P6367Predictors and covariables of incident hypertension in midlife: the Hordaland Health Study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E A Kringeland ◽  
G S Tell ◽  
H B Midtbo ◽  
T Haugsgjerd ◽  
E Gerdts
Keyword(s):  
Multivariable Analysis ◽  
Health Study ◽  
P Value ◽  
Community Based ◽  
Serum Triglycerides ◽  
Incident Hypertension ◽  
Factors Associated ◽  
European Guidelines ◽  
Univariate Analyses

Abstract Background Different blood pressure (BP) development in midlife have been described in women and men. Less is known about factors associated with incident hypertension in this age group. Purpose To identify predictors and covariables of incident hypertension in women and men in their forties. Methods 2936 women (60%) and men born 1950–51 who participated in the community-based Hordaland Health Study both in 1992–93 (baseline, mean age 42±0.7 years) and in 1997–99 and were normotensive at baseline were included. Hypertension was defined as use of antihypertensive medication and/or systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. High-normal BP was defined as systolic BP 130–139 mmHg and/or diastolic BP 85–89 mmHg following European guidelines. Predictors and covariables of incident hypertension were identified in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI). Results 348 (12%) subjects developed hypertension during an average of 5.9 years follow-up. Incident hypertension was more common among men than women (14% vs. 10%, p=0.005). In univariate analyses, incident hypertension was positively associated with high normal BP and higher body mass index (BMI), serum total cholesterol and serum triglycerides at baseline, as well as with larger increase in BMI and serum triglycerides during follow-up (all p<0.05). In multivariable analysis, incident hypertension was associated with high-normal BP and higher serum triglycerides at baseline, and larger increase in BMI during follow-up, while the association with sex became non-significant (Table). Variable Multivariable analysis OR (95% CI) P-value High-normal BP 4.87 (3.82–6.20) <0.001 ΔBMI at follow up (kg/m2) 1.33 (1.24–1.42) <0.001 Ln serum triglycerides (mmol/L) 1.41 (1.14–1.75) 0.002 Conclusion In the community-based Hordaland Health Study, a larger proportion of men than women developed hypertension in midlife. However, this sex difference in incidence was explained by differences in prevalence of high-normal BP at baseline and metabolic factors.

scholarly journals Clinical and genetic factors associated with mismanagement of dyslipidemia. Multiple cross-sectional analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
V Chekanova ◽  
P Marques-Vidal ◽  
N Abolhassani
Keyword(s):  
High Risk ◽  
Total Cholesterol ◽  
Genetic Factors ◽  
Multivariable Analysis ◽  
Population Based ◽  
P Value ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Factors Associated

