Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden

ObjectivesTo describe the incidence of atrioventricular (AV) block II–III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis (PsA) compared with the general population (GP) and with each other.MethodsA prospective nationwide study with cohorts of patients with AS (n=6448), PsA (n=16 063) and uSpA (n=5190) and a GP (n=2 66 435) cohort, identified in 2001–2009 in the Swedish National Patient and Population registers. Follow-up began on 1 January 2006 and ended at event, death, emigration or 31 December 2012. Age-standardised and sex-standardised incidence rates and hazard ratios (HRs) were calculated.ResultsThe highest incidence rates were noted for AF (5.5–7.4 events per 1000 person-years), followed by PM (1.0–2.0 events per 1000 person-years). HRs for AV block, AF, PM and aortic regurgitation were significantly increased in AS (HRs 2.3, 1.3, 2.1 and 1.9), uSpA (HRs 2.9, 1.3, 1.9 and 2.0) and PsA (HRs 1.5, 1.5, 1.6 and 1.8) compared with the GP cohort. The highest HRs were seen for AV block in male uSpA (HR 4.2) and AS (HR 2.5) compared with GP. Compared with PsA, significantly increased HRs were noted for PM (HR 1.5) in AS and for AV block (HR 1.8) in uSpA.ConclusionsPatients with SpA are at increased risk of aortic regurgitation, cardiac rhythm disturbances and, as a probable consequence, also PM. Particularly for AF, the most common arrhythmia, increased caution is warranted, whereas AV block should be looked for especially in men with AS or uSpA.

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Sarcoidosis mortality in Sweden: a population-based cohort study

European Respiratory Journal ◽

10.1183/13993003.01815-2017 ◽

2018 ◽

Vol 51 (2) ◽

pp. 1701815 ◽

Cited By ~ 23

Author(s):

Marios Rossides ◽

Susanna Kullberg ◽

Johan Askling ◽

Anders Eklund ◽

Johan Grunewald ◽

...

Keyword(s):

General Population ◽

Large Population ◽

Population Based ◽

Disease Heterogeneity ◽

International Classification Of Disease ◽

Risk Of Death ◽

Drug Register ◽

Hazard Ratios ◽

Increased Risk ◽

National Patient

We aimed to investigate sarcoidosis mortality in a large, population-based cohort, taking into account disease heterogeneity.Individuals with incident sarcoidosis (n=8207) were identified from the Swedish National Patient Register using International Classification of Disease codes (2003‒2013). In a subset, cases receiving treatment ±3 months from diagnosis were identified from the Prescribed Drug Register. Nonsarcoidosis comparators from the general population were matched to cases 10:1 on birth year, sex and county. Individuals were followed for all-cause death in the Cause of Death Register. Adjusted mortality rates, rate differences and hazard ratios (HRs) were estimated, stratifying by age, sex and treatment status.The mortality rate was 11.0 per 1000 person-years in sarcoidosis versus 6.7 in comparators (rate difference 2.7 per 1000 person-years). The HR for death was 1.61 (95% CI 1.47‒1.76), with no large variation by age or sex. For cases not receiving treatment within the first 3 months, the HR was 1.13 (95% CI 0.94‒1.35). The HR was 2.34 (95% CI 1.99‒2.75) for those receiving treatment.Individuals with sarcoidosis are at a higher risk of death compared to the general population. For the majority, the increased risk is small. However, patients whose disease leads to treatment around diagnosis have a two-fold increased risk of death. Future interventions should focus on this vulnerable group.

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Increased Risk for Other Cancers in Addition to Breast Cancer for CHEK2*1100delC Heterozygotes Estimated From the Copenhagen General Population Study

Journal of Clinical Oncology ◽

10.1200/jco.2015.63.3594 ◽

2016 ◽

Vol 34 (11) ◽

pp. 1208-1216 ◽

Cited By ~ 50

Author(s):

Charlotte Näslund-Koch ◽

Børge G. Nordestgaard ◽

Stig E. Bojesen

Keyword(s):

