Korean J Intern Med.  2020 May;35(3):682-691. 10.3904/kjim.2018.370.

Prominent seasonal variation in pulmonary embolism than deep vein thrombosis incidence: a Korean venous thrombosis epidemiology study

Affiliations
  • 1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
  • 3Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
  • 4Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
  • 5Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea
  • 6Environmental Health Center, Seoul National University College of Medicine, Seoul, Korea
  • 7Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea

Abstract

Background/Aims
Seasonal variation is an environmental factor proposed to affect the incidence of venous thromboembolism (VTE). However, VTE seasonal variation is not well studied in Asian populations, which have different genetic determinants of VTE compared to Westerners. The present study aimed at investigating seasonal variation of VTE occurrence and the effect of various demographic factors (i.e., age, sex, and co-morbidities) on variation.
Methods
VTE seasonal variation was evaluated in 59,626 index cases (from January 2009 to December 2013) in the Korean Health Insurance Review and Assessment Service database. We quantified and compared VTE occurrence across four seasons, and additionally assessed monthly through a chronobiological analysis.
Results
VTE incidence varied both seasonally and monthly, with new cases peaking in the winter (January and February) and the lowest incidence in the summer (August and September). After adjusting for sex, age, type of VTE, and combined cancer diagnosis, winter remained a significant independent factor driving VTE incidence. Additionally, seasonal variation was prominent in patients aged 60 years or older and in patients with pulmonary embolism, but not so prominent in patients of aged less than 60 years and patients with deep vein thrombosis.
Conclusions
Seasonal variation was a weak but independent contributor to VTE incidence in a Korean population diagnosed from 2009 to 2013, especially in those individuals with old age or suffering from a pulmonary embolism.

Keyword

Venous thromboembolism; Pulmonary embolism; Deep vein thrombosis; Epidemiology; Seasons
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