The Risk of Venous Thromboembolism in Patients with Gallstones
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Ethics Statement
2.3. Sampled Patients
2.4. Statistical Analysis
3. Results
4. Discussion
Strengths and Limitations of This Study
- Our population-based cohort study uses an official database of National Health Insurance Program, which mandatorily covered more than 99.2% of residents in Taiwan, and provides generalized findings with a 12-year-long follow-up in Taiwan.
- We assess not only the risk of deep vein thrombosis but also that of pulmonary embolism to validate our endpoint of venous thromboembolism.
- The comparison between cholecystectomy and non-cholecystectomy cohorts for the development of venous thromboembolism in patients with gallstones will diminish the surveillance bias in symptomatic gallstones.
- This study is subject to the inherent unavailability of several potential confounding factors, and the protective mechanisms of cholecystectomy against the development of venous thromboembolism cannot be ascertained in this observational study.
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
Data Sharing Statement
References
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Variable | Gallstones | ||||
---|---|---|---|---|---|
Comparison (n = 345,793) | Total (n = 345,793) | Without Cholecystectomy (n = 151,606) | With Cholecystectomy (n = 194,187) | Standardized Mean Differences § | |
n (%) | n (%) | n (%) | n (%) | ||
Age, years | |||||
≤49 | 97,410(28.2) | 97,904(28.3) | 29,558(19.5) | 68,346(35.2) | 0.003 |
50–64 | 95,967(27.8) | 94,795(27.4) | 36,390(24.0) | 58,405(30.1) | 0.01 |
≥65 | 152,416(44.1) | 153,094(44.3) | 85,658(56.5) | 67,436(34.7) | 0.004 |
Mean (SD) | 60.5(16.6) | 60.6(16.7) | 65.3(16.2) | 56.9(16.1) | 0.01 |
Gender | |||||
Female | 173,789(50.3) | 174,157(50.4) | 69,306(45.7) | 104,851(54.0) | 0.002 |
Male | 172,004(49.7) | 171,636(49.6) | 82,300(54.3) | 89,336(46.0) | 0.002 |
Urbanization level † | |||||
1 (highest) | 92,837(26.9) | 92,239(26.7) | 35,124(23.2) | 57,115(29.4) | 0.004 |
2 | 102,619(29.7) | 102,359(29.6) | 42,707(28.2) | 59,652(30.7) | 0.002 |
3 | 56,317(16.3) | 56,398(16.3) | 24,780(16.3) | 31,618(16.3) | 0.001 |
4 (lowest) | 94,020(27.2) | 94,797(27.4) | 48,995(32.3) | 45,802(23.6) | 0.01 |
Occupation category | |||||
White collar | 158,025(45.7) | 157,439(45.5) | 60,682(40.0) | 96,757(49.8) | 0.003 |
Blue collar | 142,477(41.2) | 142,445(41.2) | 67,529(44.5) | 74,916(38.6) | 0.000 |
Others ‡ | 45,291(13.1) | 45,909(13.3) | 23,395(15.4) | 22,514(11.6) | 0.01 |
