e70310. doi: 10.1371/journal.pone.0070310. Print 2013.
Recent linkage between primary and secondary care data has provided valuable information for studying heath outcomes that may initially present in different health care settings. The aim of this study was therefore, twofold: to use linked primary and secondary care data to determine an optimum definition for estimating the incidence of first VTE in and around pregnancy; and secondly to conduct a systematic literature review of studies on perinatal VTE incidence with the purpose of comparing our estimates.
We used primary care data from the Clinical Practice Research Datalink (CPRD), which incorporates linkages to secondary care contained within Hospital Episode Statistics (HES) between 1997 and 2010 to estimate the incidence rate of VTE in the antepartum and postpartum period. We systematically searched the literature on the incidence of VTE during antepartum and postpartum periods and performed a meta-analysis to provide comparison.
Using combined CPRD and HES data and a restrictive VTE definition, the absolute rate during the antepartum period and first six weeks postpartum (early postpartum) were 99 (95%CI 85-116) and 468 (95%CI 391-561) per 100,000 person-years respectively. These were comparable to the pooled estimates from our meta-analysis (using studies after 2005) during the antepartum period (118/100,000 person-years) and early postpartum (424/100,000 person-years). When we used only secondary care data to identify VTE events, incidence was lower during the early postpartum period (308/100,000 person-years), whereas relying only on primary care data lead to lower incidence during the time around delivery, but higher rates during the postpartum period (558/100,000 person-years).
Using combined CPRD and HES data gives estimates of the risk of VTE in and around pregnancy that are comparable to the existing literature. It also provides more accurate estimation of the date of VTE diagnosis which will allow risk stratification during specific pregnancy and postpartum periods.
最近，初级保健和二级保健数据的关联为研究最初可能出现在不同医疗保健环境中的健康结果提供了有价值的信息。因此，本研究的目的有两个：一是利用初级保健和二级保健的相关数据，确定一个最佳的定义，用于估算妊娠期间和妊娠前后静脉血栓栓塞症（VTE）的发生率；二是对围产期 VTE 发生率的研究进行系统综述，旨在比较我们的估计值。
我们使用了来自临床实践研究数据库（CPRD）的初级保健数据，该数据库结合了 1997 年至 2010 年期间包含在医院事件统计（HES）中的二级保健数据，以估算产前和产后期间 VTE 的发生率。我们系统地搜索了有关产前和产后期间 VTE 发生率的文献，并进行了荟萃分析以提供比较。
使用合并的 CPRD 和 HES 数据和一个严格的 VTE 定义，产前期间和产后六周内（早期产后）的绝对发生率分别为 99（95%CI 85-116）和 468（95%CI 391-561）每 100,000 人年。这与我们的荟萃分析（使用 2005 年后的研究）中的汇总估计值相当，产前期间为 118/100,000 人年，早期产后为 424/100,000 人年。当我们仅使用二级保健数据来识别 VTE 事件时，早期产后的发生率较低（308/100,000 人年），而仅使用初级保健数据则导致分娩前后的发生率较低，但在产后期间的发生率较高（558/100,000 人年）。
使用合并的 CPRD 和 HES 数据可以估算妊娠期间和妊娠前后 VTE 的风险，这些估计值与现有文献相当。它还提供了更准确的 VTE 诊断日期估计，这将允许在特定的妊娠和产后期间进行风险分层。