Breast Cancer ◽

General Population ◽

Population Study ◽

Cell Cycle Checkpoint ◽

Loss Of Function ◽

General Population Study ◽

Chek2 1100Delc ◽

Hazard Ratios ◽

Increased Risk ◽

Age And Sex

Purpose CHEK2 is a cell cycle checkpoint regulator, and the CHEK2*1100delC germline mutation leads to loss of function and increased breast cancer risk. It seems plausible that this mutation could also predispose to other cancers. Therefore, we tested the hypothesis that CHEK2*1100delC heterozygosity is associated with increased risk for other cancers in addition to breast cancer in the general population. Patients and Methods We examined 86,975 individuals from the Copenhagen General Population Study, recruited from 2003 through 2010. The participants completed a questionnaire on health and lifestyle, were examined physically, had blood drawn for DNA extraction, were tested for presence of CHEK2*1100delC using Taqman assays and sequencing, and were linked over 1943 through 2011 to the Danish Cancer Registry. Incidences and risks of individual cancer types, including breast cancer, were calculated using Kaplan-Meier estimates, Fine and Gray competing-risks regressions, and stratified analyses with interaction tests. Results Among 86,975 individuals, 670 (0.8%) were CHEK2*1100delC heterozygous, 2,442 developed breast cancer, and 6,635 developed other cancers. The age- and sex-adjusted hazard ratio for CHEK2*1100delC heterozygotes compared with noncarriers was 2.08 (95% CI, 1.51 to 2.85) for breast cancer and 1.45 (95% CI, 1.15 to 1.82) for other cancers. When stratifying for sex, the age-adjusted hazard ratios for other cancers were 1.54 (95% CI, 1.08 to 2.18) for women and 1.37 (95% CI, 1.01 to 1.85) for men (sex difference: P = .63). For CHEK2*1100delC heterozygotes compared with noncarriers, the age- and sex-adjusted hazard ratios were 5.76 (95% CI, 2.12 to 15.6) for stomach cancer, 3.61 (95% CI, 1.33 to 9.79) for kidney cancer, 3.45 (95% CI, 1.09 to 10.9) for sarcoma, and 1.60 (95% CI, 1.00 to 2.56) for prostate cancer. Conclusion CHEK2*1100delC heterozygosity is associated with 15% to 82% increased risk for at least some cancers in addition to breast cancer. This information may be useful in clinical counseling of patients with this loss-of-function mutation.

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Risk of first and recurrent serious infection in sarcoidosis: a Swedish register-based cohort study

European Respiratory Journal ◽

10.1183/13993003.00767-2020 ◽

2020 ◽

Vol 56 (3) ◽

pp. 2000767 ◽

Cited By ~ 1

Author(s):

Marios Rossides ◽

Susanna Kullberg ◽

Anders Eklund ◽

Daniela Di Giuseppe ◽

Johan Grunewald ◽

...

Keyword(s):

General Population ◽

International Classification Of Diseases ◽

Parametric Models ◽

National Patient Register ◽

Patient Register ◽

Drug Register ◽

Serious Infection ◽

Increased Risk ◽

Serious Infections ◽

National Patient

Serious infections impair quality of life and increase costs. Our aim was to determine if sarcoidosis is associated with a higher rate of serious infection and whether this varies by age, sex, time since diagnosis or treatment status around diagnosis.We compared individuals with sarcoidosis (at least two International Classification of Diseases codes in the Swedish National Patient Register 2003–2013; n=8737) and general population comparators matched 10:1 on age, sex and residential location (n=86 376). Patients diagnosed in 2006–2013 who were dispensed at least one immunosuppressant ±3 months from diagnosis (Swedish Prescribed Drug Register) were identified. Cases and comparators were followed in the National Patient Register for hospitalisations for infection. Using Cox and flexible parametric models, we estimated adjusted hazard ratios (aHR) and 95% confidence intervals for first and recurrent serious infections (new serious infection >30 days after previous).We identified 895 first serious infections in sarcoidosis patients and 3881 in comparators. The rate of serious infection was increased 1.8-fold in sarcoidosis compared to the general population (aHR 1.81, 95% CI 1.65–1.98). The aHR was higher in females than males and during the first 2 years of follow-up. Sarcoidosis cases treated with immunosuppressants around diagnosis had a three-fold increased risk, whereas nontreated patients had a 50% increased risk. The rate of serious infection recurrence was 2.8-fold higher in cases than in comparators.Serious infections are more common in sarcoidosis than in the general population, particularly during the first few years after diagnosis. Patients who need immunosuppressant treatment around diagnosis are twice as likely to develop a serious infection than those who do not.