Abstract Funding Acknowledgements Type of funding sources: None. Aims Identify the clinical and genetic factors associated with poor control of high cholesterol in the Swiss population. Methods Data from three waves [baseline, N = 617; first, N = 844 and second, N = 798 follow-ups] of a population-based, prospective study conducted in Lausanne, Switzerland. Inadequate management of dyslipidemia was assessed according to the most common Swiss guideline. Genetic scores for lipid levels were computed based on the existing literature. Results Prevalence of inadequately managed dyslipidemia was 30%, 31.5% and 17.4% in the baseline, first and second follow-up. On multivariable analysis, participants at high risk of CVD had a lower likelihood of being adequately managed: odds ratio (OR) and (95% confidence interval) for high-risk relative to low-risk: 0.10 (0.06-0.18), 0.11 (0.07-0.17) and 0.15 (0.09-0.27) for the baseline, first and second follow-up (p for trend &lt; 0.001). Use of more potent statins increased the likelihood of adequate management, OR and (95% CI) for third vs. first level: 2.89 (1.76-4.74) and 5.17 (2.51-10.6) in the first and second follow-up (p for trend &lt; 0.001). No differences in total cholesterol, LDL and HDL genetic scores were found between adequately and inadequately managed participants: for the total cholesterol, -3.7 ± 9.6 vs. -2.7 ± 9.4; -3.5 ± 8.9 vs. -3.7 ± 9.5 and -3.8 ± 8.9 vs. -3.3 ± 9.4 in the baseline, first and second follow-up, p = NS. Those findings were replicated when the thresholds for adequate control were relaxed. Conclusion Management of dyslipidemia is suboptimal in Switzerland. Use of newer, more potent statins in high-risk patients could improve this status. The use of genetic scores appears to be of little interest. Multivariate Analysis First FUOR (95% CI) p-value Second FUOR (95% CI) p-value CVD risk Intermediate 0.18 (0.10 - 0.32) &lt;0.001 0.22 (0.09 - 0.55) 0.001 High 0.07 (0.04 - 0.12) &lt;0.001 0.09 (0.04 - 0.2) &lt;0.001 p-value for trend &lt;0.001 &lt;0.001 Swiss vs Non-Swiss 1.34 (0.87 - 2.05) 0.181 0.79 (0.43 - 1.43) 0.428 FH dyslipidemia (yes/no) 1.02 (0.63 - 1.63) 0.948 0.55 (0.29 - 1.03) 0.060 Statins potency First 1 (ref.) 1 (ref.) Second 2.00 (1.22 - 3.27) 0.006 2.59 (1.23 - 5.44) 0.012 Third 2.89 (1.76 - 4.74) &lt;0.001 5.17 (2.51 - 10.6) &lt;0.001 p-value for trend &lt;0.001 &lt;0.001

scholarly journals The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 86
Author(s):  
Fauna Herawati ◽  
Yuni Megawati ◽  
Aslichah ◽  
Retnosari Andrajati ◽  
Rika Yulia
Keyword(s):  
Intervention Group ◽  
Personal Control ◽  
Control Group ◽  
P Value ◽  
Interactive Approach ◽  
Community Based ◽  
Tuberculosis Patients ◽  
Level Of Knowledge ◽  
The Impact

The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.

scholarly journals Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110243
Author(s):  
Tyler Lian ◽  
Kate Kutzer ◽  
Diwas Gautam ◽  
Howard Eisenson ◽  
Jane C. Crowder ◽  
...  
Keyword(s):  
Health Center ◽  
Social Services ◽  
Social Needs ◽  
Phone Call ◽  
Community Based ◽  
Factors Associated ◽  
Federally Qualified Health Center ◽  
Or Applications ◽  
Improve Health

Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.

scholarly journals Biologic refractory disease in rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

2018 ◽  
Vol 77 (10) ◽  
pp. 1405-1412 ◽  
Author(s):  
Lianne Kearsley-Fleet ◽  
Rebecca Davies ◽  
Diederik De Cock ◽  
Kath D Watson ◽  
Mark Lunt ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cox Regression ◽  
Social Deprivation ◽  
Multivariable Analysis ◽  
British Society ◽  
National Study ◽  
Refractory Disease ◽  
Factors Associated ◽  
Biologics Register

ObjectivesBiologic disease-modifying antirheumatic drugs (bDMARDs) have revolutionised treatment and outcomes for rheumatoid arthritis (RA). The expanding repertoire allows the option of switching bDMARD if current treatment is not effective. For some patients, even after switching, disease control remains elusive. This analysis aims to quantify the frequency of, and identify factors associated with, bDMARD refractory disease.MethodsPatients with RA starting first-line tumour necrosis factor inhibitor in the British Society for Rheumatology Biologics Register for RA from 2001 to 2014 were included. We defined patients as bDMARD refractory on the date they started their third class of bDMARD. Follow-up was censored at last follow-up date, 30 November 2016, or death, whichever came first. Switching patterns and stop reasons of bDMARDs were investigated. Cox regression identified baseline clinical factors associated with refractory disease. Multiple imputation of missing baseline data was used.Results867 of 13 502 (6%) patients were bDMARD refractory; median time to third bDMARD class of 8 years. In the multivariable analysis, baseline factors associated with bDMARD refractory disease included patients registered more recently, women, younger age, shorter disease duration, higher patient global assessment, higher Health Assessment Questionnaire score, current smokers, obesity and greater social deprivation.ConclusionsThis first national study has identified the frequency of bDMARD refractory disease to be at least 6% of patients who have ever received bDMARDs. As the choice of bDMARDs increases, patients are cycling through bDMARDs quicker. The aetiopathogenesis of bDMARD refractory disease requires further investigation. Focusing resources, such as nursing support, on these patients may help them achieve more stable, controlled disease.

