scholarly journals Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020856 ◽  
Author(s):  
Annette S H Schultz ◽  
Lindsey Dahl ◽  
Elizabeth McGibbon ◽  
R Jarvis Brownlie ◽  
Catherine Cook ◽  
...  
Keyword(s):  
First Nations ◽  
Descriptive Analysis ◽  
Temporal Trends ◽  
Secondary Analysis ◽  
Population Level ◽  
Cardiovascular Death ◽  
Population Based ◽  
Secondary Outcome ◽  
Income Quintile ◽  
Comorbidity Scores

ObjectivesTo investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada.SettingPopulation-based, secondary analysis of provincial administrative health data.ParticipantsAll adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009.Primary and secondary outcome measures(1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of ‘urgent’ angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old).ResultsFN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20–30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01)ConclusionsIndex angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

A Decade of Decline in Serious Cognitive Problems Among Older Americans: A Population-Based Study of 5.4 Million Respondents

2021 ◽  
pp. 1-11
Author(s):  
Esme Fuller-Thomson ◽  
Katherine Marie Ahlin
Keyword(s):  
Educational Attainment ◽  
Generational Differences ◽  
Temporal Trends ◽  
Secondary Analysis ◽  
Population Based ◽  
Community Dwelling ◽  
Older Americans ◽  
Age Cohort ◽  
Nationally Representative ◽  
Cognitive Problems

Background: Numerous studies suggest the prevalence of dementia has decreased over the past several decades in Western countries. Less is known about whether these trends differ by gender or age cohort, and if generational differences in educational attainment explain these trajectories. Objective: 1) To detect temporal trends in the age-sex-race adjusted prevalence of serious cognitive problems among Americans aged 65+; 2) To establish if these temporal trends differ by gender and age cohort; 3) To examine if these temporal trends are attenuated by generational differences in educational attainment. Methods: Secondary analysis of 10 years of annual nationally representative data from the American Community Survey with 5.4 million community-dwelling and institutionalized older adults aged 65+. The question on serious cognitive problems was, “Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?” Results: The prevalence of serious cognitive problems in the US population aged 65 and older declined from 12.2%to 10.0%between 2008 and 2017. Had the prevalence remained at the 2008 levels, there would have been an additional 1.13 million older Americans with serious cognitive problems in 2017. The decline in memory problems across the decade was higher for women (23%) than for men (13%). Adjusting for education substantially attenuated the decline. Conclusion: Between 2008 and 2017, the prevalence of serious cognitive impairment among older Americans declined significantly, although these declines were partially attributable to generational differences in educational attainment.

scholarly journals Effects of linagliptin on cardiovascular and kidney outcomes in people with normal and reduced kidney function: secondary analysis of the CARMELINA randomized trial

2020 ◽  
Author(s):  
Vlado Perkovic ◽  
Robert Toto ◽  
Mark E Cooper ◽  
Johannes FE Mann ◽  
Julio Rosenstock ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Secondary Analysis ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
First Occurrence ◽  
Outcome Trial ◽  
End Stage ◽  
Reduced Kidney Function

<b>Objective</b> <p>Type 2 diabetes is a leading cause of kidney failure, but few outcome trials proactively enrolled individuals with chronic kidney disease (CKD). We performed secondary analyses of cardiovascular and kidney outcomes across baseline eGFR categories (≥ 60, 45-<60, 30-<45 and < 30 ml/min/1.73 m<sup>2</sup>) in CARMELINA, a cardio-renal placebo-controlled outcome trial of the DPP-4 inhibitor linagliptin (NCT01897532).</p> <p><b>Research Design and Methods</b></p> <p>Participants with cardiovascular disease (CVD) and/or CKD were included. The primary outcome was time to first occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke (3P-MACE), with a secondary outcome renal death, end-stage kidney disease, or sustained ≥40% decrease in eGFR from baseline. Other endpoints included progression of albuminuria, change in HbA1c and adverse events (AEs) including hypoglycemia. </p> <p><b>Results</b></p> <p>6979 subjects (mean age 65.9 years, eGFR 54.6 ml/min/1.73m<sup>2</sup>, 80.1% albuminuria) were followed for 2.2 years. Across eGFR categories, linagliptin as compared to placebo did not affect the risk for 3P-MACE (HR.1.02 [95% CI, 0.89, 1.17]), or the secondary kidney outcome (1.04 [0.89, 1.22]) (interaction p-values > 0.05). Regardless of eGFR, albuminuria-progression was reduced with linagliptin, as was HbA1c, without increasing risk for hypoglycemia. AEs were balanced between groups overall and across eGFR categories. </p> <p><b>Conclusions </b></p> <p>Across all GFR categories, in participants with type 2 diabetes and CKD and/or CVD, there was no difference in risk for linagliptin versus placebo on CV and kidney events. Significant reductions in risk for albuminuria progression and HbA1c, and no difference in AEs was observed.</p>

