Bölgesel etmenlerin ışığında iç anadolu bölgesinde derin ven trombozu insidansı ile yaş ve cinsiyete açısından değerlendirilmesi: Nüfus bazlı çalışma

Öz

Amaç: Derin ven trombozu pulmoner tromboemboli, venöz ülser, kronik venöz yetmezlik, venöz gangren ve posttrombotik sendrom gibi ciddi komplikasyonların güncel bir sebebini oluşturmaktadır. Bu çalışmanın amacı 500.000'den fazla nüfusa sahip, gerek coğrafik, ekonomik, endüstriel ve yaş dağılımı gerekse morbidite ve mortalite oranları açısından İç Anadolu Bölgesi'nin temsil edebilecek özelliklere sahip Yozgat ilinde derin ve trombozu (DVT) insidansını tanımlamak ve DVT gelişim üzerinde etkisi olan bölgesel etmenler üzerine vurgu yapmaktır. 

Yöntemler: Bu araştırma kesitsel bir çalışma olarak planlanmıştır. Yozgat ilinde ikamet eden Bozok Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi ile Yozgat Şehir Hastanesi'nde 2012 ve 2016 yılları arasında DVT tanısı almış 15 yaş ve üzeri bireyler çalışmaya dahil edildi. Hastalar ve hasta verileri medikal kayıtlardan elde edildi. DVT dağılımı, Türkiye İstatistik Kurumu'na (TUSI) ait adrese dayalı nüfus dağılımı verileri kullanılarak yaş ve cinsiyet açısından değerlendirildi.

Bulgular: Çalışmaya 1287 hasta dahil edilmiştir. DVT dağılımı yaşlanma ile artış göstermekte özellikle 40 yaş üzerinde ciddi bir ivmelenme göstermektedir. Genel DVT insidansı 1/1000 hasta/yıl olarak belirlendi ve kadın nüfusta 1/1000 hasta/yıl iken erkek nüfusta 0.9/1000 hasta/yıl olarak tespit edildi (P=0,924). TUSI 2016 verilerine göre Yozgat, Sivas ve Kayseri illerinde ortalama beden kitle indeksi (BKI) kadın popülasyonda erkeklere göre daha yüksek idi, kadın popülasyonsa 29,2 (5,3) kg/m² iken erkek popülasyonda 26,7 (3,6) kg/m² (P<0,001) ve işgücü katılım oranı kadınlarda %28 iken erkeklerde %49,6 olarak tespit edildi. Bu durum DVT gelişiminde bölgesel etmenlerin etkinliğini ortaya koymaktadır. 

Sonuç: Bölgesel sosyoekonomik ve sosyokültürel realiteler göz önünde bulundurularak ve daha geniş çaplı çalışmalar ile elde edilecek veriler ışığında önceden alınacak önlemler ile DVT insidansını ve uygun profilaktik yaklaşımlar ile birçoğu önlenebilir olan ve yüksek sağlık giderlerine sebep olan ilgili komplikasyonların önüne geçmek mümkündür.

Anahtar Kelimeler

• Derin ven trombozu,İnsidans,Yozgat,Yaş,Cinsiyet,Beden kitle indeksi

Evaluation of deep vein thrombosis incidence with respect to age and gender in light of regional factors in central Anatolia: A population-based study

Öz

Aim: Deep vein thrombosis (DVT) is a prevailing cause of serious complications such as pulmonary thromboembolism, venous ulcer, chronic venous insufficiency, venous gangrene and postthrombotic syndrome, and significantly increased hospitalization costs. The aim of this study is to determine the incidence of DVT and regional effects for its development as well as evaluate its distribution in terms of age and gender in Yozgat, a city with a population of more than 500.000 people, which is considered to fairly represent Central Anatolia with regards to geography, economy, industry, age distribution, morbidity and mortality. 

Methods: For this cross-sectional study, we included all DVT cases aged 15 years and older from Yozgat diagnosed in Bozok University, Faculty of Medicine, Research and Application Hospital and Yozgat State Hospital between September 2012-September 2016. Patients and diagnostic characteristics were retrieved from medical records. The distribution of DVT cases were evaluated in terms of age and gender according to the data derived from address-based population registration system of Turkish Statistical Institute (TUSI) 2016.

Results: One thousand two hundred and eighty-seven patients were enrolled in this research. DVT incidence increased with age and substantially accelerated above the age of 40. The overall DVT incidence was 1:1000 persons per year and slightly higher among the female population (1:1000 persons/year vs 0.9:1000 persons/year) (P=0.924). According to TUSI 2016, the mean body mass index (BMI) of females was significantly higher than that of males (29.2 (5.3) kg/m² and 26.7 (3.6) kg/m², respectively, P<0.001). In the region comprising Yozgat, Sivas and Kayseri, labor-force participation rate of females and males were 28% and 49.6%, respectively, which was a significant regional risk factor for DVT development. 

Conclusion: It would be possible to decrease the incidence of DVT and the high hospitalization costs of related complications, most of which can be avoided with suitable prophylaxis based on more reliable results obtained from further research. Appropriate precautions should be taken after considering regional socioeconomic and sociocultural values.

