scholarly journals POS0111 DEVELOPMENT OF DAMAGE AND MORTALITY IN AN INCEPTION COHORT OF SLE PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 266.2-267
Author(s):  
C. S. Yee ◽  
V. Farewell ◽  
M. Akil ◽  
P. Lanyon ◽  
C. J. Edwards ◽  
...  
Keyword(s):  
Incidence Rate ◽  
South Asian ◽  
Drug Exposure ◽  
Inception Cohort ◽  
Research Support ◽  
Rate Of Development ◽  
Caroline Gordon ◽  
African Caribbean ◽  
The Uk

Background:There had been very limited data on the development of damage and mortality in an inception cohort of SLE patients who were recruited very soon after diagnosis.Objectives:This study aimed to analyse the development of damage and death in an inception cohort of SLE patients recruited within 1 year of diagnosis with up to 13 years of follow-up.Methods:This was a prospective multi-centre longitudinal study in the UK of SLE patients recruited within 12 months of achieving 1997 ACR revised criteria for SLE. Data were collected on BILAG-2004, BILAG2004-Pregnancy Index (during pregnancy), SLICC/ACR DI (SDI), cumulative drug exposure and death at every visit. Information on cardiovascular risk factors and antiphospholipid syndrome status were also collected. This study ran from 1st January 2005 to 31st December 2017. Mortality and development of damage were analysed.Results:There were 273 patients recruited (91.2% female, 59.3% Caucasian, 17.2% African/Caribbean, 17.2% South Asian) with mean age at recruitment of 38.5 years (SD 14.8). 97.8% had no damage at recruitment (2.2% had SDI score of 1). Median follow-up was 73.4 months (range: 1.8, 153.8) with total follow-up of 1767 patient-years.There were 13 deaths (4.8%): 76.9% female, 84.6% Caucasian, 15.4% South Asian, mean age 62.6 years (± SD 15.8) and mean disease duration 3 years (± SD 1.8). Causes of death were cancer in 5 (38.5%), infection in 3 (23.1%), ischaemic heart disease in 1 (7.7%) and unknown in 4 (30.8%).114 new damage items in 83 patients occurred during follow-up. The distribution of damage was musculoskeletal (21, 18.4%), ophthalmic (18, 15.8%), neuropsychiatric (18, 15.8%), renal (14, 12.3%), malignancy (12, 10.5%), cutaneous (7, 6.1%), GIT (7, 6.1%), cardiac (6, 5.3%), pulmonary (4, 3.5%), diabetes mellitus (4, 3.5%) and vascular (3, 2.6%). The rate of development of damage appears to be higher in the first 3 years which subsequently stabilised (Table 1).Table 1.Incidence rate of development of damage over period of follow-up at 3 yearly intervalsPeriod of follow-up (year)Person-years at riskNumber of new items of damageIncidence rate, per 1000 person-years (95% CI)0 – 3753.46079.6 (61.8, 102.6)3 – 6534.03158.1 (40.8, 82.6)6 – 9321.21237.4 (21.2, 35.8)9 – 12152.5532.8 (13.6, 78.7)> 125.90-Conclusion:Mortality is uncommon during the first 12 years of follow-up for newly diagnosed SLE patients. However, development of damage appears to be higher in the first 3 years before stabilizing to a lower rate subsequently.Acknowledgements:Versus Arthritis, VIfor PharmaDisclosure of Interests:Chee-Seng Yee Consultant of: Bristol Myer Squibb, ImmuPharma, Grant/research support from: Vifor Pharma, Vernon Farewell: None declared, Mohammed Akil: None declared, Peter Lanyon: None declared, Christopher John Edwards Consultant of: Glaxo Smith Kline, Roche, Grant/research support from: Glaxo Smith Kline, Roche, David Isenberg: None declared, Anisur Rahman: None declared, Lee-Suan Teh: None declared, Sofia Tosounidou: None declared, Robert Stevens: None declared, Ahtiveer Prabu: None declared, Bridget Griffiths: None declared, Neil McHugh: None declared, Ian N. Bruce: None declared, Yasmeen Ahmad: None declared, Munther Khamashta: None declared, Caroline Gordon Speakers bureau: UCB, Consultant of: Center for Disease Control, Astra-Zeneca, MGP, Sanofi and UCB

