scholarly journals Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052482
Author(s):  
R Asaad Baksh ◽  
Sarah E Pape ◽  
James Smith ◽  
André Strydom
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Respiratory Support ◽  
Control Group ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Presenting Symptoms ◽  
Non Invasive ◽  
Increased Risk ◽  
To Receive

ObjectivesThis study explores the hospital journey of patients with intellectual disabilities (IDs) compared with the general population after admission for COVID-19 during the first wave of the pandemic (when demand on inpatient resources was high) to identify disparities in treatment and outcomes.DesignMatched cohort study; an ID cohort of 506 patients were matched based on age, sex and ethnicity with a control group using a 1:3 ratio to compare outcomes from the International Severe Acute Respiratory and emerging Infections Consortium WHO Clinical Characterisation Protocol UK.SettingAdmissions for COVID-19 from UK hospitals; data on symptoms, severity, access to interventions, complications, mortality and length of stay were extracted.InterventionsNon-invasive respiratory support, intubation, tracheostomy, ventilation and admission to intensive care units (ICU).ResultsSubjective presenting symptoms such as loss of taste/smell were less frequently reported in ID patients, whereas indicators of more severe disease such as altered consciousness and seizures were more common. Controls had higher rates of cardiovascular risk factors, asthma, rheumatological disorder and smoking. ID patients were admitted with higher respiratory rates (median=22, range=10–48) and were more likely to require oxygen therapy (35.1% vs 28.9%). Despite this, ID patients were 37% (95% CI 13% to 57%) less likely to receive non-invasive respiratory support, 40% (95% CI 7% to 63%) less likely to receive intubation and 50% (95% CI 30% to 66%) less likely to be admitted to the ICU while in hospital. They had a 56% (95% CI 17% to 102%) increased risk of dying from COVID-19 after they were hospitalised and were dying 1.44 times faster (95% CI 1.13 to 1.84) compared with controls.ConclusionsThere have been significant disparities in healthcare between people with ID and the general population during the COVID-19 pandemic, which may have contributed to excess mortality in this group.

scholarly journals Mortality in Eosinophilic Esophagitis – a nationwide, population-based matched cohort study from 2005 to 2017

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Lovisa Röjler ◽  
John J. Garber ◽  
Bjorn Roelstraete ◽  
Marjorie M. Walker ◽  
Jonas F. Ludvigsson
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Eosinophilic Esophagitis ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Risk Of Death ◽  
Gastrointestinal Pathology ◽  
Increased Risk

Background: There is a lack of knowledge about mortality in eosinophilic esophagitis (EoE). Therefore, this study aimed to examine the mortality in EoE. Methods: A nationwide, population-based matched cohort study was conducted of all EoE patients in Sweden diagnosed between July 2005 and December 2017. Individuals with EoE (n = 1,625) were identified through prospectively recorded histopathology codes from all gastrointestinal pathology reports in Sweden, representing 28 pathology departments (the ESPRESSO study). Each individual with EoE was then matched with up to five reference individuals from the general population (n = 8,003) for age, sex, year of birth, and place of residence. We used the Cox proportional hazard modeling to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) while adjusting for other potential confounders. In sensitivity analyses, mortality in EoE patients was compared with mortality in their siblings. Results: Through December 2017, 34 deaths were confirmed in EoE patients (4.60 per 1,000 person-years) compared with 165 in reference individuals (4.57 per 1,000 person-years). This rate corresponds to an aHR of 0.97 (95% CI = 0.67–1.40). HRs were similar in males (aHR = 1.00 [0.66–1.51]) and females (aHR = 0.92 [0.38–2.18]). We observed no increased risk in mortality due to esophageal or other gastrointestinal cancers in patients with EoE (aHR = 1.02 [0.51–2.02]). Mortality was similar in EoE patients and their siblings (aHR = 0.91 [0.44–1.85]). Conclusion: In this nationwide, population-based matched cohort study in Sweden, there was no increased risk of death in patients with EoE compared with their siblings and the general population.

scholarly journals The association between bowel resection and the risk of nontyphoidal salmonella infection: a nationwide propensity score-matched cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kuang-Tsu Yang ◽  
Sin-Ei Juang ◽  
Yao-Min Hung ◽  
James Cheng-Chung Wei ◽  
Hei-Tung Yip ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Bowel Resection ◽  
Significant Risk ◽  
University Hospital ◽  
Control Group ◽  
Matched Cohort ◽  
Human Beings ◽  
Matched Cohort Study ◽  
Increased Risk

