scholarly journals Incidence and temporal trends of co-occurring personality disorder diagnoses in immune-mediated inflammatory diseases

2020 ◽  
Vol 29 ◽  
Author(s):  
C. Blaney ◽  
J. Sommer ◽  
R. El-Gabalawy ◽  
C. Bernstein ◽  
R. Walld ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Inflammatory Diseases ◽  
Temporal Trends ◽  
Negative Binomial Regression ◽  
Case Definitions ◽  
Immune Mediated ◽  
Before And After ◽  
Shared Risk ◽  
Incident Cases ◽  
Over Time

Abstract Aims Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD. Methods We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts. Results We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47–2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69–2.84), MS (IRR 1.79; 95%CI: 1.29–2.50) and RA (IRR 1.61; 95%CI: 1.29–1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45–64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls. Conclusions IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.

scholarly journals Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease

2017 ◽  
Vol 28 (03) ◽  
pp. 333-342 ◽  
Author(s):  
R. A. Marrie ◽  
R. Walld ◽  
J. M. Bolton ◽  
J. Sareen ◽  
J. R. Walker ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
General Population ◽  
Anxiety Disorders ◽  
Psychiatric Disorders ◽  
Psychiatric Comorbidity ◽  
Inflammatory Diseases ◽  
Immune Mediated ◽  
Before And After ◽  
Shared Risk ◽  
Incident Cases

Aims.After the diagnosis of immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), the incidence of psychiatric comorbidity is increased relative to the general population. We aimed to determine whether the incidence of psychiatric disorders is increased in the 5 years before the diagnosis of IMID as compared with the general population.Methods.Using population-based administrative health data from the Canadian province of Manitoba, we identified all persons with incident IBD, MS and RA between 1989 and 2012, and cohorts from the general population matched 5 : 1 on year of birth, sex and region to each disease cohort. We identified members of these groups with at least 5 years of residency before and after the IMID diagnosis date. We applied validated algorithms for depression, anxiety disorders, bipolar disorder, schizophrenia, and any psychiatric disorder to determine the annual incidence of these conditions in the 5-year periods before and after the diagnosis year.Results.We identified 12 141 incident cases of IMID (3766 IBD, 2190 MS, 6350 RA) and 65 424 matched individuals. As early as 5 years before diagnosis, the incidence of depression [incidence rate ratio (IRR) 1.54; 95% CI 1.30–1.84) and anxiety disorders (IRR 1.30; 95% CI 1.12–1.51) were elevated in the IMID cohort as compared with the matched cohort. Similar results were obtained for each of the IBD, MS and RA cohorts. The incidence of bipolar disorder was elevated beginning 3 years before IMID diagnosis (IRR 1.63; 95% CI 1.10–2.40).Conclusion.The incidence of psychiatric comorbidity is elevated in the IMID population as compared with a matched population as early as 5 years before diagnosis. Future studies should elucidate whether this reflects shared risk factors for psychiatric disorders and IMID, a shared final common inflammatory pathway or other aetiology.

scholarly journals GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

BMJ ◽  
2021 ◽  
pp. e065834
Author(s):  
Hannah R Whittaker ◽  
Claudia Gulea ◽  
Ardita Koteci ◽  
Constantinos Kallis ◽  
Ann D Morgan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Negative Control ◽  
Healthcare Use ◽  
Population Based Study ◽  
Binomial Regression ◽  
Before And After ◽  
Over Time

AbstractObjectivesTo describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19.DesignPopulation based study.Setting1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.Participants456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803).Main outcome measuresComparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression.ResultsRelative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease.ConclusionsGP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.

scholarly journals Divergent associations between incident hypertension and deprivation based on different sources of case identification

2012 ◽  
Vol 32 (3) ◽  
pp. 121-130 ◽  
Author(s):  
J. Aubé-Maurice ◽  
L. Rochette ◽  
C. Blais
Keyword(s):  
Negative Binomial ◽  
Social Deprivation ◽  
Economic Status ◽  
Negative Binomial Regression ◽  
Administrative Databases ◽  
Incident Hypertension ◽  
Case Identification ◽  
Physician Billing ◽  
Combining Data ◽  
Incident Cases

Introduction Studies suggest that hypertension is more prevalent in the most deprived. Our objective was to examine the association between incident hypertension and deprivation in Quebec based on different modes of case identification, using two administrative databases. Methods We identified new incident cases of hypertension in 2006/2007 in the population aged 20 years plus. Socio-economic status was determined using a material and social deprivation index. Negative binomial regression analyses were carried out to examine the association between incident hypertension and deprivation, adjusting for several covariates. Results We found a positive and statistically significant association between material deprivation and incident hypertension in women, irrespective of the identifying database. Using the hospitalization database, the incidence of hypertension increased for both sexes as deprivation increased, except for social deprivation in women. However, whether using the physician billing database or the validated definition of hypertension obtained by combining data from the two databases, the incidence of hypertension decreased overall as deprivation increased. Conclusion Associations between hypertension and deprivation differ based on the database used: they are generally positively associated with the hospitalization database and inversely with the standard definition and the physician billing database, which suggests a consultation bias in favour of the most socio-economically advantaged.