scholarly journals SAT0500 HOW THE ADULT CRISS WORKS IN PEDIATRIC jSSc PATIENTS - RESULTS FROM THE JUVENILE SCLERODERMA INCEPTION COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1206.2-1206
Author(s):  
J. Klotsche ◽  
I. Foeldvari ◽  
O. Kasapcopur ◽  
A. Adrovic ◽  
K. Torok ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Area Under Curve ◽  
Health Assessment ◽  
Organ Damage ◽  
Left Ventricular ◽  
Inception Cohort ◽  
Research Support ◽  
Predicted Probability ◽  
New Onset

Background:The Composite Response Index in Systemic Sclerosis (CRISS) was developed by Dinesh Khanna as a response measure in patients with adult systemic sclerosis. CRISS aims to capture the complexity of systemic sclerosis and to provide a sensitive measure for change in disease activity. The CRISS score is based on a two-step approach. First, significant disease worsening or new-onset organ damage is defined as non-responsiveness. In patients who did not fulfill the criteria of part one, a probability of improvement is calculated for each patient based the Rodnan Skin Score (mRSS), percent predicted forced vital capacity (FVC%), patient and physician global assessments (PGA), and the Health Assessment Questionnaire Disability Index (HAQ-DI). A probability of 0.6 or higher indicates improvement.Objectives:The objective of this study was to validate the CRISS in a prospectively followed cohort of patients with juvenile systemic sclerosis (jSSc).Methods:Data from the prospective international inception cohort for jSSc was used to validate the CRISS. Patients with an available 12-months follow-up were included in the analyses. Clinically improvement was defined by the anchor question about improvement (much better or little better versus almost the same, little worse or much worse) in patients overall health due to scleroderma since the last visit provided by the treating physician.Results:Forty seven jSSc patients were included in the analysis. 74.2% had diffuse subtype. The physician rated the disease as improved in 34 patients (72.3%) since the last visit. No patient had a renal crisis or new onset of left ventricular failure during the 12-months follow-up. Three patients (3.4%) each had a new onset or worsening of lung fibrosis and new onset of pulmonary arterial hypertension. In total, 6 patients resulted in a rating of not improved based on the CRISS in part I. The mRSSS, FVC%, CHAQ and PGA significantly improved during the 12-months follow-up in patients who were rated as improved. The predicted probability based on the CRISS algorithm resulted in an area under curve of 0.77 predicting the anchor question of improvement. In summary, 33 (70.0%) patients were correctly classified by the adult CRISS score resulting in an overall area under curve of 0.7.Conclusion:The CRISS score was evaluated in a pediatric jSSc cohort for the first time. It showed a good performance. However, it seems that the formula of part II of the CRISS score needs a calibration to pediatric jSSc patients.Disclosure of Interests:Jens Klotsche: None declared, Ivan Foeldvari Consultant of: Novartis, Ozgur Kasapcopur: None declared, Amra Adrovic: None declared, Kathryn Torok: None declared, Valda Stanevicha: None declared, Jordi Anton Grant/research support from: grants from Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Grant/research support from: Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Consultant of: Novartis, Sobi, Pfizer, abbvie, Consultant of: Novartis, Sobi, Pfizer, abbvie, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, edoardo marrani: None declared, Maria T. Terreri: None declared, Flávio R. Sztajnbok: None declared, Cristina Battagliotti: None declared, Lillemor Berntson Consultant of: paid by Abbvie as a consultant, Speakers bureau: paid by Abbvie for giving speaches about JIA, Despina Eleftheriou: None declared, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Farzana Nuruzzaman: None declared, Nicola Helmus: None declared

scholarly journals Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study

EP Europace ◽  
2020 ◽  
Author(s):  
Gabrielle Norrish ◽  
Henry Chubb ◽  
Ella Field ◽  
Karen McLeod ◽  
Maria Ilina ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Implantable Cardioverter Defibrillator ◽  
Incidence Rate ◽  
Clinical Outcomes ◽  
Cardioverter Defibrillator ◽  
National Cohort ◽  
Icd Shock ◽  
The Uk ◽  
Device Complications

Abstract Aims Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. Methods and results Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28–111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9–7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4–2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. Conclusion In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.

