Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study.
OBJECTIVE
Few Asian studies have evaluated the risks of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with SSc. We conducted a nationwide population-based cohort study to evaluate how SSc affected the incidence of DVT and PTE in Taiwan.


METHODS
We identified patients with an SSc diagnosis in Taiwan between 1998 and 2010 using the Catastrophic Illness Patient Database and the National Health Insurance Research Database. Each SSc patient was frequency matched to four control patients based on age, sex and index year and all patients were observed from the index date until the appearance of a DVT or PTE event or 31 December 2010. We calculated the hazard ratios and 95% CIs of DVT and PTE in the SSc and comparison cohorts using the Cox proportional hazards regression model.


RESULTS
We observed 1895 SSc patients and 7580 control patients for ∼10,128 and 46,488 person-years, respectively. The mean ages of the SSc and comparison cohorts were 50.3 and 49.9 years, respectively. After adjusting for age, sex and co-morbidities, the risks of DVT and PTE among the SSc patients were 10.5- and 7.00-fold higher than those of the control patients. The probability of developing DVT and PTE increased in the years following the SSc diagnosis.


CONCLUSIONS
SSc patients exhibited a significantly higher risk of developing DVT and PTE compared with the general population. Thus multidisciplinary teams should guide the assessment, treatment and holistic care of SSc patients.
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Wei-Sheng
WS
Chung
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Cheng-Li
CL
Lin
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Fung-Chang
FC
Sung
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Wu-Huei
WH
Hsu
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Wen-Ta
WT
Yang
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
Chuan-Chin
CC
Lu
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. d10040@mail.cmuh.org.tw.
Chia-Hung
CH
Kao
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012595:Scleroderma, Systemic / Q000150:complications* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*
deep vein thrombosis; nationwide cohort study; pulmonary thromboembolism; systemic sclerosis