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Marked Increase in Incident Gynecomastia: A 20-Year National Registry Study, 1998 to 2017

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa440 ◽

2020 ◽

Vol 105 (10) ◽

pp. 3134-3140 ◽

Cited By ~ 1

Author(s):

Trine Koch ◽

Elvira V Bräuner ◽

Alexander S Busch ◽

Martha Hickey ◽

Anders Juul

Keyword(s):

Age Groups ◽

Population Based ◽

Incidence Rates ◽

National Registry ◽

Registry Study ◽

Age Related ◽

Danish Health ◽

Increased Risk ◽

National Patient ◽

First Time

Abstract Context Gynecomastia, the proliferation of mammary glandular tissue in the male, is a frequent but little-studied condition. Available prevalence data are based on selected patient populations or autopsy cases with their inherent bias. Objective The objective of this work is to evaluate the age-related incidence and secular trends in gynecomastia in the general population. Design An observational, 20-year national registry study was conducted. Setting This population-based study used nationwide registry data. Participants Participants included all Danish males (age 0-80 years) with a first-time diagnosis of gynecomastia. Main Outcome Measures All Danish males (age 0-80 years) were followed up for incident diagnosis of gynecomastia in the Danish National Patient Registry from 1998 to 2017 using the International Codes of Diseases, 10th revision, and the Danish Health Care Classification System. Age-specific incidence rates were estimated. The hypothesis tested in this study was formulated prior to data collection. Results Overall, a total 17 601 males (age 0-80 years) were registered with an incident diagnosis of gynecomastia within the 20-year study period, corresponding to 880 new cases per year and an average 20-year incidence of 3.4 per 10 000 men (age 0-80 years). The average annual incidence was 6.5/10 000 in postpubertal males age 16 to 20 years and 4.6/10 000 in males age 61 to 80 years, with a respective 5- and 11-fold overall increase in these 2 age groups over the 20-year period. Conclusions The incidence of gynecomastia has dramatically increased over the last 20 years, implying that the endogenous or exogenous sex-steroid environment has changed, which is associated with other adverse health consequences in men such as an increased risk of prostate cancer, metabolic syndrome, type 2 diabetes, or cardiovascular disorders.

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Multi-Fetal Pregnancy, Preeclampsia, and Long-Term Cardiovascular Disease

Hypertension ◽

10.1161/hypertensionaha.120.14860 ◽

2020 ◽

Vol 76 (1) ◽

pp. 167-175 ◽

Cited By ~ 1

Author(s):

Lina Bergman ◽

Paliz Nordlöf-Callbo ◽

Anna Karin Wikström ◽

Jonathan M. Snowden ◽

Susanne Hesselman ◽

...

Keyword(s):

Cardiovascular Disease ◽

Inflammatory Factors ◽

Singleton Pregnancy ◽

Medical Birth Register ◽

Hazard Ratios ◽

Increased Risk ◽

National Patient ◽

Swedish Medical ◽

Cox Proportional Hazard Regression ◽

Joint Contribution

This Swedish register-based cohort study determined the separate and joint contribution of preeclampsia and multi-fetal pregnancy on a woman’s risk of cardiovascular disease (CVD) later in life. The study included 892 425 first deliveries between 1973 and 2010 of women born 1950 until 1971, identified in the Swedish Medical Birth Register. A composite outcome of CVD was retrieved through linkage with the National Patient and Cause of Death Registers. Cox proportional hazard regression was used to assess the risk of CVD in women who had preeclampsia in a singleton or multi-fetal pregnancy, adjusting for potential confounders, and presented as adjusted hazard ratios. Compared with women who had a singleton pregnancy without preeclampsia (the referent group), women with preeclampsia in a singleton pregnancy had an increased risk of CVD (adjusted hazard ratio 1.75 [95% CI, 1.64–1.86]). Women who had a multi-fetal pregnancy without or with preeclampsia did not have an increased risk of future CVD (adjusted hazard ratios 0.94 [95% CI, 0.79–1.10] and 1.25 [95% CI, 0.83–1.86], respectively). As opposed to preeclampsia in a first singleton pregnancy, preeclampsia in a first multi-fetal pregnancy was not associated with increased risk of future CVD. This may support the theory that preeclampsia in multi-fetal pregnancies more often occurs as a result of the larger pregnancy-related burden on the maternal cardiovascular system and excessive placenta-shed inflammatory factors, rather than the woman’s underlying cardiovascular phenotype.

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Trends of venous thromboembolism risk before and after diagnosis of gout: a general population-based study

Rheumatology ◽

10.1093/rheumatology/kez398 ◽

2019 ◽

Vol 59 (5) ◽

pp. 1099-1107 ◽

Cited By ~ 5

Author(s):

Lingyi Li ◽

Natalie McCormick ◽

Eric C Sayre ◽

John M Esdaile ◽

Diane Lacaille ◽

...

