Epidemiology of cerebral venous sinus thrombosis and cerebral venous sinus thrombosis with thrombocytopenia in the United States, 2018 and 2019

Abstract

Background: Population-based data about cerebral venous sinus thrombosis (CVST) are limited.

Objectives: To investigate the epidemiology of CVST in the United States.

Patients/methods: Three administrative data systems were analyzed: the 2018 Healthcare Cost and Utilization Project National Inpatient Sample (NIS) the 2019 IBM MarketScan Commercial and Medicare Supplemental Claims Database, and the 2019 IBM MarketScan Multi-state Medicaid Database. CVST, thrombocytopenia, and numerous comorbidities were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Incidence rates of CVST and CVST with thrombocytopenia were estimated (per 100,000 total US population [NIS] and per 100,000 population aged 0 to 64 years covered by relevant contributing health plans [MarketScan samples]). Comorbidity prevalence was estimated among CVST cases versus total inpatients in the NIS sample. Recent pregnancy prevalence was estimated for the Commercial sample.

Results: Incidence rates of CVST in NIS, Commercial, and Medicaid samples were 2.85, 2.45, and 3.16, respectively. Incidence rates of CVST with thrombocytopenia were 0.21, 0.22, and 0.16, respectively. In all samples, CVST incidence increased with age; however, peak incidence was reached at younger ages in females than males. Compared with the general inpatient population, persons with CVST had higher prevalences of hemorrhagic stroke, ischemic stroke, other venous thromboembolism (VTE), central nervous system infection, head or neck infection, prior VTE, thrombophilia, malignancy, head injury, hemorrhagic disorder, and connective tissue disorders. Women aged 18 to 49 years with CVST had a higher pregnancy prevalence than the same-aged general population.

Conclusions: Our findings provide recent and comprehensive data on the epidemiology of CVST and CVST with thrombocytopenia.

Keywords: United States; comorbidity; hemorrhagic stroke; incidence; intracranial sinus thrombosis; ischemic stroke thrombocytopenia; prevalence.

FIGURE 1

Age‐ and sex‐specific incidence rates of cerebral venous sinus thrombosis (CVST) in the United States. (A) Age‐ and sex‐specific incidence rates of CVST^a in the United States using data from the Healthcare Cost and Utilization (HCUP), 2018 National Inpatient Sample (NIS), Agency for Healthcare Research and Quality. (B) Age‐ and sex‐specific incidence rates of CVST^a among persons aged 0 to 64 years continually enrolled in an insurance plan in 2019, as recorded in the IBM Watson Health MarketScan Commercial and Medicare Supplemental Claims database (version 100% Sample 6 Plus Years 1/1/2013‐7/31/2020). (C) Age‐ and sex‐specific incidence rates^b of CVST^a among persons aged 0 to 64 years continually enrolled in an insurance plan in 2019, as recorded in the MarketScan^® Medicaid sample sampled from the IBM Watson Health MarketScan Multi‐state Medicaid Claims database (version 10 Plus Years 1/1/2009‐12/31/2019). ^aInternational Classification of Diseases, Tenth Revision, Clinical Modification codes for CVST listed anywhere on inpatient claim record. ^bDue to sparse data (cell size <10), age groups 30 to 39 years and 40 to 49 years were combined

FIGURE 2

Prevalence odds ratio estimates comparing prevalence of comorbid conditions among hospitalized persons with cerebral venous sinus thrombosis (CVST) or CVST with thrombocytopenia to the general inpatient population, in the Healthcare Cost and Utilization (HCUP), 2018 National Inpatient Sample (NIS). * Sparse data (cell size <10) precluded reporting data

FIGURE 3

Age‐ and sex‐specific prevalence and prevalence odds ratio estimates comparing prevalence of comorbid conditions among hospitalized persons with cerebral venous sinus thrombosis (CVST) to the general inpatient population, in the Healthcare Cost and Utilization (HCUP), 2018 National Inpatient Sample (NIS). * Sparse data (cell size <10) precluded reporting data