scholarly journals Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248702
Author(s):  
Brian Neelon ◽  
Fedelis Mutiso ◽  
Noel T. Mueller ◽  
John L. Pearce ◽  
Sara E. Benjamin-Neelon
Keyword(s):  
Social Vulnerability ◽  
Primary Care Physicians ◽  
Negative Binomial ◽  
Temporal Trends ◽  
The United States ◽  
Social Vulnerability Index ◽  
Crossover Effect ◽  
Death Rates ◽  
The Impact ◽  
Over Time

Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

scholarly journals Smoke-free legislation and paediatric hospitalisations for acute respiratory tract infections: national quasi-experimental study with unexpected findings and important methodological implications

2017 ◽  
Vol 27 (e2) ◽  
pp. e160-e166 ◽  
Author(s):  
Jasper V Been ◽  
Daniel F Mackay ◽  
Christopher Millett ◽  
Ireneous Soyiri ◽  
Constant P van Schayck ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Negative Binomial ◽  
Temporal Trends ◽  
Pneumococcal Vaccination ◽  
Negative Binomial Regression ◽  
Break Point ◽  
Negative Binomial Regression Model ◽  
Published Evidence ◽  
Tract Infections

ObjectivesWe investigated whether Scottish implementation of smoke-free legislation was associated with a reduction in unplanned hospitalisations or deaths (‘events’) due to respiratory tract infections (RTIs) among children.DesignInterrupted time series (ITS).Setting/participantsChildren aged 0–12 years living in Scotland during 1996–2012.InterventionNational comprehensive smoke-free legislation (March 2006).Main outcome measureAcute RTI events in the Scottish Morbidity Record-01 and/or National Records of Scotland Death Records.Results135 134 RTI events were observed over 155 million patient-months. In our prespecified negative binomial regression model accounting for underlying temporal trends, seasonality, sex, age group, region, urbanisation level, socioeconomic status and seven-valent pneumococcal vaccination status, smoke-free legislation was associated with an immediate rise in RTI events (incidence rate ratio (IRR)=1.24, 95% CI 1.20 to 1.28) and an additional gradual increase (IRR=1.05/year, 95% CI 1.05 to 1.06). Given this unanticipated finding, we conducted a number of post hoc exploratory analyses. Among these, automatic break point detection indicated that the rise in RTI events actually preceded the smoke-free law by 16 months. When accounting for this break point, smoke-free legislation was associated with a gradual decrease in acute RTI events: IRR=0.91/year, 95% CI 0.87 to 0.96.ConclusionsOur prespecified ITS approach suggested that implementation of smoke-free legislation in Scotland was associated with an increase in paediatric RTI events. We were concerned that this result, which contradicted published evidence, was spurious. The association was indeed reversed when accounting for an unanticipated antecedent break point in the temporal trend, suggesting that the legislation may in fact be protective. ITS analyses should be subjected to comprehensive robustness checks to assess consistency.

scholarly journals Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population

2020 ◽  
Author(s):  
Vikram Jairam ◽  
Daniel X Yang ◽  
Saamir Pasha ◽  
Pamela R Soulos ◽  
Cary P Gross ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Temporal Trends ◽  
State Level ◽  
Negative Binomial Regression ◽  
Time Frame ◽  
Prescribing Patterns ◽  
Annual Number ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescribing

Abstract Background In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists. Methods We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level. Results From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P &lt; .001) among oncologists and 22.8% (P &lt; .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P &lt; .001) and 23.1% (P &lt; .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P &lt; .001). During the 5-year period, 43 states experienced a decrease (P &lt; .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P &lt; .05). Conclusions Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.

The Emergence of Spatial Clustering in Medical Vaccine Exemptions Following California Senate Bill 277, 2015–2018

2020 ◽  
Vol 110 (7) ◽  
pp. 1084-1091 ◽  
Author(s):  
Ashley Gromis ◽  
Ka-Yuet Liu
Keyword(s):  
Disease Transmission ◽  
Negative Binomial ◽  
Spatial Clustering ◽  
Local Level ◽  
Spatial Association ◽  
Positive Association ◽  
Negative Binomial Regression ◽  
Scan Statistics ◽  
Senate Bill ◽  
Before And After

Objectives. To understand how the elimination of nonmedical vaccine exemptions through California Senate Bill 277 (SB277) may have resulted in increased spatial clustering of medical exemptions. Methods. We used spatial scan statistics and negative binomial regression models to examine spatial clustering in medical vaccine exemptions in California kindergartens from 2015 to 2018. Results. Spatial clustering of medical exemptions across schools emerged following SB277. Clusters were located in similar geographic areas to previous clusters of nonmedical vaccine exemptions, suggesting a spatial association between high nonmedical exemption prevalence and increasing rates of medical exemptions. Regression results confirmed this positive association at the local level. The sociodemographic characteristics of the neighborhoods in which schools were located explained some, but not all, of the positive spatial associations between exemptions before and after SB277. Conclusions. Elimination of nonmedical vaccine exemptions via SB277 may have prompted some parents to instead seek medical exemptions to required school vaccines. The spatial association of these 2 types of exemptions has implications for maintaining pockets of low vaccine compliance and increased disease transmission.

