An ecological analysis of pertussis disease in Minnesota, 2009–2013

SUMMARYThe increase in pertussis cases in Minnesota in the last decade has been mainly attributed to the switch from whole cell to acellular pertussis [as part of the diphtheria, tetanus and acellular pertussis vaccine (DTaP)]. It is unclear, however, to what degree community-level risk factors also contribute. Understanding these factors can help inform public health policy-makers about where else to target resources. We performed an ecological analysis within Minnesota to identify risk factors at the county level using a Bayesian Poisson generalized linear areal model to account for spatial dependence. Univariate analyses suggested an association between increased pertussis rates at the county level and white maternal ethnicity, being US born, urban counties and average household size. In the multivariable analysis, the rate of pertussis was 1·79 times greater for urbanvs.rural counties and 4·75 times greater for counties with a one-person larger average household size. Pertussis rates in counties with higher (i.e. 4+DTaP) receipt in children were 0·97 times lower. Examining county-level factors associated with varying levels of pertussis may help identify those counties that would most benefit from targeted interventions and increased resource allocation.

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Abstract 78: Factors Associated with Thrombotic Events During Pregnancy in the United States: NIS 2000-2010

Stroke ◽

10.1161/str.46.suppl_1.78 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Ali Razmara ◽

Steven Cen ◽

Diana L Jin ◽

Nerses Sanossian ◽

Amytis Towfighi

Keyword(s):

Risk Factors ◽

The United States ◽

The South ◽

Targeted Interventions ◽

Factors Associated ◽

Thrombosis Risk ◽

Significant Difference ◽

Acute Mi ◽

Hospital Factors ◽

Peripartum Period

Intro: Thrombosis risk is increased during pregnancy and puerperium. There are no recent data on nationwide trends in thrombotic events during the delivery period. Objective: To determine risk factors for thrombotic events in women hospitalized for deliveries. Methods: Data from the Nationwide Inpatient Sample (2000-2010) were used to identify deliveries. Weighted proportion of pregnancy hospitalizations with comorbid thrombotic events, including TIA, ischemic stroke, hemorrhagic stroke, acute MI, and venous thromboembolism, was determined. Poisson regression was used to identify risk factors for thrombotic events. The first multivariable model adjusted for sociodemographic and hospital factors. The second model in addition adjusted for comorbid conditions. Results: There were 4,305,561 women hospitalized for delivery (21.5 million US deliveries), of which 7,242 (0.17%) had thrombotic events in the peripartum period. From 2000-2010, there was an increase in deliveries with associated thrombotic events observed from 7.46/10K to 34.8/10K. Compared to 2000, deliveries with thromboses was 8-fold more likely in 2010 (RR 7.94, 95% CI 1.98-31.93). There was no significant difference in rates from 2000 to 2010 after adjustment for sociodemographic and hospital factors. From 2000-2010, pregnant women with thrombotic events were older, more likely to be White, to smoke, to lack insurance, to be admitted to rural hospitals, and to be admitted in the South or Midwest. After multivariable adjustment for sociodemographics, hospital factors, and comorbidities, admissions in the South (RR 1.26, 95% CI 1.02-1.55) or Midwest (1.33, 95% CI 1.05-1.68), atrial fibrillation (1.28, 95% CI 1.01-1.62), pre-/eclampsia (5.78, 95% CI 4.37-7.66), dyslipidemia (1.72, 95% CI 1.42-2.09), atrial septal defect (14.38, 95% CI 6.76-30.58), and valvular heart disease (1.67, 95% CI 1.25-2.24) were independently associated with higher risk of thrombotic events. Conclusions: From 2000-2010, there was a sizeable increase in deliveries with associated thrombosis. Identification of factors associated with thrombotic events for women hospitalized for normal pregnancies will aid in targeted interventions to screen for, prevent and treat thrombosis related to pregnancy.