Temporal Trends in the Microbiological Characteristics of Sepsis in the United States: A Population Based Study

2021 ◽  
pp. 088506662110537
Author(s):  
Po-Yang Tsou ◽  
Chia-Hung Yo ◽  
Yenh-Chen Hsein ◽  
Gregory Yungtum ◽  
Wan-Ting Hsu ◽  
...  
Keyword(s):  
United States ◽  
Temporal Trends ◽  
Population Level ◽  
The United States ◽  
Population Based ◽  
Epidemiologic Studies ◽  
Annual Increase ◽  
Gram Negative ◽  
Nationwide Inpatient Sample Database ◽  
Incidence And Mortality

Background Epidemiologic studies are needed for monitoring population-level trends in sepsis. This study examines sepsis-causing microorganisms from 2006 to 2014 in the United States using data from the Nationwide Inpatient Sample database. Methods 7 860 686 adults hospitalized with sepsis were identified using a validated ICD-9 coding approach. Associated microorganisms were identified by ICD-9 code and classified by major groups (Gram-positive, Gram-negative, fungi, anaerobes) and specific species for analysis of their incidence and mortality. Results The rate of sepsis incidence has increased for all four major categories of pathogens, while the mortality rate decreased. In 2014, Gram-negative pathogens had a higher incidence than Gram-positives. Anaerobes increased the fastest with an average annual increase of 20.17% (p < 0.001). Fungi had the highest mortality (19.28%) and the slowest annual decrease of mortality (−2.31%, p = 0.006) in 2013, while anaerobic sepsis had the highest hazard of mortality (adjusted HR 1.60, 95% CI 1.53-1.66). Conclusions Gram-negative pathogens have replaced Gram-positives as the leading cause of sepsis in the United States in 2014 during the study period (2006-2014). The incidence of anaerobic sepsis has an annual increase of 20%, while the mortality of fungal sepsis has not decreased at the same rate as other microorganisms. These findings should inform the diagnosis and management of septic patients, as well as the implementation of public health programs.

scholarly journals Effects of linagliptin on cardiovascular and kidney outcomes in people with normal and reduced kidney function: secondary analysis of the CARMELINA randomized trial

2020 ◽  
Author(s):  
Vlado Perkovic ◽  
Robert Toto ◽  
Mark E Cooper ◽  
Johannes FE Mann ◽  
Julio Rosenstock ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Secondary Analysis ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
First Occurrence ◽  
Outcome Trial ◽  
End Stage ◽  
Reduced Kidney Function