Prevalence and Factors Associated with Stunting Among Children 6-59 Months in Pastoralist Communities of Southeast Ethiopia

2021 ◽  
Author(s):  
Tomas Tefera ◽  
Semere Sileshi Belda ◽  
Mulusew Teshome Alemayehu ◽  
Mohammedawel Abduku Hussein ◽  
Mekonnen Tegegne Haile ◽  
...  
Keyword(s):  
Drinking Water ◽  
Bottle Feeding ◽  
P Value ◽  
Stepwise Logistic Regression ◽  
Feeding Practice ◽  
Growth Monitoring ◽  
Community Based ◽  
Cross Sectional ◽  
Factors Associated ◽  
Pastoralist Communities

Abstract Background: In Ethiopia, stunting is one of the most important public health problems. It affects human capital and productivity in several dimensions like impairing learning potential, increased economic costs to health systems and families. Hence, this study was aimed to determine the prevalence and factors associated with stunting among children 6-59months in pastoralist communities of Bale Zone, south-east Ethiopia. Methods: A community- based cross-sectional study design was executed involving 657 children paired with their mothers. A structured questionnaire was administered. Anthropometry was conducted on children following standard procedures. A stepwise logistic regression with backward elimination method was used to identify factors associated stunting. Adjusted odd ratios with 95% confidence interval and p-value of ≤ 0.05 were used to assess level of significance. Results: prevalence of stunting was 43.2 (95% CI: 39.9–47.5). Male children (AOR=3.5, 95%CI, 1.59 -7.71), mothers with primary education level (AOR=8.8 ,95%CI, 7.36 -9.19), and bottle feeding practice (AOR: 3.7, 95%CI, 1.74 -7.69) were positively associated with child stunting, whereas colostrum’s feeding practice(AOR:0.14, 95% CI, 0.06 -0.32),improved source of drinking water(AOR=0.3, 95%CI: 0.11-0.71), exclusively breast feeding (AOR: 0.4 [95%CI, 0.20 -0.92), timely of complimentary feeding initiation(AOR: 0.04, 95%CI 0.00, 0.01), growth monitoring follow up (AOR=0.3 [95%CI, 0.13 -0.59), were showed negative association. Conclusion: Prevalence of stunting was high. Therefore, due attention has to be given on child nutritional education, safe drinking water supply, and promotion of community-based growth monitoring in order to in order to end stunting in children by 2030.

Abstract 13030: Causes of Cardiovascular and Non-cardiovascular Mortality in the Ischemia Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mandeep S Sidhu ◽  
Karen P Alexander ◽  
Zhen Huang ◽  
Sean M O’Brien ◽  
Bernard R Chaitman ◽  
...  
Keyword(s):  
Management Strategies ◽  
Multivariable Analysis ◽  
International Study ◽  
Factors Associated ◽  
Clinical Events ◽  
All Cause Mortality ◽  
History Of ◽  
Multivariable Analyses ◽  
Clinical Events Committee

