Small-Area Analysis of Treatment and Clinical Outcomes in Patients with Venous Thromboembolism in Denmark: A Nationwide Cohort Study

Abstract

Objectives To investigate geographical variation in initiation and extended treatment with anticoagulants and clinical outcomes among patients hospitalized with first-time venous thromboembolism (VTE) in Denmark between 2007 and 2018.

Methods Using nationwide health care registries, we identified all patients with a first-time VTE hospital diagnosis supported by imaging data from 2007 to 2018. Patients were grouped according to residential region (5) and municipality (98) at the time of VTE diagnosis. Cumulative incidence of initiation of and extended (beyond 365 days) anticoagulation treatment as well as clinical outcomes, including recurrent VTE, major bleeding, and all-cause death, were assessed. Sex- and age-adjusted relative risks (RRs) of the outcomes were computed when comparing across individual regions and municipalities. Overall geographic variation was quantified by computing the median RR.

Results We identified 66,840 patients with a first-time VTE hospitalization. A difference in initiation of anticoagulation treatment of more than 20 percentage points between regions was observed (range: 51.9–72.4%, median RR: 1.09, 95% confidence interval [CI]: 1.04–1.13). Variation was also observed for extended treatment (range: 34.2–46.9%, median RR: 1.08, 95% CI: 1.02–1.14). The cumulative incidence of recurrent VTE ranged from 3.6 to 5.3% at 1 year (median RR: 1.08, 95% CI: 1.01–1.15). The difference remained after 5 years, and variation was also observed for major bleeding (median RR: 1.09, 95% CI: 1.03–1.15), whereas it appeared smaller for all-cause mortality (median RR: 1.03, 95% CI: 1.01–1.05).

Conclusion Substantial geographical variation in anticoagulation treatment and clinical outcomes occurs in Denmark. These findings indicate a need for initiatives to ensure uniform high-quality care for all VTE patients.

Keywords

venous thromboembolism - anticoagulation treatment - bleeding - death - small-area analysis

Data Availability Statement

Data cannot be shared publicly because of Danish legislation. Data can be accessed through the Danish Health Data Authority and Statistics Denmark for researchers at authorized institutions. Information on data access is available online (http://sundhedsdatastyrelsen.dk/da/forskerservice). Access to data requires approval from the Danish Data Protection Agency (https://www.datatilsynet.dk/english/legislation). The authors did not have special access privileges to these data.

Publication History

Received: 06 April 2022

Accepted: 31 March 2023

Accepted Manuscript online:
13 April 2023

Article published online:
01 May 2023

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