Frequency of medical visits/ per year Median (IQR) | 12(5–39) | 13(5–39) | 21(8–57) | 9(4–25) | 0.046 |
Pregnancy | 16,773(4.85) | 17,465(5.05) | 3019(1.99) | 14,446(7.44) | 0.01 |
Comorbidity | |||||
Hypertension | 114,177(33.0) | 113,501(32.8) | 58,732(38.7) | 54,769(28.2) | 0.004 |
Diabetes | 72,235(20.9) | 72,779(21.1) | 39,545(26.1) | 33,234(17.1) | 0.004 |
CVA | 38,184(11.0) | 39,898(11.5) | 25,873(17.1) | 14,025(7.22) | 0.02 |
Heart failure | 16,693(4.83) | 18,407(5.32) | 12,462(8.22) | 5945(3.06) | 0.02 |
All cancer | 21,958(6.35) | 21,730(6.28) | 12,132(8.00) | 9598(4.94) | 0.003 |
Atrial fibrillation | 9089(2.63) | 10,193(2.95) | 6371(4.20) | 3822(1.97) | 0.02 |
Lower leg fracture or surgery | 19,925(5.76) | 21,836(6.31) | 13,299(8.77) | 8537(4.40) | 0.02 |
Obesity | 920(0.27) | 1127(0.33) | 296(0.20) | 831(0.43) | 0.01 |
Alcohol-related illness | 9177(2.65) | 10,557(3.05) | 7506(4.95) | 3051(1.57) | 0.02 |
COPD | 21,925(6.34) | 25,604(7.40) | 17,031(11.2) | 8573(4.41) | 0.04 |
Variable | Comparison n = 345793 | Gallstones | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Total n = 345793 | Without Cholecystectomy n = 151606 | With Cholecystectomy n = 194187 | |||||||||
Event No | Rate | Event No | Rate | HR (95% CI) | Event No | Rate | HR (95% CI) | Event No | Rate | HR (95% CI) | |
VTE | 2403 | 11.2 | 2314 | 13.6 | 1.35(1.26, 1.45)*** | 1338 | 20.5 | 1.84(1.67, 2.02)*** | 976 | 9.27 | 0.97(0.88, 1.08) |
DVT | 1700 | 7.94 | 1644 | 9.64 | 1.35(1.25, 1.47)*** | 955 | 14.6 | 1.91(1.70, 2.14)*** | 689 | 6.54 | 0.94(0.84, 1.06) |
Age, year | |||||||||||
20–49 | 208 | 2.88 | 211 | 3.75 | 1.44(1.12, 1.84)** | 109 | 6.73 | 1.98(1.35, 2.89)*** | 102 | 2.54 | 1.13(0.81, 1.56) |
50–64 | 432 | 6.79 | 383 | 7.57 | 1.27(1.06, 1.51)** | 208 | 11.6 | 2.14(1.63, 2.81)*** | 175 | 5.35 | 0.86(0.68, 1.09) |
65+ | 1060 | 13.5 | 1050 | 16.5 | 1.40(1.25, 1.57)*** | 638 | 20.5 | 1.83(1.57, 2.13)*** | 412 | 12.7 | 0.99(0.83, 1.17) |
Gender | |||||||||||
Women | 917 | 8.27 | 888 | 9.90 | 1.32(1.17, 1.49)*** | 494 | 16.0 | 1.76(1.48, 2.08)*** | 394 | 6.71 | 0.99(0.84, 1.17) |
Men | 783 | 7.58 | 756 | 9.35 | 1.35(1.19, 1.54)*** | 461 | 13.5 | 1.96(1.64, 2.34)*** | 295 | 6.33 | 0.88(0.73, 1.06) |
Urbanization level† | |||||||||||
1 (highest) | 416 | 7.06 | 419 | 8.97 | 1.32(1.10, 1.59)** | 217 | 14.1 | 1.87(1.42, 2.48)*** | 202 | 6.45 | 0.99(0.77, 1.27) |
2 | 504 | 7.82 | 479 | 9.36 | 1.38(1.16, 1.63)*** | 284 | 15.2 | 2.17(1.69, 2.77)*** | 195 | 6.00 | 0.84(0.66, 1.08) |
3 | 295 | 8.47 | 273 | 9.84 | 1.23(0.98, 1.54) | 166 | 15.6 | 1.75(1.27, 2.41)*** | 107 | 6.25 | 0.87(0.63, 1.19) |