Keyword(s):

Venous Thromboembolism ◽

General Population ◽

Population Based ◽

Incidence Rates ◽

Vein Thrombosis ◽

Hazard Ratios ◽

Thrombosis Risk ◽

Before And After ◽

Health Database ◽

Deep Vein

Abstract Objective To estimate the overall risk and the temporal trend of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) before and after gout diagnosis in an incident gout cohort compared with the general population. Methods We conducted a matched cohort study using a province-wide population-based administrative health database in Canada. We calculated incidence rates (IRs) and multivariable adjusted hazard ratios (HRs) for the risk of VTE, DVT and PE before and after gout diagnosis. Results Among 130 708 incident individuals with gout (64% male, mean age 59 years), 2071 developed VTE, 1377 developed DVT and 1012 developed PE. IRs per 1000 person-years for gout were 2.63, 1.74 and 1.28 compared with 2.03, 1.28 and 1.06 for non-gout, respectively. The fully adjusted HRs (95% CI) for VTE, DVT and PE were 1.22 (1.13, 1.32), 1.28 (1.17, 1.41) and 1.16 (1.05, 1.29). For the pre-gout period, the fully adjusted HRs (95% CI) were 1.51 (1.38, 1.64), 1.55 (1.40, 1.72) and 1.47 (1.31, 1.66) for VTE, DVT and PE. During the third, second and first years preceding gout, the fully adjusted HRs for VTE were 1.44, 1.56 and 1.62. During the first, second, third, fourth and fifth years after gout, the fully adjusted HRs were 1.63, 1.29, 1.33, 1.28 and 1.22. Similar trends were also seen for DVT and PE. Conclusion Increased risks of VTE, DVT and PE were found both before and after gout diagnosis. The risk increased gradually before gout, peaking in the year prior to diagnosis, and then progressively declined. Gout-associated inflammation may contribute to venous thrombosis risk.

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Increased risk of hyperlipidemia in patients with anxiety disorders: A population-based study

10.21203/rs.2.24509/v1 ◽

2020 ◽

Author(s):

I-Chia Chien ◽

Ching-Heng Lin

Keyword(s):

General Population ◽

Confidence Interval ◽

Anxiety Disorders ◽

Incidence Rate ◽

Prevalence Rate ◽

Female Gender ◽

Incidence Rates ◽

Secondary Diagnosis ◽

Increased Risk ◽

Incident Cases

Abstract Objective This study examined the prevalence and incidence of hyperlipidemia among patients with anxiety disorders in Taiwan. Methods We used a large dataset containing random samples, and more than 766,000 subjects who were aged 18 years or older in 2005 were identified. Subjects who had more than one primary or secondary diagnosis of anxiety disorders were identified. Individuals who had a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. The prevalence rate of hyperlipidemia in patients with anxiety disorders with that of the general population in 2005 was compared. We then followed this cohort to monitor incident cases of hyperlipidemia in anxiety patients, and assessed whether a difference existed from the general population during the period 2006–2010. Results A higher prevalence rate of hyperlipidemia in patients with anxiety disorders was observed as compared with the general population (21.3% vs. 7.6%, odds ratio 2.14; 95% confidence interval, 2.07–2.22) in 2005. Additionally, a higher average annual incidence rate of hyperlipidemia in patients with anxiety disorders was also found as compared with the general population (5.49% vs. 2.50%, risk ratio 1.64; 95% confidence interval, 1.58–1.70) from 2006 to 2010. Conclusions Patients with anxiety disorders had higher prevalence and incidence rates of hyperlipidemia than the general population. Risk factors that were found to be associated with the higher incidence rate of hyperlipidemia among anxiety patients included a greater age, the female gender, and the presence of diabetes and hypertension.

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Severe COVID-19 in inflammatory bowel disease patients in a population-based setting

PLoS ONE ◽

10.1371/journal.pone.0258271 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258271

Author(s):

Rob H. Creemers ◽

Ashkan Rezazadeh Ardabili ◽

Daisy M. Jonkers ◽

Mathie P. G. Leers ◽

Mariëlle J. Romberg-Camps ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Incidence Rate ◽

