Lymphoma risks in patients with rheumatoid arthritis treated with biological drugs—a Swedish cohort study of risks by time, drug and lymphoma subtype

Rheumatology ◽  
2020 ◽  
Author(s):  
Karin Hellgren ◽  
Daniela Di Giuseppe ◽  
Karin E Smedby ◽  
Christer Sundström ◽  
Johan Askling ◽  
...  
Keyword(s):  
General Population ◽  
Incidence Rate ◽  
Cox Regression ◽  
Tnf Inhibitor ◽  
Crude Incidence Rate ◽  
Biological Drugs ◽  
Crude Incidence ◽  
Hazard Ratios ◽  
Lymphoma Subtype ◽  
Lymphoma Risk

Abstract Objectives To estimate the association between biological DMARDs (bDMARDs; overall and by drug) as used in RA and the risk of malignant lymphomas including subtypes. Methods By linking nationwide Swedish registers we identified cohorts of patients with RA initiating treatment with a bDMARD (n = 16 392), bDMARD-naïve (n = 55 253), an age- and sex-matched general population comparator cohort (n = 229 047), and all incident lymphomas 2001–16. We used Cox regression to calculate hazard ratios (HRs) of lymphoma taking calendar period and other factors into account. Results There were 82 lymphomas among the bDMARD-treated patients with RA, crude incidence rate 76/100 000 person-years, and 310 lymphomas among the bDMARD-naïve patients with RA, crude incidence rate 90/100 000 person-years. This resulted in an adjusted HR (aHR) associated with bDMARD treatment (vs not) of 1.08 (95% CI: 0.83, 1.41). The corresponding aHR for bDMARD-treated and bDMARD-naïve vs the general population was 1.65 (95% CI: 1.31, 2.08) and 1.56 (95% CI: 1.37, 1.78) respectively. Restricting follow-up period to after 2006, the aHR of lymphoma for patients with RA starting a first bDMARD vs bDMARD-naïve was 0.69 (95% CI: 0.47, 1.00), and for bDMARD treated vs patients with RA switching from one conventional synthetic DMARDs to another, aHR was 0.46 (95% CI: 0.28, 0.73). There were no signals of different risks with any particular TNF inhibitor (TNFi) agent. We found no different lymphoma subtype pattern following bDMARD therapy. Conclusion Treatment with bDMARDs, including both TNFi and non-TNFi bDMARDs, does not further increase the lymphoma risk in RA; instead, bDMARD treatment may actually reduce the excess lymphoma risk in RA.

scholarly journals Risk of tuberculosis in patients with spondyloarthritis: data from a centralized electronic database in Hong Kong

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Natalia Chu-Oi Ciang ◽  
Shirley Chiu Wai Chan ◽  
Chak Sing Lau ◽  
Eva Tsz Fung Chiu ◽  
Ho Yin Chung
Keyword(s):  
Risk Factors ◽  
Hong Kong ◽  
Lung Disease ◽  
Incidence Rate ◽  
Chronic Lung Disease ◽  
Cox Regression ◽  
Infliximab Therapy ◽  
Glucocorticoid Therapy ◽  
Crude Incidence Rate ◽  
Crude Incidence

Abstract Background/ objective Tuberculosis (TB) is one of the most infectious comorbidities in spondyloarthritis (SpA). Our goals were to determine the crude incidence rate of and risk factors for TB in SpA. Method Clinical data of 2984 patients with SpA from 11 rheumatology centres were reviewed. This included demographics, duration of follow-up, comorbidities including diabetes, chronic kidney disease, chronic heart disease, chronic lung disease, stroke and malignancies, date of diagnosis of tuberculosis, use of non-steroidal anti-inflammatory drugs, duration of glucocorticoid therapy for more than 6 months, conventional (cDMARD) and biological (bDMARD) disease modifying anti-rheumatic drug therapies. Crude incidence rates were reported. Cox regression models were used to determine the risk factors for TB in patients with SpA. Results Forty-three patients had TB, of which 4 (9.3%) were extra-pulmonary. The crude incidence rate of TB was 1.57 in patients with SpA, compared with 0.58 in the general population in Hong Kong. Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001). Age was associated with decreased risk (HR 0.93; p < 0.001). Conclusion Incidence of TB was higher in patients with SpA. Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB. Rheumatologists should avoid prolonged use of glucocorticoids and consider DMARDs other than infliximab in the treatment of at-risk patients.

