089 Atopic Dermatitis Is Associated With an Increased Risk of Autoimmune Diseases: A Population-Based Cohort Study Using UK Primary Care Data

ObjectivesAtrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018.DesignLongitudinal cohort study.SettingEnglish primary care electronic health records linked to Index of Multiple Deprivation data.ParticipantsCohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018.Primary and secondary outcome measuresIncident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation.ResultsIncidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation.ConclusionsChanges in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018.

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Use of biologics during pregnancy and risk of serious infections in the mother and baby: a Canadian population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-023714 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023714 ◽

Cited By ~ 7

Author(s):

Nicole W Tsao ◽

Larry D Lynd ◽

Eric C Sayre ◽

Mohsen Sadatsafavi ◽

Gillian Hanley ◽

...

Keyword(s):

Cohort Study ◽

Autoimmune Diseases ◽

Disease Diagnosis ◽

Population Based ◽

In Utero ◽

First Year ◽

Increased Risk ◽

Serious Infections ◽

Multivariable Models ◽

First Year Of Life

ObjectivesTo investigate the association between exposure to biologics during pregnancy and serious infections in mothers and infants.DesignRetrospective cohort study.SettingPopulation-based.ParticipantsWomen with one or more autoimmune diseases identified by International Classification of Diseases 9th/10th revision codes in healthcare administrative databases in British Columbia, Canada, who had pregnancies ending in a live or stillbirth between 1 January 2002 and 31 December 2012. Women were defined as exposed if they had at least one biologic prescription during pregnancy, and infants born to these women were considered exposed in utero. Disease-matched women with no biologics prescriptions during pregnancy, and their infants, comprised the unexposed groups.Primary outcome measuresSerious infections requiring hospitalisation.ResultsOver the 10-year study period, there were 6218 women (8607 pregnancies) who had an autoimmune disease diagnosis, of which 90 women were exposed to biologics during pregnancy, with 100 babies born to these women. Among women exposed to biologics during pregnancy, occurrence of serious postpartum infections were low, ranging from 0% to 5%, depending on concomitant exposures to immunosuppressants. In multivariable models using logistic regression, the OR for the association of biologics exposure with serious maternal postpartum infections was 0.79 (95% CI 0.24 to 2.54). In infants exposed to biologics in utero, occurrence of serious infections during the first year of life ranged from 0% to 7%, depending on concomitant exposures to immunosuppressants in utero. Multivariable models showed no association between biologics exposure in utero and serious infant infections (OR 0.56, 95% CI 0.17 to 1.81).ConclusionsThese population-based data suggest that the use of biologics by women with autoimmune diseases during pregnancy is not associated with an increased risk of serious infections in mothers, during post partum or in infants during the first year of life.

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Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

PLoS ONE ◽

10.1371/journal.pone.0145759 ◽

2015 ◽

Vol 10 (12) ◽

pp. e0145759 ◽

Cited By ~ 24

Author(s):

George Bouras ◽

Elaine Marie Burns ◽

Ann-Marie Howell ◽

Alex Bottle ◽

Thanos Athanasiou ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Venous Thromboembolism ◽

General Surgery ◽

Population Based ◽

Post Discharge ◽

Primary Care Data

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Autoimmune diseases in patients with multiple sclerosis and their first-degree relatives: a nationwide cohort study in Denmark

Multiple Sclerosis Journal ◽

10.1177/1352458508088936 ◽

2008 ◽

Vol 14 (6) ◽

pp. 823-829 ◽

Cited By ~ 76

Author(s):

NM Nielsen ◽

M Frisch ◽

K Rostgaard ◽

J Wohlfahrt ◽

H Hjalgrim ◽

...

Keyword(s):

