scholarly journals The incidence of clinical fractures in adults aged 50 years and older in Spain

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Carmen Gomez-Vaquero ◽  
Lidia Valencia ◽  
Joan M Nolla ◽  
Dolors Boquet ◽  
Silvia Martínez Pardo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fragility Fractures ◽  
Reference Population ◽  
Fracture Incidence ◽  
Validation Sample ◽  
Fracture Type ◽  
Entire Sample ◽  
Clinical Fractures ◽  
Validation Technique ◽  
Age And Sex

Abstract Objective The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age. Methods The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age. Results A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae. Conclusion The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.

scholarly journals Bone density testing in clinical practice

2006 ◽  
Vol 50 (4) ◽  
pp. 586-595 ◽  
Author(s):  
E. Michael Lewiecki ◽  
João Lindolfo C. Borges
Keyword(s):  
Forearm Fracture ◽  
Fragility Fractures ◽  
Cost Effective ◽  
Reference Population ◽  
Pharmacological Therapy ◽  
World Health ◽  
Mineral Density ◽  
Skeletal Health ◽  
T Score ◽  
Bmd Testing

The diagnosis of osteoporosis and monitoring of treatment is a challenge for physicians due to the large number of available tests and complexities of interpretation. Bone mineral density (BMD) testing is a non-invasive measurement to assess skeletal health. The "gold-standard" technology for diagnosis and monitoring is dual-energy X-ray absorptiometry (DXA) of the spine, hip, or forearm. Fracture risk can be predicted using DXA and other technologies at many skeletal sites. Despite guidelines for selecting patients for BMD testing and identifying those most likely to benefit from treatment, many patients are not being tested or receiving therapy. Even patients with very high risk of fracture, such as those on long-term glucocorticoid therapy or with prevalent fragility fractures, are often not managed appropriately. The optimal testing strategy varies according to local availability and affordability of BMD testing. The role of BMD testing to monitor therapy is still being defined, and interpretation of serial studies requires special attention to instrument calibration, acquisition technique, analysis, and precision assessment. BMD is usually reported as a T-score, the standard deviation variance of the patient's BMD compared to a normal young-adult reference population. BMD in postmenopausal women is classified as normal, osteopenia, or osteoporosis according to criteria established by the World Health Organization. Standardized methodologies are being developed to establish cost-effective intervention thresholds for pharmacological therapy based on T-score combined with clinical risk factors for fracture.

scholarly journals Educational inequalities in all-cause and cause-specific mortality among people with gout: a register-based matched cohort study in southern Sweden

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Ali Kiadaliri ◽  
Margarita Moreno-Betancur ◽  
Aleksandra Turkiewicz ◽  
Martin Englund
Keyword(s):  
Cohort Study ◽  
Cox Regression ◽  
Reference Population ◽  
Matched Cohort ◽  
Educational Inequalities ◽  
Southern Sweden ◽  
Relative Inequality ◽  
Matched Cohort Study ◽  
Specific Mortality ◽  
Age And Sex

Abstract Background Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden. Methods We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998–2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: “underlying cause”, “any mention”, and “weighted multiple-cause”. Results Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach. Conclusions Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.

scholarly journals Urban vs rural increase in hip fracture incidence: Age and sex of 901 cases 1980-89 in Olmsted County, U.S.A.

1993 ◽  
Vol 64 (5) ◽  
pp. 543-548 ◽  
Author(s):  
Rajan Madhok ◽  
L Joseph Melton ◽  
Elizabeth J Atkinson ◽  
W Michael O'Fallon ◽  
David G Lewallen
Keyword(s):  
Hip Fracture ◽  
Fracture Incidence ◽  
Olmsted County ◽  
Hip Fracture Incidence ◽  
Age And Sex

scholarly journals P009: Emergency department overcrowding associated with increased door-to-ecg time in patients with chest pain