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Multivariable analysis to determine risk factors associated with early pregnancy loss in thoroughbred broodmares

Theriogenology ◽

10.1016/j.theriogenology.2018.10.008 ◽

2019 ◽

Vol 124 ◽

pp. 18-23 ◽

Cited By ~ 9

Author(s):

A.M. de Mestre ◽

B.V. Rose ◽

Y.M. Chang ◽

D.C. Wathes ◽

K.L.P. Verheyen

Keyword(s):

Risk Factors ◽

Early Pregnancy ◽

Pregnancy Loss ◽

Multivariable Analysis ◽

Early Pregnancy Loss ◽

Factors Associated

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P0034IDENTIFICATION OF FACTORS ASSOCIATED WITH PROGRESSION, PROGNOSIS AND TOLVAPTAN INDICATION IN POLYCYSTIC KIDNEY DISEASE PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0034 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Myrto Kostopoulou ◽

Michaela Louka ◽

Stavros Fokas ◽

Eirini Tigka ◽

Angelos Drakopoulos ◽

...

Keyword(s):

Risk Factors ◽

Kidney Disease ◽

Polycystic Kidney Disease ◽

Multivariable Analysis ◽

Laboratory Data ◽

Kidney Volume ◽

Polycystic Kidney ◽

Factors Associated ◽

Affected Parent ◽

Male Sex

Abstract Background and Aims The identification of possible risk factors for the progression of Autosomal Dominant Polycystic Kidney Disease (ADPKD) is an emerging field especially after the introduction of the first disease-specific treatment. The present study aims to explore the associations between epidemiological, clinical and imagining data in a large cohort of ADPKD patients. Method This study was from a single outpatient clinic following patients with ADPKD. Patients were included in the study if they had a recent Magnetic Resonance Imaging (MRI) for measurement of Total Kidney Volume (TKV), a validated biomarker for disease progression. For all patients, the Mayo Clinic Imagining Category (MCIC) and the respective prediction for End Stage Renal Disease (ESRD) were calculated. Patients eligible for tolvaptan treatment (MCIC 1C, 1D, 1E, age < 55 years old and estimated-glomerular filtration rate (e-GFR) ≥ 25 ml/min) were identified. Characteristics including individual medical history, clinical and laboratory data were examined for possible associations with renal and imagining parameters using linear regression models. Results A total of 158 patients were included. Based on measurements of height-adjusted TKV (ht-TKV) and age, 5% of the patients were classified as 1A, 20% as 1B, 34% as 1C, 25% as 1D and 16% as 1E, MCIC. In multivariable analysis, patient’s age (p = 0.01), male sex (p < 0.001), parent’s age at which ESRD was reached (adjusted for patient age) (p < 0.001) and proteinuria (p = 0.04) were associated with ht-TKV. Parent’s age at ESRD differed significantly between the MCICs of the offspring (mean±(SD)), 70.83 (12.90) in 1A, 63.79 (11.39) in 1B, 57.32 (10.42) in 1C, 51.42 (9.18) in 1D and 47.94 (5.73) years old in 1E, (p < 0.001). Similarly, there were significant differences in the presence and the age of hypertension onset (p =0.004 and p = 0.003, respectively). In 104 patients (50 females, 54 males) who were eligible for tolvaptan treatment age at ADPKD diagnosis, age at hypertension onset and parent’s age reaching at ESRD were all significantly lower (p < 0.001 for all) when compared to non-eligible patients. Finally, factors associated with the prediction score of ESRD (e-GFR 10/ml/min) were hypertension, uric acid and the age at ESRD of the affected parent (p = 0.001, 0.02 and 0.01, respectively). Conclusion The age at which an affected parent had reached ESRD, as heritability estimator, was significantly associated with a worst phenotype, prognosis and tolvaptan indication. Early diagnosis of the disease, hypertension and its early onset, proteinuria and male sex are also possible risk factors for the progression of ADPKD.

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Risk Factors and Outcomes From All-Terrain Vehicle Injuries Compared With Motor Vehicle Collisions in Children

Clinical Pediatrics ◽

10.1177/0009922819855808 ◽

2019 ◽

Vol 58 (11-12) ◽

pp. 1255-1261

Author(s):

Sriram Ramgopal ◽

Natan Cramer ◽

Barbara A. Gaines ◽

Kavitha A. Conti

Keyword(s):

Risk Factors ◽

Household Income ◽

Motor Vehicle ◽

Multivariable Analysis ◽

Risk Groups ◽

Median Household Income ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Targeted Interventions ◽

