Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007−2014: a population-based cohort study from the North Denmark Region

ObjectiveDemand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital.DesignPopulation-based cohort study with linkage of Danish national registries.SettingThe North Denmark Region in 2007–2014.ParticipantsCohort of 148 757 patients transported to hospital by ambulance after calling emergency services.Main outcome measuresThe number of emergency ambulance service patients, distribution of their age, sex, hospital diagnoses, comorbidity, and 1-day and 30-day mortality were assessed by calendar year. Poisson regression with robust variance estimation was used to estimate both age-and sex-adjusted relative risk of death and prevalence ratios for Charlson Comorbidity Index (CCI) to allow comparison by year, with 2007 as reference year.ResultsThe annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48.6%, respectively. The proportion of injuries gradually declined, non-specific diagnoses increased, especially the last year. Proportion of patients with high comorbidity (CCI≥3) increased from 6.4% in 2007 to 9.4% in 2014, corresponding to an age- and sex-adjusted prevalence ratio of 1.27 (95% CI 1.16 to 1.39). The 1-day and 30 day mortality decreased from 2.40% to 1.21% and from 5.01% to 4.36%, respectively, from 2007 to 2014, corresponding to age-adjusted and sex-adjusted relative risk of 0.43 (95% CI 0.37 to 0.50) and 0.72 (95% CI 0.66 to 0.79), respectively.ConclusionDuring the 8-year period, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased.

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ABO Blood Groups and the Incidence of Complications in COVID-19 Patients: A Population-Based Prospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910039 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10039

Author(s):

Salvador Domènech-Montoliu ◽

Joan Puig-Barberà ◽

Maria Rosario Pac-Sa ◽

Paula Vidal-Utrillas ◽

Marta Latorre-Poveda ◽

...

Keyword(s):

Public Health ◽

Cohort Study ◽

Relative Risk ◽

Clinical Analysis ◽

Population Based ◽

Blood Groups ◽

Adjusted Relative Risk ◽

Abo Blood Groups ◽

The Public ◽

Telephone Interviews

After a COVID-19 outbreak in the Falles festival of Borriana (Spain) during March 2020, a cohort of patients were followed until October 2020 to estimate complications post-COVID-19, considering ABO blood groups (ABO). From 536 laboratory-confirmed cases, 483 completed the study (90.1%) carried by the Public Health Center of Castelló and the Emergency and Microbiology and Clinical Analysis of Hospital de la Plana Vila-real. The study included ABO determination and telephone interviews of patients. The participants had a mean age of 37.2 ± 17.1 years, 300 females (62.1%). ABO were O (41.4%), A (45.5%), B (9.1%), and AB (3.9%). We found no difference in the incidence of COVID-19 infections. A total of 159 (32.9%) patients reported one or more post-COVID-19 complications with divergent incidences after adjustment: O (32.3%), A (32.6%), B (54.1%), and AB (27.6%); B groups had more complications post-COVID-19 when compared with O group (adjusted relative risk [aRR] 95% confidence interval [CI] 1.68, 95% CI 1.24–2.27), and symptoms of fatigue (1.79, 95% CI 1.08–2.95), myalgia (2.06, 95% CI 1.10–3.84), headache (2.61, 95% CI 1.58–4.31), and disorder of vision (4.26 95% CI 1.33–13.60). In conclusion, we observed significant differences in post-COVID-19 complications by ABO, with a higher incidence in B group. Additional research is justified to confirm our results.