Crude Incidence Rate of Malignancy after Kidney Transplantation

2010 ◽  
Vol 24 (3) ◽  
pp. 182 ◽  
Author(s):  
Hyo Sun Kim ◽  
Young Min Seo ◽  
Ui Jun Park ◽  
Hyoung Tae Kim ◽  
Won Hyun Cho ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Incidence Rate ◽  
Crude Incidence Rate ◽  
Crude Incidence

scholarly journals Participation Rate, Risk Factors, and Incidence of Colorectal Cancer in the Screening Program Among the Population Covered by the Health Centers in Arak, Iran

2021 ◽  
Vol 14 (7) ◽  
Author(s):  
Pegah Mohaghegh ◽  
Farzane Ahmadi ◽  
Mahjabin Shiravandi ◽  
Javad Nazari
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Incidence Rate ◽  
Screening Program ◽  
Participation Rate ◽  
Health Centers ◽  
Crude Incidence Rate ◽  
Crude Incidence ◽  
Crc Screening ◽  
Rate Risk

Background: Colorectal cancer (CRC) is among the most common and preventable cancers, the incidence and risk factors of which are different in various populations. Objectives: The present study aims at assessing incidence rate, risk factors, and symptoms of CRC among the populations aged 50 to 70 years old covered by the health centers in Arak, as well as evaluating participation rate in the CRC screening program. Methods: The present cross-sectional study was conducted from 2016 to 2019 among all of the individuals aged 50 to 70 years old, who were referred to rural, urban, and suburban health centers in Arak for CRC screening, and their data were recorded in the Sib system. The participation rate, risk factors (family and individual history of CRC, colorectal adenoma, and inflammatory bowel disease), symptoms (lower gastrointestinal bleeding, constipation with or without diarrhea, and weight loss), and crude incidence rate of CRC were calculated in the age range. Results: The mean (SD) age of the CRC was 59.72 (5.56) years. In addition, the individuals’ participation rate in the program was about 44.2%, which was more among women (55.5%) and villagers (93.7%). Most subjects complained of constipation in the last month and CRC family history. The CRC crude incidence rates were 35.93 (95% CI: 25.55 - 50.54), 40.96 (95% CI: 29.81 - 56.29), 43.76 (95% CI: 32.22 - 59.43), and 52.84 (95% CI: 40.05 - 69.71) per 100000 individuals during 2016, 2017, 2018, and 2019, respectively. Conclusions: The participation rate in the CRC screening program was low, and the trend of the cancer crude incidence rate increased among the populations aged 50 to 70 years. Finally, informing about the recognition of the risk factors and symptoms of cancer, as well as the timely referral for screening was considered essential.

scholarly journals Spatial and temporal characteristics of cancer in the period from 2004 to 2013 in the Hashemite Kingdom of Jordan

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Salahuddin M. Jaber ◽  
Jwan H. Ibbini ◽  
Nawal S. Hijjawi ◽  
Juhina J. Thnaibat ◽  
Omar F. Nimri
Keyword(s):  
Incidence Rate ◽  
Cancer Incidence ◽  
Scan Statistics ◽  
Crude Incidence Rate ◽  
Control Plan ◽  
Crude Incidence ◽  
Temporal Characteristics ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence ◽  
Spatial And Temporal Characteristics

Cancer in Jordan is a major public health problem and the second leading cause of death after heart disease. This study aimed at studying the spatial and temporal characteristics of cancer in Jordan and its 12 governorates for the period 2004-2013 to establish a baseline for future research and identification of cancer risk factors paving the way for developing a cancer control plan in the country. Numerical and graphical summaries, time-series additive seasonal decomposition, the method of least squares, and spacetime scan statistics were applied in a geographic information systems environment. Although the results indicate that the cancer incidence in Jordan is comparatively low, it is increasing over time. In the 10-year study period, a total of 44,741 cases was reported with a mean annual crude incidence rate of 68.4 cases/100,000, mean annual age-adjusted incidence rate of 111.9 cases/100,000, and a monthly rate increase of 1.2 (cases/100,000)/month. This study also revealed that the spatial and temporal characteristics of cancer vary among the governorates. Amman, which includes the capital city and hosts more than one-third of the population of the country, reported 61.0% of the total number of cases. Amman also reported the highest annual crude incidence rate (105.3 cases/100,000), the highest annual age-adjusted incidence rate (160.6 cases/100,000), and the highest rate of increase (0.7 (cases/100,000)/month) forming a high-rate cluster. Excluding the three governorates Amman, Balqa, and Ma’daba, low-rate clusters were found with regard to the remaining governorates. All governorates, except Irbid and Mafraq, showed significant rates of increase of cancer incidence. However, no clear seasonality pattern with respect to cancer incidence was discerned.