Background: In the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, all-cause mortality was similar in patients with stable ischemic heart disease (SIHD) randomized to invasive (INV) and conservative (CON) management strategies. This analysis details specific causes of cardiovascular (CV) and non-CV mortality by treatment group. Methods: In ISCHEMIA, 289 deaths occurred after a median follow-up of 3.2 years; 145 (5.6%) in INV and 144 (5.6%) in CON (HR 1.05, CI 0.83-1.32). Deaths were adjudicated by an independent Clinical Events Committee as CV, non-CV with or without a CV contributor or undetermined. The protocol defined CV death as deaths from CV causes, non-CV causes with CV contributor, and cause undetermined; non-CV death was defined as death from non-CV causes without a CV contributor. Multivariable analyses were used to identify factors associated with cause-specific death. Results: CV death was similar between groups [INV 92 (3.6%), CON 111 (4.3%); HR 0.87 (CI 0.66, 1.15)], but INV had more non-CV death [INV 53 (2.0%), CON 33 (1.3%); HR 1.63 (CI 1.06, 2.52)]; fewer undetermined deaths [INV 12 (0.5%) and CON 26 (1.0%); HR 0.48 (0.24, 0.95)] and more malignancy deaths [INV 41 (1.6%), CON 20 (0.8%); HR 2.11 (1.24, 3.61)]. In multivariable analysis, risk factors associated with CV death were age [HR 1.42 (CI 1.19-1.70) per 10-year increase], diabetes [HR 1.39 (CI 1.03-1.87)], history of heart failure [HR 1.96 (CI 1.33-2.91)], and eGFR [HR 1.18 (CI 1.11-1.26) per 5-ml/min decrease below 80ml/min]. Factors associated with non-CV death were age [HR 2.31 (CI 1.75-3.03) per 10-year increase] and randomization to INV [HR 1.76 (CI 1.13-2.75)]. Conclusions: In ISCHEMIA, all-cause mortality was similar for the INV and CON strategies. Excess non-CV deaths in INV with a higher number of deaths from malignancy but a higher number of undetermined deaths in CON requires further evaluation.

Prelacteal Feeding and Associated Factors Among Northwestern Ethiopian Women Having Children Less than Six Months Age: A Community Based Cross- Sectional Study

2020 ◽  
Author(s):  
Maezu G/slassie1 ◽  
Kiflay Mulugeta ◽  
Abraha Teklay Berhe
Keyword(s):  
Breast Feeding ◽  
Associated Factors ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Prelacteal Feeding ◽  
Community Based ◽  
Cross Sectional ◽  
Timely Initiation ◽  
Factors Associated

Abstract Background: Prelacteal feeding is administration of any food or fluid other than breast milk before initiation of breast feeding. Optimal breastfeeding including discouraging prelacteal feeding could save 823,000 lives per year among children ages five years old and younger. Despite of this mothers give prelacteal feeding to their child in different part of Ethiopia; However, there is a paucity of information on prevalence of prelacteal feeding and associated factors in the study area. Thus, the current study aimed at determining of the prevalence of prelacteal feeding and associated factors among mothers of children aged less than six months in Gozamen district, East Gojjam zone, North West Ethiopia, 2019-2020Methods: A community -based cross-sectional study was conducted among 741 mothers of children aged less than six months in Gozamen district from August 2019 to Feb 2020. Stratified cluster sampling technique was used to select study participants. Data were collected by face to face interviewer-administered, pretested and semi-structured questionnaire. Descriptive analysis, bi-variable and multivariable logistic regression model were employed. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with prelacteal feeding.Results: In this study the prevalence of prelacteal feeding was found to be 17.1%with 95%CI [14.3, 20]. Mothers who had no ANC follow up [AOR: 7.53, CI; 3.32, 17.05], those mothers who did not discard colostrum [AOR: 0.12, CI; 0.07, 0.12] time of breast feeding initiation [AOR: 3.53, CI; 2.05, 6.11] and mothers who had single ANC visit [AOR: 2.98, CI; 1.52, 5.85] were significant independent factors associated with prelacteal feeding.Conclusion: This study concluded that prelacteal feeding was high in the study area .Therefore, in order to tackle this problem strengthening antenatal follow up, timely initiation of breastfeeding, health education and awarenes creation of the communities are recommended interventions.

