Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis.
Am J Med. 2019 Aug;132(8):970-976. doi: 10.1016/j.amjmed.2019.03.021. Epub 2019 Apr 4.
Venous thromboembolism incidence rates are 30%-100% higher in US blacks than whites. We examined the degree to which differences in the frequencies of socioeconomic, lifestyle, medical risk factors, and genetic variants explain the excess venous thromboembolism risk in blacks and whether some risk factors are more strongly associated with venous thromboembolism in blacks compared with whites.
We measured venous thromboembolism risk factors in black and white participants of the Atherosclerosis Risk in Communities study in 1987-1989 and followed them prospectively through 2015 for venous thromboembolism incidence.
Over a mean of 22 years, we identified 332 venous thromboembolisms in blacks and 578 in whites, yielding 65% higher crude incidence rates per 1000 person-years in blacks. The age and sex-adjusted hazard ratio (95% confidence interval) of venous thromboembolism for blacks compared with whites was 2.04 (1.76, 2.37) for follow-up >10 years and was attenuated to 1.14 (0.89, 1.46) when adjusted for baseline confounders or mediators of the race association, which tended to be more common in blacks. For example, adjustment for just baseline weight, family income, and concentration of plasma factor VIII reduced the regression coefficient for race by 75%. There were no significant (P <0.05) 2-way multiplicative interactions of race with any risk factor, except with a 5-single nucleotide polymorphism (5-SNP) genetic risk score (a weaker venous thromboembolism risk factor in blacks) and with hospitalization for heart failure (a stronger venous thromboembolism risk factor in blacks).
The higher incidence rate of venous thromboembolism in blacks than whites was mostly explained by blacks having higher frequencies of venous thromboembolism risk factors.
静脉血栓栓塞症在美国黑人群体中的发病率比白人群体高 30%-100%。我们研究了社会经济、生活方式、医疗风险因素和遗传变异的频率差异在多大程度上解释了黑人群体中静脉血栓栓塞症风险的增加，以及某些风险因素是否与黑人群体中静脉血栓栓塞症的相关性更强。
我们测量了 1987-1989 年社区动脉粥样硬化风险研究中黑人和白人参与者的静脉血栓栓塞症风险因素，并对他们进行了前瞻性随访，直到 2015 年发生静脉血栓栓塞症。
在平均 22 年的随访中，我们在黑人群体中发现了 332 例静脉血栓栓塞症，在白人群体中发现了 578 例，导致黑人群体每 1000 人年的粗发病率高出 65%。与白人相比，黑人的静脉血栓栓塞症年龄和性别调整后的风险比（95%置信区间）为 2.04（1.76，2.37），当调整种族关联的基线混杂因素或调节剂时，该比值降低到 1.14（0.89，1.46），这些因素在黑人群体中更为常见。例如，仅调整基线体重、家庭收入和血浆因子 VIII 浓度就降低了种族回归系数的 75%。除了与 5 个单核苷酸多态性（5-SNP）遗传风险评分（黑人中静脉血栓栓塞症的风险因素较弱）和心力衰竭住院治疗（黑人中静脉血栓栓塞症的风险因素较强）之间存在显著（P <0.05）的双向乘法交互作用外，种族与任何风险因素之间没有显著的（P <0.05）双向乘法交互作用。
与白人相比，黑人群体中静脉血栓栓塞症的发病率更高，主要原因是黑人群体中静脉血栓栓塞症的风险因素频率更高。