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S60-S60
Author(s):  
M. Bhatia ◽  
W. Hopman ◽  
C. Mckaigney ◽  
D. Loricchio ◽  
A. K. Hall
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Tertiary Care ◽  
Positive Association ◽  
Additional Patient ◽  
Negative Consequences ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Ed Overcrowding ◽  
Age And Sex

Introduction: Emergency Department (ED) overcrowding has been shown to delay time sensitive tests and therapies. North American guidelines call for Door-to ECG (DTE) times to be <10min in patients presenting with chest pain as delays have been shown to lead to poorer patient outcomes. We hypothesize that increased ED crowding will increase the DTE times. Methods: This was a retrospective cohort study from July 2015-May 2016 at a single tertiary care Canadian ED (53000 visits per year). Data were extracted from the ED information system (EDIS) which contains an organized record of ED activity for each visit. Our selection criteria screened for patients presenting with complaints that included chest pain, chest heaviness, chest tightness and chest burning. The primary outcome of the study was the association between ED occupancy and DTE time, which was measured using a non-parametric Spearman correlation. Multivariable linear regression models controlling for age and sex were developed for both time in minutes, and the log transformed time in minutes. Results: There were 2479 ECGs done on patients presenting with chest pain that met inclusion criteria. The median DTE time was 55.1 minutes. There was a significant positive association between DTE time and ED occupancy (rho=.133, p<0.001). DTE time increased by 0.64 minutes (or approximately 0.4%) for each additional patient in the ED, p<0.001. Additionally, younger age and female sex were also associated with increased DTE time. Conclusion: Increased ED occupancy was correlated with longer DTE times at a single Canadian ED, even after controlling for age and sex. This study provides an example of the negative consequences of ED overcrowding.

scholarly journals Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE

2020 ◽  
Vol 35 (10) ◽  
pp. 1712-1721 ◽  
Author(s):  
Louis-Charles Desbiens ◽  
Rémi Goupil ◽  
François Madore ◽  
Fabrice Mac-Way
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Population Based ◽  
Fracture Incidence ◽  
Administrative Databases ◽  
Middle Aged ◽  
Cox Models ◽  
Ckd Stage ◽  
Age And Sex

Abstract Background Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals. Methods We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added. Results A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence &lt;75 mL/min/1.73 m2 [HR = 1.18 (1.04–1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91–1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28–4.67) at 45 years; 1.11 (0.73–1.67) at 65 years] and in men. Conclusions Even early CKD increases fracture incidence, especially in younger individuals and in men.

M2043 An Epidemiological Study of Celiac Disease (CD) Adjusted for Age and Sex to the Reference Population Suggests a High Frequency of Evolution Towards Latency

2009 ◽  
Vol 136 (5) ◽  
pp. A-473
Author(s):  
Meritxell Mariné ◽  
Carme Farré ◽  
Montserrat Alsina ◽  
Pere Vilar ◽  
Antonio Salas ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Epidemiological Study ◽  
High Frequency ◽  
Reference Population ◽  
Age And Sex

scholarly journals Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios

2020 ◽  
Author(s):  
Valentina Gallo ◽  
Paolo Chiodini ◽  
Dario Bruzzese ◽  
Elias Kondilis ◽  
Daniel Howdon ◽  
...  
Keyword(s):  
Total Mortality ◽  
Reference Population ◽  
Mortality Rates ◽  
Mortality Data ◽  
Mortality Trend ◽  
Cumulative Mortality ◽  
Crude Mortality ◽  
Specific Mortality ◽  
Over Time ◽  
Age And Sex

