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. 2020 Jun 22;6(2):00181-2020.
doi: 10.1183/23120541.00181-2020. eCollection 2020 Apr.

Sex-specific and age-related seasonal variations regarding incidence and in-hospital mortality of pulmonary embolism in Germany

Karsten Keller  1   2 , Lukas Hobohm  1   2 , Thomas Münzel  1   3 , Stavros V Konstantinides  2   4 , Mareike Lankeit  2   5   6
Affiliations

Sex-specific and age-related seasonal variations regarding incidence and in-hospital mortality of pulmonary embolism in Germany

Karsten Keller et al. ERJ Open Res. .

Abstract

Background: Studies have reported seasonal variations regarding the incidence and the short-term mortality of pulmonary embolism (PE). The aim of this study was to identify sex-specific and age-related differences in seasonal patterns regarding hospitalisations and mortality of PE patients.

Methods: We analysed the impact of seasons on incidence and in-hospital mortality of male and female hospitalised PE patients in Germany (2005-2015) based on the German nationwide inpatient sample.

Results: The German nationwide inpatient sample comprised 885 806 hospitalisations due to PE (2005-2015). Seasonal variations of both incidence (p=0.021) and in-hospital mortality (p<0.001) were of significant magnitude. Quarterly annual incidence (25.5 versus 23.7 of 100 000 citizens per year, p=0.021) and in-hospital mortality (17.0% versus 16.7%, p=0.008) were higher in winter than in summer. Risk of in-hospital mortality in winter was slightly higher (OR 1.03 (95% CI 1.01-1.06), p=0.015) compared to summer, independently of sex, age and comorbidities. Additionally, we observed sex-specific differences during seasons: the highest number of hospitalisations of PE patients of both sexes was during winter, whereas the nadir of male patients was in spring and that of female patients was in summer. Both sexes showed a maximum of in-hospital mortality in spring. Seasonal variation regarding incidence and mortality was pronounced in older patients.

Conclusion: Incidence and the in-hospital mortality of PE patients showed a significant seasonal variation with sex-specific differences. Although it has to be hypothesised that the seasonal variation of PE is multifactorially dependent, variation in each season was not explained by seasonal differences regarding age, sex and the prevalence of important comorbidities.

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Conflict of interest statement

Conflict of interest: K. Keller reports that this study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503) via an Institutional Grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication. Conflict of interest: L. Hobohm reports lecture honoraria from MSD outside the submitted work, and that this study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503) via an Institutional Grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication. Conflict of interest: T. Münzel reports that this study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503) via an Institutional Grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication. T. Münzel is principal investigator of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. Conflict of interest: S.V. Konstantinides reports consultancy and lecture honoraria from Bayer, Boehringer Ingelheim, Daiichi-Sankyo, MSD, Pfizer and Bristol-Myers Squibb, and institutional grants from Actelion, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Pfizer and Bristol-Myers Squibb, all outside the submitted work; and that this study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503) via an Institutional Grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication. Conflict of interest: M. Lankeit reports consultancy and lecture honoraria from Actelion, Bayer, Daiichi-Sankyo, MSD, Pfizer and Bristol-Myers Squibb, and research funding from BRAHMS and Thermo Fisher scientific, all outside the submitted work; and that this study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503) via an Institutional Grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication.

Figures

FIGURE 1
FIGURE 1
a) Absolute numbers of pulmonary embolism (PE) (bars) and in-hospital mortality rate (line) stratified for seasons in the years 2005–2015. b) Absolute numbers of PE (bars) and in-hospital mortality rate (line) stratified by seasons (cumulative 2005–2015).
FIGURE 2
FIGURE 2
Time trend of absolute numbers of pulmonary embolism (PE) (bars) and in-hospital mortality rate (line) stratified for months from 2005–2015.
FIGURE 3
FIGURE 3
a) Seasonal proportion of numbers of pulmonary embolism (PE) (cumulative 2005–2015) in the different age-decades (sum of seasonal percentages in each age-decade is 100%). b) Seasonal proportion of deaths (cumulative 2005–2015) in the different age-decades (sum of seasonal percentages in each age-decade is 100%).
FIGURE 4
FIGURE 4
Absolute numbers of PE events (bars) and in-hospital mortality rate (line) stratified by seasons in a) female and b) male patients (cumulative 2005–2015).
See this image and copyright information in PMC

References

    1. Manfredini R, Gallerani M, Boari B, et al. . Seasonal variation in onset of pulmonary embolism is independent of patients’ underlying risk comorbid conditions. Clin Appl Thromb Hemost 2004; 10: 39–43. doi:10.1177/107602960401000106 - DOI - PubMed
    1. Guijarro R, Trujillo-Santos J, Bernal-Lopez MR, et al. . Trend and seasonality in hospitalizations for pulmonary embolism: a time-series analysis. J Thromb Haemost 2015; 13: 23–30. doi:10.1111/jth.12772 - DOI - PubMed
    1. Spencer FA, Goldberg RJ, Becker RC, et al. . Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol 1998; 31: 1226–1233. doi:10.1016/S0735-1097(98)00098-9 - DOI - PubMed
    1. Sheth T, Nair C, Muller J, et al. . Increased winter mortality from acute myocardial infarction and stroke: the effect of age. J Am Coll Cardiol 1999; 33: 1916–1919. doi:10.1016/S0735-1097(99)00137-0 - DOI - PubMed
    1. Gerber Y, Jacobsen SJ, Killian JM, et al. . Seasonality and daily weather conditions in relation to myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, 1979 to 2002. J Am Coll Cardiol 2006; 48: 287–292. doi:10.1016/j.jacc.2006.02.065 - DOI - PubMed

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