Abstract
Incidence of venous thromboembolism (VTE) risk varies by age and sex. Some studies have reported overall higher risk in men, especially when VTEs triggered by female reproductive factors are excluded. However, higher mortality rates in men may have led to overestimation of lifetime VTE risk in men compared with women. Therefore, we estimated the lifetime risk of VTE in men and women in a Danish, nationwide cohort, taking into account the competing risk of death. Within the population of Denmark (> 5 million persons), all first-time VTEs occurring in 1995–2016 were identified from the Danish National Patient Registry covering all Danish hospitals. The cumulative incidences of VTE were estimated in men and women with age as timescale, taking into account the competing risk of death. Estimated lifetime risk was defined as cumulative incidence at age 100. In a simulation study, we excluded the proportion of female cases that could be attributed to reproductive risk factors and re-estimated the cumulative incidence. We identified 123,543 incident VTEs. The cumulative incidence of VTE was 1.9% in women and 1.3% in men at age 50, 4.3% in women and 4.4% in men at age 70, and 9.3% in women and 8.1% in men at age 100. After accounting for VTEs attributed to reproductive factors, the corresponding incidences in women were 1.2% at age 50, 3.2% at age 70, and 8.2% at age 100. In conclusion, the estimated lifetime risk of VTE was slightly higher in women than in men when accounting for competing risk of death. Our simulation study suggested that reproductive risk factors contribute modestly to the estimated lifetime VTE risk in women.
Highlights
Previous studies of venous thromboembolism (VTE) risk by sex have provided inconsistent results, with some studies reporting a higher risk in women [1], some reporting a higher risk in men [2,3,4], and others finding no difference [5]
We assessed age-specific cumulative incidence and estimated lifetime risk of VTE in men and women from the entire Danish population from 1995 to 2016, using an approach accounting for the competing risk of death
The estimated lifetime risk of VTE, was 9.3% in women and 8.1% in men based on incidence rates from a time period of approximately 20 years
Summary
Previous studies of venous thromboembolism (VTE) risk by sex have provided inconsistent results, with some studies reporting a higher risk in women [1], some reporting a higher risk in men [2,3,4], and others finding no difference [5]. In younger age groups (< 50 years) the incidence of VTE is higher in women than in men [7] due to female reproductive risk factors (e.g. oral contraceptives and pregnancy), while in middle-aged persons (50–70 years) the incidence is higher in men than in women [2, 6]. A case–control study of persons aged 18–70 years reported that when female reproductive factors were taken into account, the odds ratio was twofold higher in men than in women [8]. This has led to the hypothesis that men have a higher intrinsic risk of incident VTE than women [8]. Female reproductive risk factors are mainly present at young age (< 50 years), when the baseline risk of VTE is low, resulting in a large relative, but modest absolute
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