<b>Objective</b> <p>Type 2 diabetes is a leading cause of kidney failure, but few outcome trials proactively enrolled individuals with chronic kidney disease (CKD). We performed secondary analyses of cardiovascular and kidney outcomes across baseline eGFR categories (≥ 60, 45-<60, 30-<45 and < 30 ml/min/1.73 m<sup>2</sup>) in CARMELINA, a cardio-renal placebo-controlled outcome trial of the DPP-4 inhibitor linagliptin (NCT01897532).</p> <p><b>Research Design and Methods</b></p> <p>Participants with cardiovascular disease (CVD) and/or CKD were included. The primary outcome was time to first occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke (3P-MACE), with a secondary outcome renal death, end-stage kidney disease, or sustained ≥40% decrease in eGFR from baseline. Other endpoints included progression of albuminuria, change in HbA1c and adverse events (AEs) including hypoglycemia. </p> <p><b>Results</b></p> <p>6979 subjects (mean age 65.9 years, eGFR 54.6 ml/min/1.73m<sup>2</sup>, 80.1% albuminuria) were followed for 2.2 years. Across eGFR categories, linagliptin as compared to placebo did not affect the risk for 3P-MACE (HR.1.02 [95% CI, 0.89, 1.17]), or the secondary kidney outcome (1.04 [0.89, 1.22]) (interaction p-values > 0.05). Regardless of eGFR, albuminuria-progression was reduced with linagliptin, as was HbA1c, without increasing risk for hypoglycemia. AEs were balanced between groups overall and across eGFR categories. </p> <p><b>Conclusions </b></p> <p>Across all GFR categories, in participants with type 2 diabetes and CKD and/or CVD, there was no difference in risk for linagliptin versus placebo on CV and kidney events. Significant reductions in risk for albuminuria progression and HbA1c, and no difference in AEs was observed.</p>

Risk of secondary sarcoma after abdominopelvic cancer treatment: Results from a contemporary cohort.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 317-317
Author(s):  
Amanda Elizabeth Hird ◽  
Rano Matta ◽  
Diana E. Magee ◽  
Girish S. Kulkarni ◽  
Ronald Kodama ◽  
...  
Keyword(s):  
General Population ◽  
Hazard Analysis ◽  
Relative Rate ◽  
Primary Treatment ◽  
Population Based ◽  
Secondary Outcome ◽  
Income Quintile ◽  
Testis Cancer ◽  
Solid Organ ◽  
Increased Risk

317 Background: Our objective was to explore the risk of sarcoma in a large cohort of patients with localized abdominopelvic cancer treated with radiotherapy (RT) compared to surgery. The risk of other secondary non-sarcoma solid organ tumors was also explored. Methods: This is a population-based retrospective cohort study examining the risk of sarcoma in patients with localized prostate, bladder, colorectal, cervical, uterine, and testis cancer between January 1, 2002-December 31, 2016. Multivariable Cox proportional hazard analysis was used to compare time from primary treatment (radical surgery or RT) to second cancer, adjusting for age, comorbidity, income quintile, and rurality, accounting for death as a competing risk. The standardized incidence rate (SIR) was calculated as the ratio of the observed divided by the age- and sex-stratified expected number of sarcoma cases from the Ontario population. Results: 173,580 patients were included (79,662 underwent surgery and 93,918 underwent RT). Most patients had genitourinary (51.4%) or colorectal cancer (39.9%) and 24.4% received chemotherapy. Overall, 332 sarcomas developed over a median 5.7 years (IQR: 2.2-8.9) and were more common in the RT group (239/93918 [0.3%]) compared to the surgery group (93/79662 [0.1%], p<0.001). RT exposure (unadjusted HR=2.67, 95%CI:2.10-3.40, p<0.001, adjusted HR=2.59, 95%CI:2.03-3.31, p<0.001) and perioperative chemotherapy use (HR=1.31, 95%CI:1.03-1.69, p=0.038) were associated with an increased relative rate of sarcoma. Patients who received RT had an increased risk of sarcoma compared to the general population (SIR=1.46, 95%CI:1.12-1.90, p=0.005). For our secondary outcome, patients who received RT had an increased hazard of developing a second non-sarcoma solid malignancy compared to patients who underwent surgery (HR=1.16, 95%CI:1.10-1.22, p<0.001). Conclusions: This is the largest cohort investigating sarcoma in patients with abdominopelvic cancer. Patients treated with RT have a markedly increased risk of sarcoma compared to the general population. RT was an independent risk factor for sarcoma and non-sarcoma second malignancy.

scholarly journals Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e044126
Author(s):  
Louise Y Sun ◽  
Lisa M Mielniczuk ◽  
Peter P Liu ◽  
Rob S Beanlands ◽  
Sharon Chih ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Temporal Trends ◽  
Population Based ◽  
Outpatient Setting ◽  
Secondary Outcome ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
New Diagnosis

ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

EXPRESS: What is the Median Volume of Intracerebral Hemorrhage and is it Changing?