4 (lowest) | 485 | 8.65 | 473 | 10.5 | 1.36(1.15, 1.61)*** | 288 | 14.0 | 1.80(1.43, 2.26)*** | 185 | 7.58 | 0.96(0.74, 1.23) |
Occupation category | |||||||||||
White collar | 655 | 6.44 | 638 | 7.96 | 1.39(1.20, 1.60)*** | 405 | 14.0 | 2.25(1.83, 2.77)*** | 259 | 4.88 | 0.86(0.70, 1.05) |
Blue collar | 775 | 8.96 | 737 | 10.6 | 1.26(1.10, 1.44)*** | 171 | 18.5 | 1.59(1.32, 1.91)*** | 332 | 8.20 | 1.00(0.83, 1.20) |
Others ‡ | 270 | 10.4 | 269 | 12.8 | 1.53(1.18, 1.97)** | 259 | 4.88 | 2.69(1.84, 3.93)*** | 98 | 8.33 | 0.86(0.60, 1.23) |
Comorbidity § or history of pregnancy | |||||||||||
None | 548 | 4.75 | 453 | 5.22 | 1.21(1.03, 1.42)* | 227 | 8.32 | 1.89(1.48, 2.42)*** | 226 | 3.80 | 0.86(0.69, 1.06) |
With any one | 1152 | 11.7 | 1191 | 14.2 | 1.43(1.29, 1.58)*** | 728 | 19.2 | 1.78(1.55, 2.05)*** | 463 | 10.1 | 1.07(0.92, 1.26) |
PE | 841 | 3.92 | 794 | 4.65 | 1.35(1.20, 1.53)*** | 447 | 6.84 | 1.71(1.45, 2.03)*** | 347 | 3.29 | 1.05(0.88, 1.24) |
Age, year | |||||||||||
20–49 | 67 | 0.93 | 96 | 1.70 | 2.12(1.40, 3.21)*** | 59 | 3.64 | 2.77(1.59, 4.81)*** | 37 | 0.92 | 1.49(0.81, 2.73) |
50–64 | 187 | 2.94 | 170 | 3.36 | 1.29(0.98, 1.69) | 80 | 4.47 | 1.61(1.06, 2.42)* | 90 | 2.75 | 1.09(0.77, 1.56) |
65+ | 587 | 7.47 | 528 | 8.27 | 1.32(1.12, 1.56)** | 308 | 9.85 | 1.58(1.26, 1.98)*** | 220 | 6.75 | 1.06(0.83,1.36) |
Gender | |||||||||||
Women | 461 | 4.15 | 420 | 4.68 | 1.33(1.12, 1.59)** | 221 | 7.12 | 1.53(1.19, 1.96)*** | 199 | 3.38 | 1.16(0.91, 1.49) |
Men | 380 | 3.67 | 374 | 4.62 | 1.40(1.15,1.69)*** | 226 | 6.58 | 1.99(1.53, 2.59)*** | 148 | 3.17 | 0.92(0.69, 1.22) |
Urbanization level † | |||||||||||
1 (highest) | 200 | 3.39 | 188 | 4.02 | 1.26(0.94, 1.71) | 93 | 6.02 | 1.37(0.88, 2.11) | 95 | 3.03 | 1.18(0.78, 1.78) |
2 | 239 | 3.71 | 195 | 3.81 | 1.26(0.97, 1.64) | 103 | 5.51 | 1.62(1.11, 2.36)* | 92 | 2.83 | 0.99(0.68, 1.43) |
3 | 130 | 3.73 | 120 | 4.32 | 1.45(1.02, 2.07)* | 63 | 5.91 | 1.73(1.05, 2.85)* | 57 | 3.33 | 1.21(0.73, 1.99) |
4 (lowest) | 272 | 4.85 | 291 | 6.47 | 1.67(1.32, 2.11)*** | 188 | 9.14 | 2.53(1.82, 3.51)*** | 103 | 4.22 | 1.03(0.73, 1.45) |
Occupation category | |||||||||||
White collar | 312 | 3.07 | 296 | 3.69 | 1.38(1.11, 1.71)** | 165 | 6.08 | 1.66(1.23, 2.25)*** | 131 | 2.47 | 1.12(0.82, 1.53) |
Blue collar | 412 | 4.76 | 395 | 5.69 | 1.46(1.21, 1.76)*** | 219 | 7.57 | 1.74(1.34, 2.25)*** | 176 | 4.34 | 1.20(0.91, 1.57) |
Others ‡ | 117 | 4.48 | 103 | 4.89 | 1.40(0.92, 2.13) | 63 | 6.78 | 2.40(1.28, 4.48)** | 40 | 3.40 | 0.80(0.44, 1.47) |