Extremity Injuries

We compared risk factors and outcomes of children injured from all-terrain vehicle (ATV) injuries to those injured from motor vehicle collisions (MVC). We reviewed records of patients ≤18 years of age admitted to a trauma center with ATV- or MVC-related injuries between January 1, 2000, and December 31, 2015. Demographics were compared using logistic regression. Rates of injuries were compared using χ2 tests. Of 6293 patients, 1140 (18%) ATV and 5153 (82%) MVC events were identified. In multivariable analysis (adjusted odds ratio [aOR], 95% confidence interval [CI]), patients with ATV-related injuries occurred more at older age (≥12 years; aOR = 4.29, 95% CI = 3.20-5.77), in rural counties (aOR = 3.72, 95% CI = 2.62-5.28), in regions with lower median household income (aOR = 1.37, 95% CI = 1.03-1.83), and in the spring (aOR = 2.44, 95% CI = 1.87-3.18), and summer (aOR = 2.50, 95% CI = 1.93-3.25) compared with winter. ATV-related injuries occurred less frequently among females (aOR = 0.76, 95% CI = 0.65-0.89). Upper extremity injuries were associated with ATV-related injuries ( P ≤ .001). Findings may facilitate identification of at-risk groups for targeted interventions.

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Factors associated with 21-gene assay receipt among women with lymph node positive breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6554 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6554-6554

Author(s):

Megan Roberts ◽

Allison W. Kurian ◽

Valentina I. Petkov

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Multivariable Analysis ◽

Recurrence Score ◽

Low Ses ◽

Targeted Interventions ◽

Factors Associated ◽

Node Positive ◽

Gene Assay ◽

Lymph Node Positive

6554 Background: The 21-gene Breast Recurrence Score (RS) assay predicts breast cancer (BC) recurrence and adjuvant chemotherapy benefit in select patients with lymph node-positive (LN+), hormone receptor-positive (HR+), HER2 negative BC. This study examines factors associated with assay uptake among women with LN+ BC in SEER databases. Methods: In this population-based study, incident BC cases in SEER registries (2010-2013) were linked to RS results from assays performed by Genomic Health. Our study sample included women with non-metastatic, LN+ (≥1 positive LN), HER2-, HR+, BC. We use logistic regression to identify demographic, SES, and tumor characteristics associated with having the 21-gene assay ordered. Results: A total of 4428 (14.0%) of 31520 women with LN+, HR+, HER2-, BC had the assay ordered. Uni- and multi-variate analyses identified key factors that were significantly associated with the proportion of women tested. In the multivariable analysis, age (aOR: 2.23, p<0.001, 65-74 v <45 years) and BC diagnosis year (aOR:1.75, P<0.001 2013 vs 2010) were positively associated with assay receipt; whereas number of positive LN (aOR: 0.14, p<0.001, 4+ positive LN vs 1 positive LN), tumor grade and size, low SES, being black, and being widowed were negatively associated with assay uptake (p<0.001). Having Medicaid was associated with lower odds of test receipt (p=0.01). Finally, we identified geographic variation in assay ordering. See univariate results (Table). Conclusions: Important demographic and SES variables were associated with test receipt in LN+ disease, and differed from those previously reported in node negative disease. Moving forward, increased awareness of these disparities, particularly among low SES, Medicaid, Black and widowed patients, along with targeted interventions may help to improve quality of care and equity in test receipt. [Table: see text]

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Parental risk factors associated with congenital heart disease in a Thai population: multivariable analysis

Asian Biomedicine ◽

10.2478/abm-2021-0033 ◽

2021 ◽

Vol 15 (6) ◽

pp. 267-276 ◽

Cited By ~ 1

Author(s):

Chayamon Suwansumrit ◽

Worawan Jittham

Keyword(s):

