title: Venous thromboembolism incidence, recurrence, and mortality based on Women's Health Initiative data and Medicare claims.
abstract: BACKGROUND
  Our objective was to compare Medicare claims to physician review and adjudication of medical records for identifying venous thromboembolism (VTE), and to assess VTE incidence, recurrence, and mortality in a large national cohort of post-menopausal women followed up to 19years.
  
  
  METHODS
  We used detailed clinical data from the Women's Health Initiative (WHI) linked to Medicare claims. Agreement between data sources was evaluated among 16,003 women during 1993-2010. A claims-based definition was selected to analyze VTE occurrence and impact among 71,267 women during 1993-2012.
  
  
  RESULTS
  Our VTE definition had 83% sensitivity. Positive predictive value was 69% when all records were included, and 94% after limiting Medicare records to those with a WHI hospitalization adjudicated. Annualized VTE incidence was 4.06/1000person-years (PY), recurrence was 5.30/100PY, and both rates varied by race/ethnicity. Post-VTE mortality within 1year was 22.49% from all causes, including 1.01% from pulmonary embolism, 10.40% from cancer, and 11.08% from other causes. Cancer-related VTE compared to non-cancer VTE had significantly (p<0.001) higher recurrence (9.86/100PY vs. 4.43/100PY) and mortality from all causes (45.89% vs. 12.28%), but not from pulmonary embolism (0.40% vs. 1.27%).
  
  
  CONCLUSIONS
  Medicare claims compared reasonably well to physician adjudication. The combined data sources provided new insights about VTE burden and prognosis in older women.
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, United States. Electronic address: dale.burwen@ahrq.hhs.gov.
authors.forename: Dale R
authors.initials: DR
authors.lastname: Burwen
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
authors.forename: Chunyuan
authors.initials: C
authors.lastname: Wu
authors.affiliation: University of Rochester Medical Center, Rochester, NY, United States.
authors.forename: Dominic
authors.initials: D
authors.lastname: Cirillo
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, MD, United States.
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Rossouw
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN, United States.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, United States.
authors.forename: Marian
authors.initials: M
authors.lastname: Limacher
authors.affiliation: University of Iowa, Iowa City, IA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Wallace
authors.affiliation: University of California, San Diego, CA, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.affiliation: Departments of Family Medicine and Epidemiology, Brown University, and Memorial Hospital of Rhode Island, Pawtucket, RI, United States.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.affiliation: University of Alabama, Birmingham, AL, United States.
authors.forename: Monika
authors.initials: M
authors.lastname: Safford
authors.affiliation: Vanderbilt University, Nashville, TN, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Freiberg
mesh_terms: D000067575:Administrative Claims, Healthcare; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008499:Medical Records; D006278:Medicare; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D012008:Recurrence; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016387:Women's Health
keywords: Deep venous thrombosis; Medicare claims; Pulmonary embolism; Venous thromboembolism