P0671THE ASSOCIATION BETWEEN HYPERKALAEMIA RISK AND CARDIOVASCULAR AND RENAL COMORBIDITIES IN A LARGE REAL-WORLD COHORT OF CKD PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Louise Hoskin ◽  
Karolina Badora ◽  
Phil McEwan ◽  
Daniel Sugrue ◽  
Lei Qin ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Real World ◽  
Index Date ◽  
Fold Increase ◽  
Read Code ◽  
Crude Incidence Rate ◽  
Crude Incidence ◽  
Comorbidity Burden ◽  
Look Back ◽  
The Uk

Abstract Background and Aims Approximately 275.9 million people globally and 5.6 million people in the UK are living with chronic kidney disease (CKD). The risk of hyperkalaemia (HK) is elevated in CKD due to renal impairment and may increase further upon treatment with renin-angiotensin-aldosterone system inhibitors, which are commonly used in many cardiovascular and renal conditions. This study aimed to assess the relationship between comorbidity burden and HK risk in a large cohort of UK CKD patients. Method Primary and secondary care data from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) were used to identify patients aged ≥18 years who had a diagnosis of stage 3+ CKD (identified as either a READ code for non-dialysis CKD stage 3+ or an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73m2 without a prior READ code for dialysis) during the study period (2008–June 2018) or the five-year look-back period (2003–2007). Patient’s index date was 1st January 2008 or the first date of CKD diagnosis, whichever occurred later. Diagnoses based on the presence of READ codes were used to define the accumulation of further cardiovascular or renal comorbidities of interest (resistant hypertension, heart failure, diabetes or dialysis-dependent CKD). The incidence of HK was defined as serum potassium (K+) thresholds of ≥5.0, ≥5.5 and ≥6.0 mmol/L. Results In total, 297,702 eligible patients had a CKD diagnosis during the study or look back periods and their mean follow-up was 5.6 (SD 3.2) years from index date. At baseline, mean age was 74.7 (11.3) years, mean body mass index was 28.3 (5.9) kg/m2, and 58.6% of patients were female. CKD was the first diagnosis in 169,532 patients (56.9% of all CKD diagnoses), second diagnosis in 92,651 patients (31.1%), third in 32,606 patients (11.0%) and fourth or fifth in 2,913 patients (1.0%); however, only 11,129 CKD patients (3.74%) developed four or more comorbidities of interest. In total, 1.5% of the cohort (4,544 patients) progressed to dialysis and 29.6% (88,245 patients) died during the study period. In general, the incidence of HK increased with the number of comorbidities of interest (Figure 1). At a K+ threshold of ≥5.0 mmol/L, crude incidence rate of HK was 286.5 (95% CI: 285.2–287.8) per 1,000 patient-years in patients with CKD only; this increased 2.8-fold to 806.8 (741.5–876.4) in patients with five comorbidities of interest. A similar trend was observed at K+ thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L. A 5.9 fold increase was observed in crude incidence rate of HK (from 59.7 [59.1–60.3] with CKD only, to 350.3 [307.7–397.1] with all five comorbidities) at a threshold of ≥5.5 mmol/L and a 10.6-fold increase (from 9.1 [8.9–9.4] to 96.2 [74.6–122.2]) at the ≥6.0 mmol/L threshold. Conclusion This assessment of a large real-world patient cohort showed that the risk of HK in patients with CKD increases with the number of cardiovascular or renal comorbidities. Emphasis should be put on effective prevention and treatment of HK in CKD, especially in patients with high comorbidity burden.

scholarly journals A population-based longitudinal study of Clostridium difficile infection-related hospitalization in mid-age and older Australians

2016 ◽  
Vol 145 (3) ◽  
pp. 575-582 ◽  
Author(s):  
Y. CHEN ◽  
K. GLASS ◽  
B. LIU ◽  
T.V. RILEY ◽  
R. KORDA ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Cox Regression ◽  
New South ◽  
Population Based ◽  
Crude Incidence ◽  
Median Hospital Stay ◽  
Hospitalization Rates ◽  
South Wales ◽  
Hazard Ratios

SUMMARYClostridium difficile is the principal cause of infectious diarrhoea in hospitalized patients. We investigated the incidence and risk factors for hospitalization due to C. difficile infection (CDI) in older Australians. We linked data from a population-based prospective cohort study (the 45 and Up Study) of 266 922 adults aged ⩾45 years recruited in New South Wales, Australia to hospitalization and death records for 2006–2012. We estimated the incidence of CDI hospitalization and calculated days in hospital and costs per hospitalization. We also estimated hazard ratios (HR) for CDI hospitalization using Cox regression with age as the underlying time variable. Over a total follow-up of 1 126 708 person-years, 187 adults had an incident CDI hospitalization. The crude incidence of CDI hospitalization was 16·6/100 000 person-years, with a median hospital stay of 6 days, and a median cost of AUD 6102 per admission. Incidence increased with age and year of follow-up, with a threefold increase for 2009–2012. After adjustment, CDI hospitalization rates were significantly lower in males than females (adjusted HR 0·6, 95% confidence interval 0·4–0·7). CDI hospitalization rates increased significantly over 2009–2012. There is a need to better understand the increasing risk of CDI hospitalization in women.