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Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00874-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Stine Ibsen ◽

Tim Alex Lindskou ◽

Christian H. Nickel ◽

Torben Kløjgård ◽

Erika Frischknecht Christensen ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Chest Pain ◽

Emergency Medical Service ◽

Medical Service ◽

Population Based ◽

Mechanism Of Injury ◽

Short Term ◽

Risk Of Death ◽

Age And Sex

Abstract Background Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1–30 day-mortality for each symptom/ injury. Methods Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016–31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population. Results The five most frequent reasons for calling 112 were “chest pain” (15.9%), “unclear problem” (11.9%), “accidents” (11.2%), “possible stroke” (10.9%), and “breathing difficulties” (8.3%). Four of these contributed to the highest numbers of deaths: “breathing difficulties” (17.2%), “unclear problem” (13.2%), “possible stroke” (8.7%), and “chest pain” (4.7%), all exceeded by “unconscious adult – possible cardiac arrest” (25.3%). Age and sex adjusted IR of mortality per 100,000 person-year was 3.65 (CI 3.01–4.44) for “unconscious adult – possible cardiac arrest” followed by “breathing difficulties” (0.45, CI 0.37–0.54), “unclear problem”(0.30, CI 0.11–0.17), “possible stroke”(0.13, CI 0.11–0.17) and “chest pain”(0.07, CI 0.05–0.09). Conclusion In terms of risk of death on the same day and the day after the 112-call, “unconscious adult/possible cardiac arrest” was the most deadly symptom, about eight times more deadly than “breathing difficulties”, 12 times more deadly than “unclear problem”, 28 times more deadly than “possible stroke”, and 52 times more deadly than “chest pain”. “Breathing difficulties” and “unclear problem” as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.

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Multimorbidity Burden in Rheumatoid Arthritis: A Population-Based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.200971 ◽

2021 ◽

pp. jrheum.200971

Author(s):

Tina M. Gunderson ◽

Elena Myasoedova ◽

John M. Davis ◽

Cynthia S. Crowson

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Cumulative Incidence ◽

Index Date ◽

Population Based ◽

Olmsted County ◽

Risk Of Death ◽

Age And Sex ◽

Chronic Comorbidities

Objective To estimate the prevalence and incidence of multimorbidity in a populationbased cohort of patients with rheumatoid arthritis (RA) compared to subjects without RA. Methods Residents of Olmsted County, Minnesota with incident RA by 1987 ACR criteria in 1999-2013 were compared to age and sex-matched non-RA subjects from the same population. Twenty-five chronic comorbidities from a combination of the Charlson, Elixhauser and Rheumatic Disease Comorbidity Indexes were included, excluding rheumatic comorbidities. Aalen-Johansen methods were used to estimate the cumulative incidence of multimorbidity (2 or more chronic comorbidities) or substantial multimorbidity (5 or more), adjusting for the competing risk of death. Results The study included 597 patients with RA and 594 non-RA subjects (70% female, 90% Caucasian, mean age 55.5 years). At incidence/index date, the prevalence of multimorbidity was higher in RA than non-RA subjects (38% RA vs. 32% non-RA, p=0.021) while prevalence of substantial multimorbidity was similar (5% RA vs. 4% non- RA, p=0.68). During follow-up (median 11.6 years RA, 11.3 years non-RA), more RA patients developed multimorbidity (214 RA vs. 188 non-RA; adjusted hazard ratio (HR): 1.39; 95% confidence interval (CI):1.14–1.69). By 10 years after RA incidence/index, the cumulative incidence of multimorbidity was 56.5% among the RA patients (95%CI: 56.5-62.3%) compared with 47.9% among the non-RA (95%CI:42.8-53.7%). RA patients showed no evidence of increase in incidence of substantial multimorbidity (adjusted HR: 1.17; 95%CI: 0.93-1.47). Conclusion Patients with RA have both a higher prevalence of multimorbidity at the time of RA incidence as well as increased incidence thereafter.

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Which symptoms pose the highest risk in patients calling for an ambulance? A population-based cohort study from Denmark

10.21203/rs.3.rs-113012/v1 ◽

2020 ◽

Author(s):

Stine Ibsen ◽

Tim Alex Lindskou ◽

Christian H. Nickel ◽

Torben Kløjgård ◽

Erika Frischknecht Christensen ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Chest Pain ◽

