title: Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009).
abstract: BACKGROUND
  The clinical epidemiology of venous thromboembolism has changed recently because of advances in identification, prophylaxis, and treatment. We sought to describe secular trends in the occurrence of venous thromboembolism among residents of the Worcester, Massachusetts, metropolitan statistical area.
  
  
  METHODS
  Population-based methods were used to monitor trends in event rates of first-time or recurrent venous thromboembolism in 5025 Worcester, Massachusetts, metropolitan statistical area residents who were diagnosed with acute pulmonary embolism or lower-extremity deep vein thrombosis during 9 annual periods between 1985 and 2009. Medical records were reviewed by abstractors and validated by clinicians.
  
  
  RESULTS
  Age- and sex-adjusted annual event rates for first-time venous thromboembolism increased from 73 (95% confidence interval [CI], 64-82) per 100,000 in 1985/1986 to 133 (CI, 122-143) in 2009, primarily because of an increase in pulmonary embolism. The rate of recurrent venous thromboembolism decreased from 39 (CI, 32-45) in 1985/1986 to 19 (CI, 15-23) in 2003, and then increased to 35 (CI, 29-40) in 2009. There was an increasing trend in using noninvasive diagnostic testing, with approximately half of tests being invasive in 1985/1986 and almost all noninvasive by 2009.
  
  
  CONCLUSIONS
  Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the annual event rate of venous thromboembolism has increased and remains high. Although these increases partially may be due to increased sensitivity of diagnostic methods, especially for pulmonary embolism, they also may imply that current prevention and treatment strategies are less than optimal.
authors.affiliation: Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester. Electronic address: wei.Huang@umassmed.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.affiliation: Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester.
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D016012:Poisson Distribution; D011159:Population Surveillance; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012044:Regression Analysis; D054556:Venous Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology*
keywords: Incidence; Outcomes research; Pulmonary embolism; Venous thromboembolism; Venous thrombosis