Clinical study
Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census

https://doi.org/10.1016/j.amjmed.2003.11.020Get rights and content

Abstract

Purpose

To assess the rate of diagnosis of deep venous thrombosis, pulmonary embolism, and venous thromboembolism; the incidence in hospitalized patients; and mortality from pulmonary embolism among Asians/Pacific Islanders in the United States.

Methods

The number of patients discharged from hospitals with a diagnostic code for pulmonary embolism or deep venous thrombosis from 1990 through 1999 was obtained from the National Hospital Discharge Survey. Population estimates and deaths from pulmonary embolism from 1990 through 1998 were obtained from the United States Bureau of the Census.

Results

Rate ratios of 10-year age-adjusted rates of diagnosis of deep venous thrombosis, pulmonary embolism, and venous thromboembolism comparing Asians/Pacific Islanders with whites and African Americans ranged from 0.16 to 0.21. Rate ratios comparing incidences in hospitalized patients ranged from 0.32 to 0.42. The age-adjusted rate ratio of mortality in “others” (which included Asians/Pacific Islanders) was 0.29 (95% confidence interval [CI]: 0.01 to 0.87) compared with whites and 0.14 (95% CI: 0.0 to 0.58) compared with African Americans.

Conclusion

Rates of deep venous thrombosis, pulmonary embolism, and venous thromboembolism; incidences in hospitalized patients; and the mortality rate from pulmonary embolism were markedly lower in Asians/Pacific Islanders than in whites and African Americans. Clinical assessment of the prior probability of venous thromboembolic disease at the bedside should probably be adjusted based on these ethnic differences.

Section snippets

Data sources

The number of patients discharged from hospitals with a diagnostic code of pulmonary embolism or deep venous thrombosis was obtained from the National Hospital Discharge Survey (23), which is based on data abstracted from a national probability sample of discharges from short-stay nonfederal hospitals in 50 states and the District of Columbia. From 1990 through 1999, data were obtained annually from 235,000 to 307,000 sampled patient abstracts from 458 to 494 hospitals (23). About 8% of

Results

Age-adjusted rates of diagnosis of deep venous thrombosis during the 10-year observation period were lower in Asians/Pacific Islanders than in African Americans and whites (Table 1; Figure 1). Rate ratios were 0.97 (95% confidence interval [CI]: 0.92 to 0.99) comparing whites with African Americans, 0.21 (95% CI: 0.14 to 0.30) comparing Asians/Pacific Islanders with whites, and 0.20 (95% CI: 0.13 to 0.29) comparing Asians/Pacific Islanders with African Americans. In age groups 20 to 49 years,

Discussion

We found that the rate of deep venous thrombosis, pulmonary embolism, and venous thromboembolism; the incidence in hospitalized patients; and mortality rate from pulmonary embolism were all lower in Asians/Pacific Islanders than in whites and African Americans. Rate ratios showed markedly lower values in Asians/Pacific Islanders.

Klatsky et al (12) reported even lower rates of diagnosis of venous thromboembolic disease among Asian Americans, whites, and African Americans in California. The

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