Risk Factors ◽

Family History ◽

Cigarette Smoke ◽

Congenital Heart ◽

Heart Diseases ◽

Multivariable Analysis ◽

Significant Risk ◽

Maternal Exposure ◽

Factors Associated ◽

History Of

Abstract Background Congenital heart diseases (CHDs) are the most common types of birth defects and contribute to a large proportion of infant morbidities and mortalities worldwide. These defects may require multiple surgical interventions impacting the infant's quality of life. Objectives To identify risk factors associated with CHD in a population of Thai children. Methods We conducted a case–control study of patients attending the Pediatric Clinic, Naresuan University Hospital, Thailand. We included data from pediatric patients diagnosed with CHDs as cases, and patients without cardiovascular abnormalities as controls. Risk data were collected from July 2019 to April 2020 using face-to-face interviews. Multiple logistic regression was used to analyze parental factors associated with CHDs. Results We included 249 cases classified into 2 groups according to severity and 304 patients as controls. For those less-severely affected (155 patients, 62.2%), ventricular septal defect (27.7%) was the most prevalent, whereas for those with severe CHDs, tetralogy of Fallot was the most prevalent (14.0%). There was no difference in sex distribution or maternal obstetric history between the groups. In multivariable analysis, a family history of CHDs (adjusted odds ratio [AOR] 4.67, 95% confidence interval (CI) 1.61–13.57, P = 0.005) and maternal exposure to second-hand cigarette smoke (AOR 1.58, 95% CI 1.03–2.42, P = 0.002) were identified as significant risk factors for CHDs. Conclusion A family history of CHDs and maternal exposure to second-hand cigarette smoke are associated with having offspring with CHDs in the population studied. These findings help us to encourage affected parents to obtain a fetal echocardiogram.

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Risk factors associated with early postoperative complications following laparoscopic total gastrectomy: Experience from the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) group.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15544 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15544-e15544

Author(s):

Jingdong Liu ◽

Haojie Li ◽

Gang Zhao ◽

Zekuan Xu ◽

Guoxin Li ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Postoperative Complications ◽

Total Gastrectomy ◽

Multivariable Analysis ◽

Laparoscopic Total Gastrectomy ◽

Morbidity And Mortality ◽

Reconstruction Method ◽

Factors Associated ◽

Early Postoperative Complications

e15544 Background: The incidence rate of proximal gastric cancer has been rising steadily, and laparoscopic total gastrectomy (LTG) has been widely adopted. However, the safety of LTG still lacks solid evidence to prove. The aim of this study was to evaluate morbidity and mortality of LTG, and determine the risk factors associated with early postoperative complications. Methods: A retrospective multicenter study was carried out in China, and medical records of 109 gastric cancer patients receiving LTG during September 2014 and June 2016 were retrieved from the database. Patient characteristics, surgical outcomes, and postoperative morbidities and mortalities were analyzed. Results: Morbidity and mortality rates were 22.0% and 0% respectively. Pulmonary infection (13.8%, n = 15) was the most common complication. Most complications were grade II (15.5%, n = 17) according to the Clavien-Dindo classification. Multivariable analysis identified comorbidity, type of reconstruction method (TLTG) were independent risk factors of early postoperative complications. Comorbidity was the only independent risk factor of complications graded more than II. Diabetes mellitus was found correlated with surgical complication in subgroup analysis. Conclusions: LTG is safe and technically feasible in treating gastric cancer. Careful selection of patients without comorbidity and applying laparoscopy-assisted total gastrectomy instead of totally laparoscopic total gastrectomy may decrease postoperative complications.

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Disparities in receipt of complete diagnostic evaluation to confirm myelodysplastic syndromes.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7555 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7555-7555

Author(s):

Sudipto Mukherjee ◽

Weichuan Dong ◽

Abby Statler ◽

Siran M. Koroukian

Keyword(s):