Comorbidity § or history of pregnancy | |||||||||||
None | 259 | 2.24 | 231 | 2.66 | 1.47(1.16, 1.87)** | 112 | 4.10 | 1.81(1.28, 2.58)*** | 119 | 2.00 | 1.21(0.87, 1.69) |
With any one | 582 | 5.88 | 563 | 6.71 | 1.34(1.15, 1.57)*** | 335 | 8.81 | 1.67(1.36, 2.06)*** | 228 | 4.97 | 1.02(0.81, 1.29) |
Variable | Without cholecystectomy n = 151606 | With cholecystectomy n = 194187 |
---|---|---|
aHR (95% CI) | aHR (95% CI) | |
VTE | 1.00 | 0.62(0.57, 0.67)*** |
DVT | 1.00 | 0.60(0.54, 0.67)*** |
Age, year | ||
20–49 | 1.00 | 0.56(0.42, 0.75)*** |
50–64 | 1.00 | 0.53(0.43, 0.65)*** |
65+ | 1.00 | 0.64(0.56, 0.72)*** |
Gender | ||
Women | 1.00 | 0.63(0.55, 0.72)*** |
Men | 1.00 | 0.57(0.49, 0.67)*** |
Urbanization level † | ||
1 (highest) | 1.00 | 0.68(0.56, 0.83)*** |
2 | 1.00 | 0.53(0.44, 0.64)*** |
3 | 1.00 | 0.51(0.40, 0.66)*** |
4 (lowest) | 1.00 | 0.68(0.56, 0.82)*** |
Occupation category | ||
White collar | 1.00 | 0.50(0.42, 0.59)*** |
Blue collar | 1.00 | 0.74(0.63, 0.86)*** |
Others ‡ | 1.00 | 0.56(0.43, 0.72)*** |
Comorbidity § or history of pregnancy | ||
None | 1.00 | 0.58(0.48, 0.70)*** |
With any one | 1.00 | 0.60(0.53, 0.67)*** |
PE | 1.00 | 0.67(0.58, 0.77)*** |
Age, year | ||
20–49 | 1.00 | 0.32(0.21, 0.50)*** |
50–64 | 1.00 | 0.71(0.52, 0.97)* |
65+ | 1.00 | 0.74(0.62, 0.88)*** |
Gender | ||
Women | 1.00 | 0.75(0.61, 091)** |
Men | 1.00 | 0.62(0.50, 0.76)*** |
Urbanization level † | ||
1 (highest) | 1.00 | 0.74(0.55, 1.00)* |
2 | 1.00 | 0.69(0.51, 0.93)* |
3 | 1.00 | 0.78(0.53, 1.13) |
4 (lowest) | 1.00 | 0.59(0.46, 0.75)*** |
Occupation category | ||
White collar | 1.00 | 0.60(0.47, 0.76)*** |
Blue collar | 1.00 | 0.76(0.62, 0.93)** |
Others‡ | 1.00 | 0.62(0.41, 0.94)* |
Comorbidity § or history of pregnancy | ||
None | 1.00 | 0.60(0.46, 0.79)*** |
With any one | 1.00 | 0.69(0.58, 0.82)*** |
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Chen, C.-H.; Lin, C.-L.; Kao, C.-H. The Risk of Venous Thromboembolism in Patients with Gallstones. Int. J. Environ. Res. Public Health 2020, 17, 2930. https://doi.org/10.3390/ijerph17082930
Chen C-H, Lin C-L, Kao C-H. The Risk of Venous Thromboembolism in Patients with Gallstones. International Journal of Environmental Research and Public Health. 2020; 17(8):2930. https://doi.org/10.3390/ijerph17082930
Chicago/Turabian StyleChen, Chien-Hua, Cheng-Li Lin, and Chia-Hung Kao. 2020. "The Risk of Venous Thromboembolism in Patients with Gallstones" International Journal of Environmental Research and Public Health 17, no. 8: 2930. https://doi.org/10.3390/ijerph17082930