scholarly journals FRI0325 UVEITIS OCCURRENCE IN EARLY INFLAMMATORY BACK PAIN. FIVE YEARS DATA FROM A PROSPECTIVE FRENCH NATIONWIDE COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 754.1-755
Author(s):  
D. Wendling ◽  
C. Prati ◽  
T. Lequerre ◽  
C. Miceli Richard ◽  
M. Dougados ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Back Pain ◽  
Incidence Rate ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Recent Onset ◽  
History Of ◽  
Observational Cohort ◽  
Baseline Factors

Background:Uveitis is the most frequent extra rheumatological manifestation in axial Spondyloarthritis (SpA). DESIR is a prospective multicenter cohort of patients with early inflammatory back pain suggestive of SpA. We reported previously a 8.5% baseline prevalence of uveitis for the patients included in the cohort; this history of uveitis at the first visit of the cohort was associated with inflammatory bowel disease (IBD) and preceding infection (1).Objectives:The aim of the study was to evaluate the prevalence and incidence of uveitis over the first five years of prospective follow-up of the cohort, and to evaluate its associated factors.Methods:DESIR is a prospective observational cohort of patients with recent onset inflammatory back pain (more than 3 months, less than 3 years), suggestive of axial SpA, All available factors in the database were compared between patients with and without uveitis at 5 years, by uni and then multivariate analysis. Baseline factors associated with new cases of uveitis occurrence over the 5 years were also analyzed. Significance: p less than 0.05.Results:After 5 years, 91 patients (out of 480 with complete follow-up) had at least one uveitis episode, giving an estimated prevalence of 18.9% [95%CI: 15.4-22.4]. In multivariate analysis, uveitis was associated with dactylitis (OR 2.92 [2.06 – 4.14]; p=0.002**), ESR > 7mm (median value) (OR 2.19 [1.57 – 3.06]; p=0.018*).New incident uveitis occurred in 31 cases over 5 years, giving an estimated incidence rate of 1.29 [0.84 – 1.74] / 100 patient-years. New incidence of uveitis was associated in multivariate analysis with the following baseline factors: diagnosis of SpA (OR 9.65 [3.21 – 28.96]; p=0.039*), total sacro iliac MRI inflammatory SPARCC score (central reading) over median (OR 3.98 [2.26 – 7]; p=0.015*), dactylitis (OR 4.7 [2.65 – 8.36]; p=0.007**), syndesmophyte score over median (central reading) (OR 0.22 [0.1 – 0.45]; p=0.039*).No significant association was found with HLA-B27, cs or b DMARDs, BASDAI, ASDAS, BASFI.Conclusion:Five-years data of the DESIR cohort allowed an estimation of incidence rate of uveitis of 1.3/100p-y; over five years, uveitis was associated with dactylitis, biologic and sacro iliac MRI inflammation.References:[1]Wendling D, et al.Arthritis Care Res(Hoboken). 2012 Jul;64(7):1089-93.Disclosure of Interests:Daniel Wendling: None declared, Clément Prati: None declared, Thierry Lequerre: None declared, Corinne Miceli Richard: None declared, Maxime Dougados Grant/research support from: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Speakers bureau: AbbVie, Eli Lilly, Merck, Novartis, Pfizer and UCB Pharma, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB, xavier guillot: None declared

scholarly journals POS1034 RESPONSE TO SEQUENTIAL LINES OF BIOLOGICAL THERAPY IN PSORIATIC ARTHRITIS: A SINGLE CENTRE COHORT STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 789.2-790
Author(s):  
A. Abdalla ◽  
A. Rambojun ◽  
L. C. Coates ◽  
E. Korendowych ◽  
N. Mchugh ◽  
...  
Keyword(s):  
Clinical Response ◽  
Patient Reported Outcomes ◽  
Routine Care ◽  
First Line ◽  
Single Centre ◽  
Research Support ◽  
Patient Reported ◽  
Line Of Therapy ◽  
The Uk