Emergency Medical Service ◽

Medical Service ◽

Population Based ◽

Mechanism Of Injury ◽

Short Term ◽

Risk Of Death ◽

Age And Sex

Abstract Background Emergency medical service patients are a vulnerable population and the risk of mortality is considerable. In Denmark, healthcare professionals receive 112-emergency calls and assess the main reason for calling. The main aim was to investigate which of these reasons, i.e. which symptoms or mechanism of injury, contributed to short-term risk of death. Secondary aim was to study 1-30 day-mortality for each symptom/ injury.Methods Historic population-based cohort study of emergency medical service patients calling 112 in the North Denmark Region between 01.01.2016–31.12.2018. We defined 1-day mortality as death on the same or the following day. The frequency of each symptom and cumulative number of deaths on day 1 and 30 together with 1- and 30-day mortality for each symptom/mechanism of injury is presented in proportions. Poisson regression with robust variance estimation was used to estimate incident rates (IR) of mortality with 95% confidence intervals (CI), crude and age and sex adjusted, mortality rates on day 1 per 100,000 person-year in the population.Results The five most frequent reasons for calling 112 were “chest pain” (15.9%), “unclear problem” (11.9%), “accidents” (11.2%), “possible stroke” (10.9%), and “breathing difficulties” (8.3%). Four of these contributed to the highest numbers of deaths: “breathing difficulties” (17.2%), “unclear problem” (13.2%), “possible stroke” (8.7%), and “chest pain” (4.7%), all exceeded by “unconscious adult – possible cardiac arrest” (25.3%). Age and sex adjusted IR per 100,000 person-year was 3.65 (CI 3.01-4.44) for “unconscious adult – possible cardiac arrest” followed by “breathing difficulties” (0.45, CI 0.37-0.54), “unclear problem”(0.30, CI 0.11-0.17), “possible stroke”(0.13 , CI 0.11-0.17) and “chest pain”(0.07, CI 0.05-0.09). Conclusion In terms of risk of death on the same day and the day after the 112-call, “unconscious adult/possible cardiac arrest” was the most deadly symptom, about eight times more deadly than “breathing difficulties”, 12 times more deadly than “unclear problem”, 28 times more deadly than “possible stroke”, and 52 times more deadly than “chest pain”. “Breathing difficulties” and “unclear problem” as presented when calling 112 are among the top three contributing to short term deaths when calling 112, exceeding both stroke symptoms and chest pain.

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Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1694731 ◽

2019 ◽

Vol 38 (01) ◽

pp. 044-059 ◽

Cited By ~ 1

Author(s):

Eric J.M. Lentz ◽

Alison L. Park ◽

Alec W.R. Langlois ◽

Tianhua Huang ◽

Wendy S. Meschino ◽

...

Keyword(s):

Cohort Study ◽

Maternal Mortality ◽

Maternal Morbidity ◽

Protein A ◽

Population Based ◽

Severe Maternal Morbidity ◽

Adjusted Relative Risk ◽

Biochemical Screening ◽

High Concentration ◽

Increased Risk

Abstract Objective This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. Study Design This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. Results Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97–2.25) and DIA (aRR: 2.33; 95% CI: 1.98–2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. Conclusion Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.

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Attendance of routine childcare visits in primary care for children of mothers with depression: a nationwide population-based cohort study

British Journal of General Practice ◽

10.3399/bjgp18x694565 ◽

2018 ◽

Vol 68 (667) ◽

pp. e97-e104 ◽

Cited By ~ 6

Author(s):

Bente Kjær Lyngsøe ◽

Claus Høstrup Vestergaard ◽

Dorte Rytter ◽

Mogens Vestergaard ◽

Trine Munk-Olsen ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Relative Risk ◽