Multivariable Analysis ◽

Diagnostic Evaluation ◽

Classification And Regression Tree ◽

Physician Education ◽

County Level ◽

Factors Associated ◽

Cart Analysis ◽

Comorbidity Burden ◽

Study Population ◽

To Receive

7555 Background: A complete diagnostic evaluation (CDE), including bone marrow (BM) biopsy, cytogenic testing, FISH panel, and/or flow cytometry, is widely accepted as a prerequisite for histopathologic confirmation of MDS. Earlier reports have raised concerns regarding accuracy of MDS diagnosis in population registries that do not require confirmatory tests for disease reporting. We queried Medicare files to analyze the extent of use of, and factors associated with CDE for diagnosing MDS. Methods: The study population included Medicare patients with at least one inpatient or two outpatient claims for MDS within a 12-month period during the years 2012 and 2013. Variables included age, sex, race, morphologic MDS categories, cytopenias (isolated or any combination), transfusion burden, comorbididities, as well as county-level characteristics (income, educational attainment, rurality, and availability of internal medicine subspecialists). Classification and regression tree (CART) and multivariable logistic regression analysis were used to identify combinations of factors associated with receipt of CDE. Results: Our study population included 45,067 MDS patients, of whom only 68.6% received CDE that included BM biopsy and/or chromosomal studies. The percent of patients undergoing CDE was significantly lower among those 85 years of age or older (56.1%); women (63.7%); Blacks (64.2%); patients with isolated anemia (60.3%); and those who were transfusion independent (p < 0.001 for all comparisons). On the other hand, CDE was significantly higher among patients with the category of MDS with excess blasts (89.4%); those presenting with pancytopenia (92.2%); and those with high transfusion burden (80%). There was little variation by comorbidity burden, county level characteristics, or availability of subspecialists. In CART analysis, 80% of patients presenting with any two or more cytopenias received CDE. In multivariable analysis, advanced age, female sex, Black race, higher comorbidity burden and availability of subspecialists were associated with a lower likelihood to receive CDE, while patients with MDS with excess blasts, and with any > 2 cytopenias were more likely to receive CDE ( P< .0001). Conclusions: Nearly one third (31%) of MDS patients in the Medicare database lack CDE especially BM biopsy. Disparities in CDE can be corrected through proper physician education and stringent registry reporting to avoid such high diagnostic inaccuracies, leading to potential missed treatment opportunities.

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Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00938-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hannah R. Meredith ◽

Sarath Kularatna ◽

Kristin Nagaro ◽

Ajith Nagahawatte ◽

Champica Bodinayake ◽

...

Keyword(s):

Risk Factors ◽

Sri Lanka ◽

Post Partum ◽

Multivariable Analysis ◽

Multidrug Resistant ◽

Intestinal Colonization ◽

Exact Methods ◽

Factors Associated ◽

Carbapenem Resistant ◽

Genes Encoding

Abstract Background The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka. Methods Women and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4–6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher’s exact and Kruskal–Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI’s AMRfinder tool. Results Overall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers’ isolates and 16/20 (80%) of infants’ isolates and genes encoding resistance to colistin were found in one (2%) mother’s isolate. Conclusions Our results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission.

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1133. Epidemiology of Invasive Fungal Infections in Lung Transplant Recipients: Harnessing Data Mining Tools to Build a Comprehensive Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.966 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S340-S340

Author(s):

Christina Yek ◽

Donglu Xie ◽

Nicolas Barros ◽

Terrence Liu ◽

Ashley Wallace ◽

...

Keyword(s):

Risk Factors ◽

Data Mining ◽

Lung Transplant ◽

Fungal Infections ◽

Multivariable Analysis ◽

First Episode ◽

Transplant Recipients ◽

Targeted Interventions ◽

Social Security Death Index ◽

Mining Tools

Abstract Background Despite advances in diagnostic and therapeutic tools, mortality of invasive fungal disease (IFD) in lung transplant (LT) recipients remains high. This study aimed to describe the epidemiology of IFD in LT recipients at a large academic center. Methods This retrospective single-center cohort study included all first-time LT recipients transplanted between 2010 and 2016 at the University of Texas Southwestern Medical Center in Dallas, TX. Data mining tools were used to extract data from the electronic health record and merge it with information from the Scientific Registry of Transplant Recipients and the Social Security Death Index (Figure 1). Medical records of subjects with positive fungal serologies, cultures or histopathology were manually reviewed and presence of IFD adjudicated using standardized definitions. Multivariable analysis was conducted using Cox proportional hazard models, with input variables treated as time dependent covariates where applicable, to identify risk factors for IFD and 1-year mortality. Results Of 393 LT recipients that met inclusion criteria, 68 (17%) developed a proven or probable IFD with median time to onset of 110 days (IQR 46–213) (Figure 2). The most common pathogens were: Aspergillus sp. (41%), and Candida sp. (34%). The most common sites of IFD were: lower respiratory tract (38%), tracheobronchial (25%), pleural/pericardial (15%), and bloodstream (7%). In multivariable analysis, incidence of IFD was associated with male gender (P = 0.02; HR=2.05, 95% CI 1.14–3.68), and prior CMV disease (P = 0.003; HR=4.16, 95% CI 1.65–10.50) (Figure 3). The 12-week mortality after the first episode of IFD was 3%; IFD was not associated with 1-year mortality (P = 0.51, HR = 1.27, 95% CI 0.63–2.53). Conclusion IFD is a frequent complication after LT. Efforts to identify risk factors may help guide the development of targeted interventions to reduce the burden of IFD in this vulnerable population. Disclosures All authors: No reported disclosures.

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