Background:Biologic interventions using highly specific immuno-modulatory biologic disease-modifying anti-rheumatic drugs (bDMARDs) represent a rapidly developing therapeutic approach to the treatment of Psoriatic Arthritis (PsA). However, despite high rates of response, adverse events, primary and secondary inefficacy are common, and multiple sequential lines of bDMARDs are often required. Data on drug persistence, as a surrogate for response, from national registries indicates switching has become accepted routine practice. One third of patients will fail or discontinue their first biologic with a significant proportion switching on to a 3rd biologic or higher.1-4 Due to a lack of evidence on the response to sequential therapies, individual patients may not have further lines routinely funded after three bDMARDs in the UK. While limiting lines of therapy remains a UK concern, many countries with rationed healthcare systems follow the UK model of drug usage.Objectives:To describe the response to sequential lines of bDMARD therapy prescribed in routine care in a UK single centre cohort.Methods:A retrospective sample of patients with PsA who fulfilled CASPAR criteria and had received at least one bDMARD were taken from the Bath longitudinal cohort for inclusion in the study. Clinical and laboratory variables that constitute physician and patient-reported outcome measures were collected at baseline and after a median (range) follow-up of 3 months (2-5) into their respective therapy line in accordance with the National Institute for Health and Care Excellence (NICE) rules. The mean change with a 95% confidence interval (CI) was used to report the difference between the baseline and follow-up measures. All patients provided consent to use their data collected during routine care, and ethical approval by the local committee was granted.Results:The patients mean age was 57.7 (SD 12.2) with a median (range) disease duration of 14.4 years (9.7 – 23.2). Data was available for 194 patients commencing 1st line bDMARD, 106 (2nd line), 93 (3rd line), 33 (4th line), 12 (5th line), and 9 (6th line and higher) from a total of 759 patients in the cohort. Mean tender and swollen joint count at baseline 1st bDMARD was 7 (SD 4.7) and 22 (SD 14.0), pain visual analogue scale 50 (SD 27.6) and PASI 1.3 (SD 2.2). Reasons for changing biological therapies include lack or loss of efficacy, intolerance, side effects, and comorbidities. Mean levels of joint disease at drug initiation did not diminish with subsequent lines of therapy. Clinical and patient reported outcomes by line of therapy are reported in Figure 1. Clinical responses were greatest to first line bDMARD, however clinically relevant DAPSA improvements were seen up to 5th line. Absolute levels of psoriasis in the cohort were low, however improvement in PASI was achieved across all lines of therapy. Patient and Physician Global Assessments (1-5 on Likert scale) and the Pain Visual analogue score (VAS on 1-10 Likert scale) showed a similar trend with greatest improvement to first line treatment across all lines of therapy.Conclusion:In this study we report the clinical response to sequential lines of bDMARD therapy for active PsA in routine clinical practice. Clinical response was greatest to the first line bDMARD but overall improvement in DAPSA, PASI or pain response did not appear to diminish up to 5th line. Further study in larger cohorts is required to confirm this finding and build on our understanding of clinical response to sequential lines of bDMARD therapy.References:[1]Hyrish et al 2006 Rheum 45, 1558-65[2]Kawabe A. 2020 Arth Res Ther 22, 136[3]Park DJ. 2017 Clin Rheum 36, 1013-22[4]Karlsson. 2007 JA Rheum 47,507-13Figure 1.Clinical and patient reported outcomes by line of therapyDisclosure of Interests:Abuelmagd Abdalla: None declared, Adwaye Rambojun: None declared, Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB., Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Eleanor Korendowych Consultant of: Abbvie, Celgene, Janssen, Lilly and Novartis., Neil McHugh: None declared, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc., and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc., and UCB., Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc., and UCB.

SAT0062 INCIDENCE OF STAPHYLOCOCCUS AUREUS BACTEREMIA IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 964.1-964
Author(s):  
S. Dieperink ◽  
B. Glintborg ◽  
L. B. Oestergaard ◽  
M. Nørgaard ◽  
T. Benfield ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Staphylococcus Aureus ◽  
General Population ◽  
Incidence Rate ◽  
Orthopaedic Implant ◽  
Research Support ◽  
Population Cohort ◽  
General Population Cohort ◽  
First Time