P3131Evolution of subclinical rheumatic heart disease: a multi-centre retrospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sanyahumbi ◽  
G Karthikeyan ◽  
T Aliku ◽  
A Beaton ◽  
J Carapetis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariable Analysis ◽  
Subtype C ◽  
Factors Associated ◽  
Rheumatic Heart

Abstract Background Screening echocardiography (echo) detects subclinical rheumatic heart disease (RHD) which is categorised as definite or borderline. The natural history of subclinical RHD is not known. Follow up single centre studies have included a relatively small number of participants, and have shown variable progression rates. Aim To determine incidence of and factors associated with progression and regression among a cohort of children with baseline subclinical RHD across multiple countries and regions. Methods This is a retrospective cohort study of RHD evolution in children with subclinical RHD. Study sites were Australia, Fiji, Malawi, New Zealand, and Uganda. Progression or regression was determined from echos obtained at baseline and most recent follow-up. Factors associated with echo progression or regression were identified using multivariable logistic regression. Results 482 participants (131 with definite, 351 with borderline subclinical RHD) from 5 countries were included (mean age 11.5 years, range 5–19 years). Mean follow up was 3.4 yrs (range 0.4–9.5 yrs). Of 482 participating children, 204 (42%) regressed. Among 131 children with definite lesions, 48 (37%) regressed to borderline or normal, and 83 (63%) remained definite. Among 351 children with borderline lesions, 39 (11.1%) progressed, 156 (44.4%) remained borderline, and 156 (44.4%) regressed to normal. World Heart Federation defines subcategories based on characteristics of affected valves. By subcategory, children with definite C (pathological aortic regurgitation and 2 morphologic characteristics of the aortic valve) and borderline A (at least 2 morphologic features of the mitral valve without pathologic mitral regurgitation or stenosis) were less likely to regress, and borderline A was more likely to progress. In univariable analysis, good adherence (>80%) to penicillin prophylaxis (BPG) was associated with more regression among all patients (definite + borderline) (OR 1.9, CI 1, 3.5; p=0.04) but this association did not remain significant after adjustment. With multivariable analysis, borderlines prescribed BPG was the only factor related to progression from borderline to definite (OR 4.1, CI 1.8, 9.3, p<0.01). Conclusion This is the largest reported subclinical RHD cohort followed to report outcomes. 42% of definite RHD regressed with subtype C more likely to regress. 11% of borderline RHD progressed. Borderline A was more likely to progress and less likely to regress. We have also identified that being prescribed BPG is associated with borderline progression. This is likely because children with more advanced borderline disease may be more likely to be prescribed BPG. This study highlights that RHD evolution is variable out to 3–4 years post echo detection. While borderline disease is likely, in some cases, to reflect the earliest change of RHD, how this should be monitored and whether it should be treated with BPG should be a priority for future prospective evaluation.

scholarly journals Medication Adherence and Associated Factors among Chronic Heart Failure Clients on Follow Up Oromia Region, West Ethiopia

2019 ◽  
Vol 17 (2) ◽  
pp. 104-114
Author(s):  
Getahun Fetensa ◽  
Birhanu Yadecha ◽  
Tadesse Tolossa ◽  
Tariku Tesfaye Bekuma
Keyword(s):  
Heart Failure ◽  
Medication Adherence ◽  
Chronic Heart Failure ◽  
Health Education ◽  
Study Design ◽  
Associated Factors ◽  
Multivariable Analysis ◽  
Self Care ◽  
P Value

Background: Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. Methods: Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. Results: A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. Conclusion and Recommendation: Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.

