Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States.
Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States.
Thromb Haemost. 2018 Jul;118(7):1316-1328. doi: 10.1055/s-0038-1660436. Epub 2018 Jul 2.
Nursing home (NH) residency is an independent risk factor for venous thromboembolism (VTE), but the VTE burden within the NH population is uncertain. This study estimates VTE incidence and VTE-associated mortality among NH residents. We identified all NH residents in any NH in Olmsted County, Minnesota, United States, 1 October 1998 to 31 December 2005 and all first lifetime VTE among county residents to estimate VTE incidence while resident of local NHs (NHVTE), using Centers for Medicare and Medicaid Services Minimum Data Set and Rochester Epidemiology Project resources. We tested associations between NHVTE and age, sex and time since each NH admission using Poisson modelling. Additionally, we tested incident NHVTE as a potential predictor of survival using Cox proportional hazards, adjusting for age, sex and NH residency. Between 1 October 1998 and 31 December 2005, 3,465 Olmsted County residents with ≥1 admission to a local NH, contributed 4,762 NH stays. Of the 3,465 NH residents, 111 experienced incident NHVTE (2.3% of all eligible stays), for an overall rate of 3,653/100,000 NH person-years (NH-PY). VTE incidence was inversely associated with time since each NH admission, and was highest in the first 7 days after each NH admission (18,764/100,000 NH-PY). The adjusted hazard of death for incident NHVTE was 1.90 (95% confidence interval [CI]: 1.38-2.62). In conclusion, VTE incidence among NH residents was nearly 30-fold higher than published incidence rates for the general Olmsted County population. VTE incidence was highest within 7 days after NH admission, and NHVTE was associated with significantly reduced survival. These data can inform future research and construction of clinical trials regarding short-term prophylaxis.
养老院（NH）居住是静脉血栓栓塞症（VTE）的独立危险因素，但 NH 人群中的 VTE 负担不确定。本研究估计 NH 居民的 VTE 发病率和与 VTE 相关的死亡率。我们确定了美国明尼苏达州奥姆斯特德县任何 NH 中的所有 NH 居民，1998 年 10 月 1 日至 2005 年 12 月 31 日，以及该县居民中的所有首次终身 VTE，以估计当地 NH 居民的 VTE 发病率（NHVTE），使用医疗保险和医疗补助服务最低数据集和罗切斯特流行病学项目资源。我们使用泊松模型测试了 NHVTE 与年龄、性别和每次 NH 入院时间之间的关联。此外，我们使用 Cox 比例风险模型测试了 NHVTE 作为生存的潜在预测因子，调整了年龄、性别和 NH 居住情况。1998 年 10 月 1 日至 2005 年 12 月 31 日期间，3465 名奥姆斯特德县居民至少有一次 NH 入住，共入住 NH4762 次。在 3465 名 NH 居民中，有 111 人发生了 NHVTE（所有合格入住者的 2.3%），总发生率为 3653/100000 NH 人年（NH-PY）。VTE 发病率与每次 NH 入院时间呈反比，每次 NH 入院后 7 天内最高（18764/100000 NH-PY）。NHVTE 事件的死亡调整风险比为 1.90（95%置信区间[CI]：1.38-2.62）。总之，NH 居民的 VTE 发病率比奥姆斯特德县一般人群的公布发病率高近 30 倍。NH 入院后 7 天内 VTE 发病率最高，NHVTE 与生存率显著降低相关。这些数据可以为未来关于短期预防的研究和临床试验提供信息。