Background:Staphylococcus aureusis a frequent cause of bacteremia (SAB) associated with high mortality and morbidity. Patients with rheumatoid arthritis (RA) are at increased risk of septic arthritis and prosthetic joint infection withS. aureus.Objectives:To assess the incidence rate (IR) of first-time SAB in patients with RA and to estimate the incidence rate ratio (IRR) of SAB with a general population cohort without RA serving as the reference.Methods:Individuals with no prior history of SAB or RA were included consecutively from 31 December 1996, their 18th birthday or date of immigration, whichever came latest, and followed until first-time SAB, death, emigration or 31 December 2017, whichever came first. Information on RA diagnosis, vital status, age, sex, place of residence, comorbidities, medication and first-time SAB were achieved on an individual level through cross-linkage between five virtually complete Danish nationwide registries (Civil Registration System, National Patient Registry, Register of Medicinal Product Statistics, DANBIO rheumatology registry and the SAB database). We used Poisson regression to estimate adjusted IRRs overall and stratified by age and sex.Results:In total, 6,127,150 individuals were included of whom 34,627 individuals developed RA. In the RA cohort, 228 first-time SAB events occurred during 283,186 person years (PY) of follow-up (IR 80.5/100,000 PY) compared with 25,268 events during 87,521,120 PY of follow-up in the general population cohort (IR 28.9/100,000 PY). Median follow-up was 7.2 years (IQR 3.5-12.3) after RA diagnosis and 18.7 years (IQR 6.8-21) in the general population cohort. Individuals with RA who developed SAB were more often women, had an orthopaedic implant and had recent use of glucocorticoids compared with individuals with SAB without RA. (Table 1) IRs of SAB were higher among patients with RA compared with the general population in all age categories. The IRs increased with age and were higher in men, both in patients with RA and in the general population cohort. After adjustment, the IRR remained higher for individuals younger than 70 years with RA compared with the general population but was similar for older individuals. (Figure 1)Conclusion:In this nationwide cohort with more than 25,000 observed first-time SAB events, patients with RA younger than 70 years old had a 1.5-2 times higher incidence rate compared with the general population. The significance of anti-rheumatic treatments on risk and the prognosis of SAB in patients with RA remain to be explored.Acknowledgments:We wish to thank patient representative Pia Lüchau PedersenDisclosure of Interests:Sabine Dieperink: None declared, Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Louise Bruun Oestergaard: None declared, Mette Nørgaard: None declared, Thomas Benfield Grant/research support from: Pfizer, Novo Nordisk and GSK, Frank Mehnert: None declared, Andreas Petersen: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis

First-contact incidence rate of schizophrenia on Barbados

1999 ◽  
Vol 175 (1) ◽  
pp. 28-33 ◽  
Author(s):  
George E. Mahy ◽  
Rosemarie Mallett ◽  
Julian Leff ◽  
Dinesh Bhugra
Keyword(s):  
Incidence Rate ◽  
High Rate ◽  
World Health ◽  
Measurement Instruments ◽  
Comparable Rate ◽  
The United Kingdom ◽  
African Caribbean ◽  
Health Organization ◽  
The Uk ◽  
First Contact

BackgroundThe incidence rate for broad schizophrenia among second-generation African–Caribbean people in the United Kingdom has been reported as high. Ethnicity, migration and psychosocial stressors have been suggested as causal factors.AimsTo determine the incidence of schizophrenia for the whole population of Barbados using an identical methodology to two previous studies in Trinidad (Bhugra et al, 1996) and London (Bhugra et al, 1997)MethodA12-month study of all persons in the 18–54-year age group presenting with a psychosis for the first time was carried out on the population of Barbados. Information was collected using World Health Organization screening and measurement instruments.ResultsOn an island of just over a quarter of a million, 40 out of the 53 patients that met the inclusion criteria were categorised as S+ (narrow) schizophrenia, giving an incidence rate of 2.8/10 000 (95% CI 1.97–3.7). The incidence rate for broad schizophrenia was calculated at 3.2/10 000 (95% CI 2.3–4.1), which is significantly lower than the comparable rate for London's African–Caribbeans of 6.6/10000 (95% CI 4.5–8.7)ConclusionsThe very high rate for broad schizophrenia among African–Caribbean people in the UK is probably due to environmental factors.