Confidence Interval ◽

Maternal Depression ◽

Vaccination Programme ◽

Population Based ◽

Point Of Interest ◽

Vulnerable Families

BackgroundDepression is a common and potentially debilitating illness worldwide. Attendance to routine childcare appointments is a key point of interest in the effort to improve the health and care for families facing depression.AimTo evaluate the association between maternal depression and offspring non-attendance to the Danish childcare and vaccination programme (CCP) for children from 0–5 years of age. The CCP consists of seven separate visits and several vaccinations. To investigate if exposure to recent and previous depression may affect attendance differently.Design and settingPopulation-based cohort study using Danish nationwide registers.MethodParticipants were all live-born children (n = 853 315) in Denmark in the period from 1 January 2000 until 31 August 2013, and their mothers. The outcome of interest was non-attendance of each one of the seven scheduled childcare visits and two vaccination entities in the CCP. Exposure was maternal (both previous and recent) depression. All information was obtained from Danish national registries.ResultsThe risk of not attending CCP was higher for children of mothers with depression. For children of mothers with previous depression, the relative risk (RR) was 1.01 (95% confidence interval [CI] = 0.98 to 1.03) at the 5-week childcare visit, and 1.12 (95% CI = 1.09 to 1.14) at the 5-year childcare visit. For children of mothers with recent depression, the RR was 1.07 (95% CI = 1.03 to 1.13) at the 5-week visit, and 1.15 (95% CI = 1.13 to 1.17) at the 5-year visit. Furthermore, the risk of missing at least four of the seven childcare visits was higher for children of females with maternal depression (RR = 1.16, 95% CI = 1.13 to 1.19).ConclusionMaternal depression seems to compromise CCP attendance. These findings suggest a need for careful clinical attention to these vulnerable families, even years after a diagnosis of depression.

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The North Carolina–Louisiana Prostate Cancer Project (PCaP): Methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes

The Prostate ◽

10.1002/pros.20449 ◽

2006 ◽

Vol 66 (11) ◽

pp. 1162-1176 ◽

Cited By ~ 49

Author(s):

Jane C. Schroeder ◽

Jeannette T. Bensen ◽

L. Joseph Su ◽

Merle Mishel ◽

Anastasia Ivanova ◽

...

Keyword(s):

Prostate Cancer ◽

North Carolina ◽

Cohort Study ◽

Racial Differences ◽

Population Based ◽

Cancer Outcomes ◽

The North ◽

Cancer Project

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No association between colon cancer and adenocarcinoma of the oesophagus in a population based cohort study in Sweden

Gut ◽

10.1136/gut.44.6.819 ◽

1999 ◽

Vol 44 (6) ◽

pp. 819-821 ◽

Cited By ~ 15

Author(s):

J Lagergren ◽

O Nyren

Keyword(s):

Colon Cancer ◽

Cohort Study ◽

Relative Risk ◽

Population Based ◽

Oesophageal Adenocarcinoma ◽

Expected Number ◽

Colonic Neoplasia ◽

Barrett's Metaplasia ◽

Barrett’S Metaplasia

BACKGROUNDPrevious reports have indicated an association between Barrett’s metaplasia or adenocarcinoma of the oesophagus and colonic neoplasia, but the findings have been inconsistent. If true, such an association suggests common causal mechanisms.AIMSTo test the hypothesis of an association between Barrett’s metaplasia or adenocarcinoma of the oesophagus and colonic neoplasia.METHODSA population based, retrospective cohort study was performed on all Swedish patients with colon cancer diagnosed between 1958 and 1992. 538 500 person years at risk were reviewed among the 118 030 patients in the cohort (average follow up 4.6 years, median 2.1 years). The standardised incidence ratio (SIR), the ratio of the observed to the expected number of incident oesophageal adenocarcinomas, was used as a measure of relative risk. The expected number was derived from the entire Swedish population.RESULTSEleven oesophageal adenocarcinomas were found during follow up in the cohort, as against 9.5 expected (SIR=1.2; 95% confidence interval 0.6–2.1). Analysis by latency intervals after diagnosis of colon cancer showed no trend towards increasing or decreasing risk over time. There were no important sex differences in relative risk.CONCLUSIONSResults provide no support for a common link between colon cancer and oesophageal adenocarcinoma. Although the direct relation between colon cancer and Barrett’s oesophagus was not looked at, a search for common aetiological factors or genetic defects may not be fruitful. Screening for colonic neoplasia among patients with malignant or premalignant oesophageal mucosa, or vice versa, may not be warranted.

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