Bowel Disease ◽

Clinical Course ◽

Population Based ◽

Incidence Rates ◽

Systemic Medication ◽

Increased Risk ◽

Inflammatory Bowel

Objective Data on the course of severe COVID-19 in inflammatory bowel disease (IBD) patients remains limited. We aimed to determine the incidence rate and clinical course of severe COVID-19 in the heavily affected South-Limburg region in the Netherlands. Methods All COVID-19 patients admitted to the only two hospitals covering the whole South-Limburg region between February 27, 2020 and January 4, 2021 were included. Incidence rates for hospitalization due to COVID-19 were determined for the IBD (n = 4980) and general population (n = 597,184) in South-Limburg. Results During a follow-up of 4254 and 510,120 person-years, 20 IBD patients (0.40%; 11 ulcerative colitis (UC), 9 Crohn’s disease (CD)) and 1425 (0.24%) patients from the general population were hospitalized due to proven COVID-19 corresponding to an incidence rate of 4.7 (95% Confidence interval (CI) 3.0–7.1) and 2.8 (95% CI 2.6–2.9) per 1000 patient years, respectively (Incidence rate ratio: 1.68, 95% CI 1.08–2.62, p = 0.019). Median age (IBD: 63.0 (IQR 58.0–75.8) years vs. general population: 72.0 (IQR 62.0–80.0) years, p = 0.10) and mean BMI (IBD: 24.4 (SD 3.3) kg/m2 vs. general population 24.1 (SD 4.9) kg/m2, p = 0.79) at admission were comparable in both populations. As for course of severe COVID-19, similar rates of ICU admission (IBD: 12.5% vs. general population: 15.7%, p = 1.00), mechanical ventilation (6.3% vs. 11.2%, p = 1.00) and death were observed (6.3% vs. 21.8%, p = 0.22). Conclusion We found a statistically significant higher rate of hospitalization due to COVID-19 in IBD patients in a population-based setting in a heavily impacted Dutch region. This finding reflects previous research that showed IBD patients using systemic medication were at an increased risk of serious infection. However, although at an increased risk of hospitalization, clinical course of severe COVID-19 was comparable to hospitalized patients without IBD.

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Increased risk of malignancy in patients with systemic lupus erythematosus: population-based cohort study in Korea

Arthritis Research & Therapy ◽

10.1186/s13075-021-02648-y ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Jung-Yong Han ◽

Hyoungyoung Kim ◽

Sun-Young Jung ◽

Eun Jin Jang ◽

Soo-Kyung Cho ◽

...

Keyword(s):

Cohort Study ◽

General Population ◽

Reproductive System ◽

Incidence Rates ◽

Crude Incidence ◽

Korean Patients ◽

Solid Malignancies ◽

Increased Risk ◽

Risk Of Malignancy ◽

Haematologic Malignancies

Abstract Background This study aimed to evaluate the crude incidence rates and relative risk of malignancy in Korean patients with SLE. Methods We conducted a retrospective nationwide cohort study using databases from the National Health Insurance Service in Korea. All prevalent SLE patients aged over 19 were identified from January 2012 to December 2014 and observed until the diagnosis of malignancy, death, or end of the study, December 2015. The crude incidence rates (IRs) and standardised incidence ratios (SIRs) of overall and site-specific malignancies in SLE patients were estimated. Results We identified 17,854 SLE patients and during the observation period (60,511 person-years [PYs]), 768 solid malignancies (126.9/10,000 PYs) and 68 haematologic malignancies (11.2/10,000 PYs) occurred in SLE patients. In SLE patients, breast and reproductive system and thyroid cancers occurred predominantly, followed by liver and colon cancers. The SIRs of overall, solid, and haematologic malignancies of SLE patients compared to the general population were 1.8 (95% confidence interval [CI] 1.6–1.9), 1.7 (95% CI 1.5–1.8), and 5.9 (95% CI 4.8–7.3), respectively. In solid malignancies, head and neck (2.7, 95% CI 1.1–4.2), bladder (2.4, 95% CI 1.1–3.8), liver (1.9, 95% CI 1.4–2.3), pancreas (1.9, 95% CI 1.3–2.6), lung (1.8, 95% CI 1.2–2.4), colon (1.7, 95% CI 1.3–2.2), thyroid (1.6, 95% CI 1.3–1.8) and breast and reproductive system (1.5, 95% CI 1.2–1.7) cancers are at increased risk in SLE patients. Conclusion An increased risk of haematologic and solid malignancies was observed in Korean patients with SLE compared to the general population.

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Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.2021.176 ◽

2021 ◽

pp. 1-8

Author(s):

Rebecca Musgrove ◽

Matthew J. Carr ◽

Nav Kapur ◽

Carolyn A. Chew-Graham ◽

Faraz Mughal ◽

...

Keyword(s):

Older Adults ◽

General Population ◽

Cumulative Incidence ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Close Monitoring ◽

Post Discharge ◽

Hazard Ratios ◽

Increased Risk ◽

Working Age

Background Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. Aims To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. Method Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001–2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18–64 and ≥65 years with additional stratification by gender and practice-level deprivation. Results The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0–2.3) and 14.1% (95% CI 13.6–14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0–292.0) among working-age adults and 125.4 (95% CI 52.6–298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. Conclusions Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.

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