scholarly journals Future Incidence of Malignant Mesothelioma in South Korea: Updated Projection to 2038

2021 ◽  
Vol 18 (12) ◽  
pp. 6614
Author(s):  
Kyeongmin Kwak ◽  
Sung-il Cho ◽  
Domyung Paek
Keyword(s):  
South Korea ◽  
Incidence Rate ◽  
Malignant Mesothelioma ◽  
Poisson Model ◽  
Crude Incidence Rate ◽  
Continuous Increase ◽  
Crude Incidence ◽  
Incidence Data ◽  
Rate Of Increase ◽  
Asbestos Consumption

Malignant mesothelioma (MM) is a cancer that is largely caused by exposure to asbestos. Although asbestos is no longer used in South Korea, the incidence of MM continues to increase due to its long latent period. We aimed to update the previous prediction of MM incidence until 2038. We predicted the incidence of MM over the next 20 years (2019–2038) in South Korea using Møller’s age–period–cohort (APC) model and a Poisson regression model based on asbestos consumption. The APC model predicted that the crude incidence rate would increase sharply in men and slowly in women. Despite the sex discrepancy in the rate of increase, the incidence rate for both sexes is expected to continue increasing until 2038. In the Poisson model, the crude incidence rate was predicted to increase continuously until 2038, and far more cases of MM were predicted to occur compared with the results of the APC model. When compared with actual incidence data, the APC model was deemed more suitable than the Poisson model. The APC model predicted a continuous increase over the next 20 years with no peak, suggesting that the incidence of MM will continue to rise far into the future.

scholarly journals Epidemiology of Clinical Hantavirus Infections in Barbados, 2008-2016

2019 ◽  
Author(s):  
Kirk Osmond Douglas ◽  
Thelma Alafia Samuels ◽  
Marquita Gittens-St. Hilaire
Keyword(s):  
Incidence Rate ◽  
Rainy Season ◽  
Epidemiological Data ◽  
Incidence Rates ◽  
Seasonal Distribution ◽  
Entire Population ◽  
National Surveillance ◽  
Crude Incidence Rate ◽  
Crude Incidence ◽  
English Speaking

Analysis of the demographic, temporal and seasonal distribution of hantavirus infections in Barbados was conducted using national surveillance data for 861 laboratory confirmed cases during 2008-2016. The crude incidence rate of hantavirus infections varied from 5.05 to 100.16 per 100,000 persons per year. One major hantavirus epidemic occurred in Barbados during 2010. Hantavirus cases occurred throughout the year with low level transmission during the dry season (December to June) with increased transmission during rainy season (July to November) and a seasonal peak in August. Hantavirus incidence rates were significantly higher in females than males every year during the study period. More than 50% of hantavirus cases were 30 years of age or less. The highest incidence rate (63.36 cases per 100,000 population) was observed among patients 0&ndash;4 years of age. This represents the first epidemiological data for hantavirus disease among an entire population in the English-speaking Caribbean.

scholarly journals 1375Age-standardization to world population and under-estimation of oral cancer burden

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Kishore Chaudhry ◽  
Prashanti Bollu
Keyword(s):  
Oral Cancer ◽  
Incidence Rate ◽  
Cancer Incidence ◽  
Cancer Registries ◽  
Healthcare Services ◽  
Incidence Rates ◽  
International Agency ◽  
World Population ◽  
Crude Incidence Rate ◽  
Crude Incidence

Abstract Background Age-standardization is common for adjustment of unequal population in different ages as it can influence cancer incidence. However, for planning healthcare services (including screening), one needs absolute magnitude since everyone needs intervention. This study assessed the effect of age-standardization on understanding the global differentials in magnitude of oral cancer. Methods Data on cancer incidence rates of oral cancers for 2008-2012, was obtained from the website of international agency for research on cancer for all 334 population-based cancer registries. Scatter plots were prepared between age-standardized and crude incidence rates to assess the ratio between them according to proportion of old people for all countries. Areas with high occurrence of oral cancer were identified. Results The ratio between age-standardized and crude incidence rate was &gt;1 in countries with high proportion of older population (high-development-index countries), indicating an artificial widening of gap between incidence rates between countries due to age-standardization. Six areas had higher crude incidence rate among men than India. Based on the published estimates, the per-unit-population burden in Europe was 6.3% higher than India, while in USA it was merely 12.5% lower than India. Conclusions The perception of low burden of oral cancer in high-economy countries is artificial, brought about by common practice of age-standardization. Key messages Organization of oral cancer screening activities by countries with resources and expertise will provide much needed knowledge on its natural history and efficacy of control strategies.

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