Multiple Sclerosis ◽

Ulcerative Colitis ◽

Cohort Study ◽

Autoimmune Diseases ◽

Population Based ◽

Incidence Rates ◽

Registration System ◽

Civil Registration ◽

First Degree Relatives ◽

Increased Risk

Background Multiple sclerosis (MS) and other autoimmune diseases might cluster. Our aim was to estimate the relative risk (RR) of other autoimmune diseases among MS patients and their first-degree relatives in a population-based cohort study. Methods Using the Danish Multiple Sclerosis Register, the Danish Hospital Discharge Register, and the Danish Civil Registration System, we estimated RRs for 42 different autoimmune diseases in a population-based cohort of 12 403 MS patients and 20 798 of their first-degree relatives. Ratios of observed to expected numbers of autoimmune diseases, based on national sex-, age-, and period-specific incidence rates, served as measures of the RRs. Results Compared with the general population, MS patients were at an increased risk of developing ulcerative colitis (RR = 2.0 (95% confidence interval (CI): 1.4–2.8), n = 29) and pemphigoid (RR = 15.4 (CI: 8.7–27.1), n = 12) but at reduced risk of rheumatoid arthritis (RR = 0.5 (CI: 0.4–0.8), n = 28) and temporal arteritis (RR = 0.5 (CI: 0.3–0.97), n = 11). First-degree relatives of MS patients were at increased risks of Crohn’s disease (RR = 1.4 (CI: 1.04–1.9), n = 44), ulcerative colitis (RR = 1.3 (CI: 0.99–1.7), n = 51), Addison’s disease (RR = 3.4 (CI: 1.3–9.0), n = 4), and polyarteritis nodosa (RR = 3.7 (CI: 1.4–10.0), n = 4). Conclusion Patients with MS and their first-degree relatives seem to be at an increased risk of acquiring certain other autoimmune diseases.

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Systemic autoimmune diseases are associated with an increased risk of bipolar disorder: A nationwide population-based cohort study

Journal of Affective Disorders ◽

10.1016/j.jad.2017.10.027 ◽

2018 ◽

Vol 227 ◽

pp. 31-37 ◽

Cited By ~ 14

Author(s):

Ling-Yi Wang ◽

Jen-Huai Chiang ◽

Shih-Fen Chen ◽

Yu-Chih Shen

Keyword(s):

Bipolar Disorder ◽

Cohort Study ◽

Autoimmune Diseases ◽

Population Based ◽

Systemic Autoimmune Diseases ◽

Increased Risk

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Associations between primary care recorded cannabis use and mental ill health in the UK: a population-based retrospective cohort study using UK primary care data

Psychological Medicine ◽

10.1017/s003329172100386x ◽

2021 ◽

pp. 1-10

Author(s):

Deepiksana Keerthy ◽

Joht Singh Chandan ◽

Juste Abramovaite ◽

Krishna Margadhamane Gokhale ◽

Siddhartha Bandyopadhyay ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Mental Illness ◽

Cohort Study ◽

Population Based ◽

Cannabis Use ◽

Sensitivity Analyses ◽

Public Health Issue ◽

Public Health Approach ◽

Increased Risk

Abstract Background Cannabis use is a global public health issue associated with increased risks of developing mental health disorders, especially in young people. We aimed to investigate the relationships between cannabis exposure and risks of receiving mental illness diagnoses or treatment as outcomes. Methods A population based, retrospective, open cohort study using patients recorded in ‘IQVIA medical research data’, a UK primary care database. Read codes were used to confirm patients with recorded exposure to cannabis use who were matched up to two unexposed patients. We examined the risk of developing three categories of mental ill health: depression, anxiety or serious mental illness (SMI). Results At study entry, the exposed cohort had an increased likelihood of having experienced mental ill health [odds ratio (OR) 4.13; 95% confidence interval (CI) 3.99–4.27] and mental ill health-related prescription (OR 2.95; 95% CI 2.86–3.05) compared to the unexposed group. During the study period we found that exposure to cannabis was associated with an increased risk of developing any mental disorder [adjusted hazard ratio (aHR) 2.73; 95% CI 2.59–2.88], also noted when examining by subtype of disorder: anxiety (aHR 2.46; 95% CI 2.29–2.64), depression (aHR 2.34; 95% CI 2.20–2.49) and SMI (aHR 6.41; 95% CI 5.42–7.57). These results remained robust in sensitivity analyses. Conclusion These findings point to the potential need for a public health approach to the management of people misusing cannabis. However, there is a gross under-recording of cannabis use in GP records, as seen by the prevalence of recorded cannabis exposure substantially lower than self-reported survey records.

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Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study

Acta Endocrinologica ◽

10.1530/eje-20-1163 ◽

2021 ◽

Vol 184 (5) ◽

pp. 637-645 ◽

Cited By ~ 2

Author(s):

Anuradhaa Subramanian ◽

Astha Anand ◽

Nicola J Adderley ◽

Kelvin Okoth ◽

Konstantinos A Toulis ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Cohort Study ◽

Polycystic Ovary ◽

Population Based ◽

Glucose Regulation ◽

Impaired Glucose Regulation ◽

Ovary Syndrome ◽

Explanatory Variables ◽

Increased Risk

Objective Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection. Design Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN). Methods The main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS. Results We identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27–1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14–1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05–1.56), P = 0.015). Conclusion Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic. Significance statement Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.

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