2021 ◽  
pp. 174749302110325
Author(s):  
David Robinson ◽  
Carson Van Sanford ◽  
Soo Young Kwon ◽  
Elisheva Coleman ◽  
Padmini Sekar ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intracerebral Hemorrhage ◽  
Temporal Trends ◽  
Clinical Trial Design ◽  
Population Level ◽  
Population Based ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Risk Factor Management ◽  
Median Volume

Abstract: Objectives: Population-level estimates of the median intracerebral hemorrhage (ICH) volume would allow for the evaluation of clinical trial external validity and determination of temporal trends. We previously reported the median ICH volume in 1988. However, differences in risk factor management, neuroimaging and demographics may have affected ICH volumes. The goal of this study was to determine the median volume of ICH within a population-based cross-sectional study, including whether it has changed over time. Methods: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke study was a population-based study of ICH among residents of the Greater Cincinnati/Northern Kentucky region from 2008 through 2012. The current study utilizes those data and compares with ICH cases from the same region in 1988. Initial CT images of the head were reviewed, and ICH volumes were calculated using consistent methodology. Results: From 2008 through 2012, we identified 1117 cases of ICH. The median volume of ICH was 14.0 mL and was lower in black (11.6) than in white (15.5) patients. Median volumes of lobar and deep ICH were 28·8 mL and 9.8 mL, respectively. Median ICH volume changed significantly from 1988 to 2008-2012, with age-and-race adjusted volume decreasing from 18.3 mL to 13.76 mL (p=0.025). Conclusions: Median volume of ICH was 13.76 mL, and this should be considered in clinical trial design. Median ICH volume has apparently decreased from 1988 to 2008-2012.

scholarly journals A Biopsychosocial Profile of Adult Canadians with and without Chronic Back Disorders: A Population-Based Analysis of the 2009-2010 Canadian Community Health Surveys

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Brenna Bath ◽  
Catherine Trask ◽  
Jesse McCrosky ◽  
Josh Lawson
Keyword(s):  
Community Health ◽  
Health Surveys ◽  
Secondary Analysis ◽  
Population Level ◽  
Population Based ◽  
Current Smoker ◽  
Vulnerable Groups ◽  
Health Concern ◽  
Never Married ◽  
Back Disorders

Chronic back disorders (CBD) are a significant public health concern. Profiling Canadians with CBD and the associated biopsychosocial factors at a national population level is important to understand the burden of this condition and how clinicians, health systems, and related policies might address this potentially growing problem. We performed a secondary analysis of the 2009 and 2010 Canadian Community Health Surveys to calculate prevalence and to better understand the differences between people with and without CBD. An estimated 20.2% of the adult Canadian population reports having back problems lasting for 6 months or more. Among people with CBD, there was significantly greater likelihood of living in a more rural or remote location, being Aboriginal, being a former or current smoker, being overweight, having other chronic health conditions, having greater activity limitations, having higher levels of stress, and having lower perceived mental health. People who were single/never married or had an ethnicity other than Caucasian or Aboriginal were less likely to report having CBD. These results contribute to a growing body of research in the area that may assist with strategic prioritization and tailoring of health promotion efforts and health services for people with CBD, particularly among vulnerable groups.

scholarly journals Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042518
Author(s):  
Sílvia C Mendonça ◽  
Catherine L Saunders ◽  
Jenny Lund ◽  
Jonathan Mant ◽  
Duncan Edwards
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Cohort Study ◽  
Temporal Trends ◽  
Population Based ◽  
Incidence Rates ◽  
Secondary Outcome ◽  
Policy Initiatives ◽  
Increased Risk ◽  
Quality And Outcomes

ObjectivesAtrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018.DesignLongitudinal cohort study.SettingEnglish primary care electronic health records linked to Index of Multiple Deprivation data.ParticipantsCohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018.Primary and secondary outcome measuresIncident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation.ResultsIncidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation.ConclusionsChanges in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018.

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