Background Since COVID19 was declared a pandemic, attempts have been made to monitor trends over time and to compare countries and regions. Insufficient testing for COVID19 underestimates the incidence and inflates the case/fatality proportion. Given the age and sex distribution of morbidity and mortality from COVID19, the underlying sex and age distribution of a population needs to be accounted for. The aim of this paper is to present a method for monitoring trends of COVID19 using adjusted mortality trend ratios (AMTR). Methods Age and sex mortality distribution of a reference population composed of the first 14,086 fatalities which occurred before the end of March and were reported in Europe by some countries were used to calculate age and sex specific mortality rates per 1,000,000 population. These were applied to each country population to calculate the expected deaths. Adjusted Mortality Trend Ratios (AMTRs) with 95% confidence intervals (C.I.) were calculated for selected European countries from 17/03/2020 to 22/06/2020 by dividing observed cumulative mortality, by expected mortality times the crude mortality of the reference population. These estimated the sex and age adjusted mortality for COVID19 per million population in each country. Results The cumulative mortality from COVID19, the crude mortality rates, and the AMTRs were calculated for each country and compared. United Kingdom, Italy, France and Spain registered the highest mortality in Europe. On 22/06/2020 in Europe the total mortality rate from COVID-19 was 352 per 1,000,000 inhabitants; and it was highest in Belgium (850 per 1,000,000 inhabitants) followed by Spain, UK, Italy, Sweden and France. When accounting for the underlying age and sex structure of each country, Belgium remained the single country experiencing the highest AMTR of 929 per million inhabitants on 22/06/2020; however Ireland (which had a CMR in line with the total European population) emerged as having experienced a much more important impact of COVID19 mortality with an AMTR of 550/million on 22/06/2020, higher than Sweden and Italy. Conclusions In understanding and managing the pandemic of COVID19, comparable international data is a priority. Our methods allow a fair comparison of mortality in space and over time. The authors urge the WHO, given the absence of age and sex-specific mortality data for direct standardisation, to adopt this method to estimate the comparative mortality from COVID19 pandemic worldwide.

scholarly journals Epidemiologic trends in cancer-related emergency department utilization in Korea from 2015 to 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sun Young Lee ◽  
Young Sun Ro ◽  
Sang Do Shin ◽  
Sungwoo Moon
Keyword(s):  
Emergency Department ◽  
Cancer Patients ◽  
Incidence Rate ◽  
Survival Rates ◽  
Incidence Rates ◽  
Emergency Department Utilization ◽  
Cancer Type ◽  
Cross Sectional ◽  
Ed Visits ◽  
Age And Sex

AbstractIt is inevitable for cancer patients to visit the emergency department (ED) for symptoms of cancer itself and various treatment-related complications. As the prevalence of cancer increases along with cancer survival rates, the number of ED visits of cancer patients may increase. This study aimed to investigate the epidemiologic trends and characteristics of cancer-related ED visits. A cross-sectional study was conducted for all ED visits nationwide between 2015 and 2019. The characteristics of cancer- and non-cancer-related ED visits were compared, and the cancer type and primary reason for ED visits were investigated for cancer-related ED visits. The age- and sex-standardized incidence rate per 100,000 population was calculated. Among 44,983,523 ED visits for 5 years, 1,372,119 (3.1%) were cancer-related. Among cancer-related ED visits, 54.8% led to hospitalization including 5.1% in ICU, and 9.5% died in the hospital. The age- and sex-standardized incidence rates of cancer-related ED visits per 100,000 population increased from 521.8 in 2015 to 642.2 in 2019 (p-for-trends, < 0.01), and rates of cancer-related hospital admission via ED were 309.0 in 2015 and 336.6 in 2019 (p-for-trends, 0.75). The most common cancer types were lung cancer (14.7%), liver cancer (13.1%), and colorectal cancer (11.5%). The most common primary reasons of cancer-related ED visits were pneumonia (3.6%), gastroenteritis (2.7%), fever (2.6%), abdominal pain (2.4%), and ileus (2.1%). Cancer-related ED visits accounted for 3.1% of all ED visits, with 1.37 million cases over five years. The incidence rate of cancer-related ED visits has increased year by year, with high hospitalization and mortality rates, and the burden of cancer-related ED visits will continue to increase as the prevalence increases.

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