scholarly journals Ethnic differences in guideline-indicated statin initiation for people with type 2 diabetes in UK primary care, 2006–2019: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (6) ◽  
pp. e1003672
Author(s):  
Sophie V. Eastwood ◽  
Rohini Mathur ◽  
Naveed Sattar ◽  
Liam Smeeth ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
South Asian ◽  
Ethnic Differences ◽  
Asian Ethnicity ◽  
African Caribbean ◽  
South Asian Ethnicity ◽  
Ascvd Risk ◽  
The Uk ◽  
To Receive

Background Type 2 diabetes is 2–3 times more prevalent in people of South Asian and African/African Caribbean ethnicity than people of European ethnicity living in the UK. The former 2 groups also experience excess atherosclerotic cardiovascular disease (ASCVD) complications of diabetes. We aimed to study ethnic differences in statin initiation, a cornerstone of ASCVD primary prevention, for people with type 2 diabetes. Methods and findings Observational cohort study of UK primary care records, from 1 January 2006 to 30 June 2019. Data were studied from 27,511 (88%) people of European ethnicity, 2,386 (8%) people of South Asian ethnicity, and 1,142 (4%) people of African/African Caribbean ethnicity with incident type 2 diabetes, no previous ASCVD, and statin use indicated by guidelines. Statin initiation rates were contrasted by ethnicity, and the number of ASCVD events that could be prevented by equalising prescribing rates across ethnic groups was estimated. Median time to statin initiation was 79, 109, and 84 days for people of European, South Asian, and African/African Caribbean ethnicity, respectively. People of African/African Caribbean ethnicity were a third less likely to receive guideline-indicated statins than European people (n/N [%]: 605/1,142 [53%] and 18,803/27,511 [68%], respectively; age- and gender-adjusted HR 0.67 [95% CI 0.60 to 0.76], p < 0.001). The HR attenuated marginally in a model adjusting for total cholesterol/high-density lipoprotein cholesterol ratio (0.77 [95% CI 0.69 to 0.85], p < 0.001), with no further diminution when deprivation, ASCVD risk factors, comorbidity, polypharmacy, and healthcare usage were accounted for (fully adjusted HR 0.76 [95% CI 0.68, 0.85], p < 0.001). People of South Asian ethnicity were 10% less likely to receive a statin than European people (1,489/2,386 [62%] and 18,803/27,511 [68%], respectively; fully adjusted HR 0.91 [95% CI 0.85 to 0.98], p = 0.008, adjusting for all covariates). We estimated that up to 12,600 ASCVD events could be prevented over the lifetimes of people currently affected by type 2 diabetes in the UK by equalising statin prescribing across ethnic groups. Limitations included incompleteness of recording of routinely collected data. Conclusions In this study we observed that people of African/African Caribbean ethnicity with type 2 diabetes were substantially less likely, and people of South Asian ethnicity marginally less likely, to receive guideline-indicated statins than people of European ethnicity, even after accounting for sociodemographics, healthcare usage, ASCVD risk factors, and comorbidity. Underuse of statins in people of African/African Caribbean or South Asian ethnicity with type 2 diabetes is a missed opportunity to prevent cardiovascular events.

scholarly journals Does racial discrimination cause mental illness?

2002 ◽  
Vol 180 (06) ◽  
pp. 475-477 ◽  
Author(s):  
Apu Chakraborty ◽  
Kwame McKenzie
Keyword(s):  
Mental Illness ◽  
Racial Discrimination ◽  
Ethnic Groups ◽  
South Asian ◽  
Prevalence Rates ◽  
High Incidence ◽  
African Caribbean ◽  
The Uk ◽  
Caribbean Populations

Different rates of mental illness have been reported in ethnic groups in the UK (Nazroo, 1997). Early work was criticised because of methodological flaws but more rigorous studies have confirmed high community prevalence rates of depression in both South Asian and African-Caribbean populations (Nazroo, 1997), high incidence and prevalence rates of psychosis in African-Caribbean groups (see Bhugra &amp; Cochrane, 2001, for review), and higher rates of suicide in some South Asian groups (Neeleman et al, 1997) compared with the White British population. Similarly high rates have not been reported in the countries of origin of these groups (Hickling &amp; Rodgers-Johnson, 1995; Patel &amp; Gaw, 1996), which has led to a search for possible causes within the UK.

Sign in / Sign up

Export Citation Format

Share Document