Anahtar Kelimeler

• Deep vein thrombosis,Incidence,Yozgat,Age,Gender,Body mass index

Kaynakça

1. 1. Goldhaber SZ. Venous thromboembolism: Epidemiology and magnitude of the problem. Best Practice & Research Clinical Haematology 2012;25:235–42.
2. 2. Albay A, Kanatsız B, Platin AR, Çakır HS, Oludağ G, Basat S. A case of Behcet's disease with upper extremity thrombosis. J Surg Med. 2018;2(1):35-7. doi: 10.28982/josam.358749.
3. 3. Polat A, Ketenciler S, Yücel C, Boyacıoğlu K, Akdemir İ, Kük ZG, et al. Accelerated catheter-directed thrombolytic treatment in deep venous thrombosis: mid-term results. Turk Gogus Kalp Damar. 2015;23(3):485-92.
4. 4. Fowkes FJ, Price JF, Fowkes FGR. Incidence of Diagnosed Deep Vein Thrombosis in the General Population: Systematic Review. Eur J Vasc Endovasc Surg. 2003 Jan;25(1):1-5.
5. 5. Hansson PO, Welin L, Tibblin G, Eriksson H. Deep vein thrombosis and pulmonary embolism in the general population. The study of men born in 1913. Arch Int Med. 1997;157:1665-70.
6. 6. Kniffin WD Jr, Baron JA, Barrett J, Birkmeyer JD, Anderson FA Jr. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Int Med. 1994;154:861-6.
7. 7. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism. A 25-year population-based study. Arch Int Med. 1998;158:585-93.
8. 8. Oger E. Incidence of venous thromboembolism: A community-based study in Western France. Thromb and Haemost. 2000;83:657-60.

9. 9. NordstroÈm M, Lindblad B, Bergqvist D, KjellstroÈm T. A prospective study of the incidence of deep vein thrombosis within a defined urban population. J Int Med. 1992;232:155-60.
10. 10. Nylander G, Olivecrona H. The phlebographic pattern of acute leg thrombosis within a defined urban population. Acta Chir Scand. 1976;142:505-11.
11. 11. Kahn SR. Frequency and determinants of the posttrombotik syndrome after venous thromboembolism. Current Opinion in Pulmonary Medicine. 2006;12:299–303.
12. 12. Ruppert A, Steinle T, Lees M. Economic burden of venous thromboembolism: A systematic review. Journal of Medical Economics. 2011;14:65-74.
13. 13. Mahan CE, Holdsworth MT, Welch SM, Borrego M, Spyropoulos AC. Deep-vein thrombosis: A United States cost model for a preventable and costly adverse event. Thromb Haemost. 2011;106(3):405-15.
14. 14. Okuhara A, Navarro TP, Procópio RJ, Bernardes Rde C, Oliveira Lde C, Nishiyama MP. Incidence of deep vein thrombosis and quality of venous thromboembolism prophylaxis. Rev Col Bras Cir. 2014;41(1):2-6.
15. 15. Caprini JA, Tapson VF, Hyers TM, Waldo AL, Wittkowsky AK, Friedman R, et al. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg. 2005;42(4):726-33.
16. 16. Stein PD, Hull RD, Kayali F, Ghali WA, Alshab AK, Olson RE. Venous thromboembolism according to age: The impact of an aging population. Archives of Internal Medicine. 2004;164:2260–5.
17. 17. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933–8.
18. 18. Cushman M, Glynn RJ, Goldhaber SZ, Moll S, Bauer KA, Deitcher S, et al. Hormonal factors and risk of recurrent venous thrombosis: the prevention of recurrent venous thromboembolism. Journal of thrombosis and Haemostasis. 2006;4:2199-203.
19. 19. Klovaite J, Benn M, Nordestgaard BG. Obesity as a causal risk factor for deep venous thrombosis: A Mendelian randomization study. J Intern Med. 2015;277(5):573-84.
20. 20. Cushman M. Epidemiology and Risk Factors for Venous Thrombosis. Semin Hematol. 2007;44(2):62–9.
21. 21. White RH, Zhou H, Murin S, Harvey D. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Journal of Thrombosis and Haemostasis. 2005;93:298–305.
22. 22. Bounameaux H, Hicklin L, Desmarais S. Seasonal variation in deep vein thrombosis. BMJ. 1996;312(7040):1227.
23. 23. Shapira-Rootman M, Beckerman M, Soimu U, Nachtigal A, Zeina AR. The prevalence of pulmonary embolism among patients suffering from acute exacerbations of chronic obstructive pulmonary disease. Emerg Radiol. 2015;22:257–60.
24. 24. Bahloul M, Chaari A, Tounsi A, Baccouche N, Abid H, Chtara K, et al. Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseases. Clin Respir J. 2015;9:270–7.
25. 25. Chen CY, Liao KM. The Incidence of Deep Vein Thrombosis in Asian Patients With Chronic Obstructive Pulmonary Disease. Medicine (Baltimore). 2015;94(44):e1741.