Effect of Median Design on Rural Freeway Safety

2008 ◽  
Vol 2060 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Andrew P. Tarko ◽  
Natalie M. Villwock ◽  
Nicolas Blond
Keyword(s):  
Opposite Direction ◽  
Negative Binomial ◽  
Prediction Models ◽  
Negative Binomial Regression ◽  
Well Being ◽  
Crash Severity ◽  
Before And After ◽  
Single Vehicle ◽  
Median Width ◽  
The Impact

Although median barriers are an absolute means of preventing drivers from crossing road medians and colliding with vehicles moving in the opposite direction, they may cause additional crashes. This perhaps complex safety effect of median barriers has not been investigated well. Being able to predict the safety impact of most types of median barriers on rural freeways is becoming more desirable because some state departments of transportation plan to expand many of their four-lane rural freeways to six lanes to accommodate increases in traffic volume. Realistic crash prediction models sensitive to the median design would provide the needed guidance useful in designing adequate median treatments on widened freeways. The impact of median designs on crash frequency was investigated in this study through negative binomial regression and before-and-after studies based on data collected in eight participating states. The impact on crash severity was investigated with a logit model. The separate effects of changes in median geometry were quantified for single-vehicle, multiple-vehicle same direction, and multiple-vehicle opposite direction crashes. The results were significantly different and indicated that reducing the median width without adding barriers (the remaining median width is still reasonably wide) increases the severity of crashes, particularly opposite direction crashes. Further, reducing the median and installing concrete barriers eliminates opposite direction crashes but doubles the frequency of single-vehicle crashes and tends to lessen the frequency of same direction crashes. The crash severity also tends to increase.

scholarly journals Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic

2021 ◽  
Author(s):  
Linh Luong ◽  
Michaela Beder ◽  
Rosane Nisenbaum ◽  
Aaron Orkin ◽  
Jonathan Wong ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Infection Rates ◽  
Individual Site ◽  
Site Characteristics ◽  
Increased Risk ◽  
Binomial Regression ◽  
Great Heterogeneity ◽  
The Relationship ◽  
Over Time

Background: People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. Methods: The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). Results: The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06, 0.75) during T2 and 0.14 times lower (95% CI: 0.043, 0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. Interpretation: During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks and/or individual site characteristics.

scholarly journals Shifting from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: predictors, patterns and temporal trends

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur Shiyovich ◽  
Varda Shalev ◽  
Gabriel Chodick ◽  
Matanya Tirosh ◽  
Amos Katz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Female Gender ◽  
Healthcare Services ◽  
Vitamin K Antagonist ◽  
Incident Cases ◽  
Over Time

Abstract Background Non-Vitamin K antagonist oral anticoagulants (NOACs) emerged as an alternative with comparable or superior efficacy and safety to vitamin K antagonists (VKAs) for stroke prevention in patients with non-valvular atrial fibrillation (AF). Objectives The aim of the current study was to investigate the patterns, predictors, timelines and temporal trends of shifting from VKAs to NOACs. Methods In this retrospective observational study, the computerized database of a large healthcare provider in Israel, Maccabi Healthcare Services, was searched to identify patients with AF for whom either a VKA or NOAC was prescribed between 2012 and 2015. Time from diagnosis to therapy initiation and to shifting between therapies was evaluated. Results Out of 6987 eligible AF incident patients, 2338 (33.4%) initiated treatment with a VKA and 2221 (31.7%) with a NOAC. In addition, 5259 prevalent patients were analyzed. During the study period, NOAC prescriptions proportion among the newly diagnosed cases increased from 32 to 68.4% (p for trend <  0.001). The median time from diagnosis to first dispensing was greater in NOAC than VKA and decreased among patients treated with NOAC during the study period (2012: 1.9 and 0.3 months, 2015: 0.7 and 0.2 months, respectively). During follow-up, 3737 (49%) patients (54.3% and 47.1% of the incident and prevalent cases, respectively), shifted from a VKA to a NOAC, after a median of 22 months and 39 months in the incident and prevalent cases, respectively, decreasing throughout the study period. Female gender, younger age, southern district, higher CHADS2 and CHA2DS2-VASC score, non-smoking, and treatment with antiplatelets were associated with a greater likelihood for therapy shift. Shifting from a NOAC to a VKA decreased over time from 8 to 4.5% in 2012 to 0.5% and 0.7% in 2015 in the incident and prevalent groups, p <  0.001 respectively. Conclusions Shifting from VKA to NOAC occurred in 50% of the cases, more frequently among incident cases, and younger patients with greater stroke risk. Shifting from a NOAC to a VKA was much less frequent, yet it occurred more often in incident cases and decreased over time. A socially and economically sensitive program to optimize the initiation of OAC therapy upon diagnosis is warranted.

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