Intracranial Hemorrhage in Patients with Hemophilia in the Prophylaxis Era.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3388-3388
Author(s):  
Char Witmer ◽  
Rodney Pressley ◽  
Roshni Kulkarni ◽  
J. Michael Soucie ◽  
Catherine Scott Manno
Keyword(s):  
Mortality Rate ◽  
Reference Group ◽  
Univariate Analysis ◽  
P Value ◽  
Severe Hemophilia ◽  
Clinical Factors ◽  
Factors Associated ◽  
Annual Visit ◽  
Nested Case Control

Abstract Objective: With a mortality rate of 20%, intracranial hemorrhage (ICH) accounts for the highest number of deaths from bleeding in patients with hemophilia and is a common cause of long-term disability. We performed a nested case-control study within a cohort of males with hemophilia enrolled in the Centers for Disease Control and Prevention (CDC) Universal Data Collection (UDC) project. The study objective was to identify rates and risk factors associated with ICH in the modern era of prophylaxis. Patients and methods: Study participants were males with hemophilia A or B, enrolled in the CDC UDC project, 2 years or older, who had an initial visit, and at least one follow up event between May 1998 and March 2008. Patients were followed from the initial visit until their study termination event, defined as an ICH reported during a subsequent annual visit, death, or the latest annual visit held during the study period. Cases were patients who after UDC enrollment either had an ICH or whose cause of death was from an ICH. The following clinical factors were examined for an association with ICH: hemophilia type, severity level, prior ICH, presence of an inhibitor, treatment with prophylaxis, HIV status, chronic hepatitis B, hepatitis C, alcohol abuse, elevated prothrombin time, ethnicity and age. Data analysis was conducted using SAS 9.2 (SAS Institute, Cary, NC). Factors associated with ICH were identified using a nested case control design. Interaction effects were assessed using the Breslow-Day Test for homogeneity of the odds ratios. The independent association between prophylaxis and ICH was assessed using logistic regression. All hypothesis testing was two tailed with odds ratios and confidence intervals reported. Results: During the study period 10,262 patients were identified who met the inclusion criteria. Of these, 199 (1.9%) experienced an ICH. Based on patient follow up time (mean 4.9 +/−2.46 years) the incidence rate was 3.9 per thousand patient years. Thirty-nine of the 199 ICH cases died from the event, resulting in a mortality rate of 19.6%. In 148 (74%) of the ICH cases, the subjects had severe hemophilia. See table 1 for univariate analysis of all patients. Table 1: Clinical factors associated with ICH for all patients in the cohort, N=10,262 (univariate analysis) Clinical Factors Odds Ratio (95% CI) P-Value *Reference group White (non-Hispanic). **Reference group age 10–15 years. Prior ICH 3.62 (2.66–4.92) <0.001 Severe Hemophilia 3.25 (2.01–5.25) <0.001 High Titer Inhibitor 4.01 (2.40–6.71) <0.001 Hepatitis C 1.73 (1.30–2.29) <0.001 Black (non-Hispanic)* 2.07 (1.46–2.96) <0.001 Age 2-9 years** 1.85 (1.14–2.99) 0.01 Age >41 years** 2.17 (1.34–3.50) 0.001 For the entire cohort, prophylaxis use was not associated with a statistically significantly reduced risk of ICH (0.83 (0.61–1.15) p=0.26). However, further analysis (see table 2), restricted to patients with severe hemophilia, demonstrated a protective effect of prophylaxis use that was limited only to patients who did not have an inhibitor and who were not infected with HIV. Table 2: Clinical factors independently associated with ICH among 5,485 patients with severe hemophilia (multivariate analysis) Clinical Factors Odds Ratio (95% CI) P-Value **Reference group age 10–15 years. Prophylaxis no inhibitor 0.50 (0.32–0.77) 0.002 Prophylaxis no HIV 0.52 (0.34–0.81) 0.004 Prior ICH 3.24 (2.27–4.64) <0.0001 Chronic Hepatitis B 2.99 (1.03–8.63) 0.043 Age 2–9 years** 1.92 (1.05–3.51) 0.034 Conclusion: This study demonstrates that patients with severe hemophilia who use prophylaxis and are not HIV positive and do not have an inhibitor experience a 50% risk reduction for ICH. This study confirms the previously identified risk factors for ICH including severity of disease, prior ICH, young age and the presence of an inhibitor. The strongest predictor for ICH was a history of ICH before enrollment in the UDC. Unfortunately even in the age of widely available prophylactic therapy, the mortality rate from ICH remains quite high at 19.6%.

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