Clinical Factors Impacting Differences in Rates of Venous Thromboembolism Black and White Veterans
Monday, March 4, 2024
8:30 AM – 8:37 AM EST
Location: Tampa Bay Ballroom Salons 1-4
Objective: Hospitalization is a known risk factor for venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE). It affects over half a million individuals annually in the United States. The incidence of several disease states is known to vary by race. In this study, we tested whether rates of VTE differed between Black and white Veterans, and evaluated potential reasons for any disparities identified.
Methods: We analyzed information from the first hospital admission of all Veterans nationwide at a Veterans Affairs (VA) facility between 2016 to 2021. We excluded patients with a prior history of VTE within 90 days before admission. Patient-level information was sourced from the VA Informatics and Computing Infrastructure (VINCI) database, including demographics, medical conditions, procedures, and VTE prophylactic measures. A diagnosis of VTE was established based on ICD-10 codes. Logistic regression models were used to assess the odds of VTE in Black patients relative to White patients.
Results: Among 1,153,284 hospitalized patients, 32,768 patients developed VTE within 90 days after admission. While the overall rate was 2.8%, Black patients had a higher incidence (3.3%) compared to White patients (2.7%) (Table 1). We extracted information on over 30 clinical risk factors and compared their prevalence between the two groups. We also compared the distribution of blood group types; prevalence of type O was higher among Black patients (42.3%) compared to Whites (37.9%), while non-O blood groups were more prevalent in Whites (43.2%) vs. Black patients (41.6%) (Table 1). After adjusting for prophylaxis use, logistic regression identified the key risk factors that accounted for the disparities in VTE incidence by race. These included: emergency surgery, hemoglobin levels, hemodialysis, fibrinogen levels, and the Social Deprivation Index score.
Conclusions: Given the observed racial disparities in VTE rates, healthcare institutions should consider implementing targeted prevention strategies, particularly among Black patients. Our findings suggest a link between racial disparities in VTE rates, and the prevalence of emergency surgery, reduced hemoglobin levels, hemodialysis, lower fibrinogen concentrations, and lower social deprivation index scores. These risk factors that are driving the disparities offer potential targets for tailored interventions to reduce the disparity in VTE incidence.
.jpg "Hilary Hayssen, MD photo")