Population Health Research Institute, DBCVSRI, Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada.
McMaster University, Hamilton, ON, Canada.
Cardiovasc Res. 2021 Jan 21;117(2):576-584. doi: 10.1093/cvr/cvaa044.
To examine the rates of venous thromboembolism (VTE) in high-income, upper middle-income, and lower middle/low-income countries (World Bank Classification).
We examined the rates of VTE in high-income, upper middle-income, and lower middle/low-income countries (World Bank Classification) in a cohort derived from four prospective international studies (PURE, HOPE-3, ORIGIN, and COMPASS). The primary outcome was a composite of pulmonary embolism, deep vein thrombosis, and thrombophlebitis. We calculated age- and sex-standardized incidence rates (per 1000 person-years) and used a Cox frailty model adjusted for covariates to examine associations between the incidence of VTE and country income level. A total of 215 307 individuals (1.5 million person-years of follow-up) from high-income (n = 60 403), upper middle-income (n = 42 066), and lower middle/low-income (n = 112 838) countries were included. The age- and sex-standardized incidence rates of VTE per 1000 person-years in high-, upper middle-, and lower middle/low-income countries were 0.87, 0.25, and 0.06, respectively. After adjusting for age, body mass index (BMI), smoking, antiplatelet therapy, anticoagulant therapy, education level, ethnicity, and incident cancer diagnosis or hospitalization, individuals from high-income and upper middle-income countries had a significantly higher risk of VTE than those from lower middle/low-income countries [hazard ratio (HR) 3.57, 95% confidence interval (CI) 2.40-5.30 and HR 2.27, 95% CI 1.59-3.23, respectively]. The effect of country income level on VTE risk was markedly stronger in people with a lower BMI, hypertension, diabetes, non-White ethnicity, and higher education.
The rates of VTE are substantially higher in high-income than in low-income countries. The factors underlying the increased VTE risk in higher-income countries remain unknown.
检查高收入、中上收入和中下等收入/低收入国家（世界银行分类）的静脉血栓栓塞症（VTE）发生率。
我们在四项前瞻性国际研究（PURE、HOPE-3、ORIGIN 和 COMPASS）中得出的队列中检查了高收入、中上收入和中下等收入/低收入国家（世界银行分类）的 VTE 发生率。主要结局是肺栓塞、深静脉血栓形成和血栓性静脉炎的复合。我们计算了年龄和性别标准化的发病率（每 1000 人年），并使用 Cox 脆弱模型调整了协变量，以检查 VTE 发生率与国家收入水平之间的关联。共有 215307 名个体（150 万人年随访）来自高收入（n=60403）、中上收入（n=42066）和中下等收入/低收入（n=112838）国家。高、中上和中下等收入/低收入国家每 1000 人年的 VTE 年龄和性别标准化发病率分别为 0.87、0.25 和 0.06。在校正年龄、体重指数（BMI）、吸烟、抗血小板治疗、抗凝治疗、教育水平、种族以及新发癌症诊断或住院治疗后，来自高收入和中上收入国家的个体发生 VTE 的风险明显高于来自中下等收入/低收入国家的个体[风险比（HR）3.57，95%置信区间（CI）2.40-5.30 和 HR 2.27，95%CI 1.59-3.23]。在 BMI 较低、高血压、糖尿病、非白人种族和受教育程度较高的人群中，国家收入水平对 VTE 风险的影响更为显著。
VTE 在高收入国家的发生率明显高于低收入国家。高收入国家 VTE 风险增加的潜在因素尚不清楚。