AbstractNontyphoidal salmonella (NTS) infection has a high mortality rate. Bowel resections affect gut microbiota and immune function, and the association between bowel resection and NTS infection in human beings has not been addressed. We conducted a nationwide propensity score (PS)-matched cohort study to clarify this association. Data from the Longitudinal Health Insurance Database of Taiwan were used to establish a case-cohort with bowel resections from 2000 to 2013. Informed consent was waived by the Institutional Review Board of China Medical University Hospital (CMUH104-REC2-115) because all personal identifying information used had been de-identified. Each case was matched with one control without any bowel resection according to age, gender, index date, and propensity score (PS). Cumulative incidences of and hazard ratios (HRs) for NTS infection development were analyzed. The incidence of NTS infection was greater in patients with a bowel resection than in the control group (2.97 vs. 1.92 per 10,000 person-years), with an adjusted hazard ratio (aHR) of 1.64 (95% CI = 1.08–2.48). The incidence of NTS infection increased significantly for cases with small bowel resections and right hemicolectomies. Age (31–40 and > 50 years), hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and autoimmune diseases were significant risk factors of NTS infection. Stratification analysis revealed that patients without comorbidities were prone to NTS infection after bowel resections. The increased risk of developing NTS infection could be related to the bowel resection. Specific age groups and comorbidities also contribute to increased risk of NTS infection.

Increased risk of adhesive capsulitis among patients with gout: A nationwide population-based matched-cohort study

2018 ◽  
Vol 21 (9) ◽  
pp. 1716-1722 ◽  
Author(s):  
Kao-Chih Hsu ◽  
Chia-Hung Sun ◽  
Yin-Yin Wu ◽  
Liang-Cheng Chen ◽  
Yung-Tsan Wu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adhesive Capsulitis ◽  
Population Based ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Increased Risk

scholarly journals Differential cerebrovascular risks in glioblastoma and meningioma patients: a population-based matched cohort study in Wales (United Kingdom)

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Michael T C Poon ◽  
Kai Jin ◽  
Paul M Brennan ◽  
Jonine Figueroa ◽  
Cathie Sudlow
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Ischaemic Stroke ◽  
Population Based ◽  
Parametric Models ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Hazard Ratios ◽  
History Of

Abstract Aims There is limited evidence on cerebrovascular risks in glioblastoma and meningioma patients. We aimed to compare cerebrovascular risks of these patients with the general population. Method We used population-based routine healthcare and administrative data linkage in this matched cohort study. Cases were adult glioblastoma and meningioma patients diagnosed in Wales 2000-2014 identified in the cancer registry. Controls from cancer-free general population were matched to cases (5:1 ratio) on age (±5 years), sex and GP practice. Factors included in multivariable models were age, sex, index of multiple deprivation, hypertension, diabetes, high cholesterol, history of cardiovascular disease, and medications for cardiovascular diseases. Outcomes were fatal and non-fatal haemorrhagic and ischaemic stroke. We used flexible parametric models adjusting for confounders to calculate the hazard ratios (HR). Results Final analytic population was 16,921 participants, of which 1,340 had glioblastoma and 1,498 had meningioma. The median follow-up time was 0.5 year for glioblastoma patients, 4.9 years for meningioma patients, and 6.6 years for controls. The number of haemorrhage and ischaemic stroke was 154 and 374 in the glioblastoma matched cohort, respectively, and 180 and 569 in the meningioma matched cohort, respectively. The adjusted HRs for haemorrhagic and ischaemic stroke were 3.74 (95%CI 1.87-6.57) and 5.62 (95%CI 2.56-10.42) in glioblastoma patients, respectively, and were 2.42 (95%CI 1.58-3.52) and 1.86 (95%CI 1.54-2.23) in meningioma patients compared with their controls. Conclusion Glioblastoma and meningioma patients had higher cerebrovascular risks; these risks were even higher for glioblastoma patients. Further assessment of these potentially modifiable risks may improve survivorship.

scholarly journals Incidence of osteoporosis and fragility fractures in asthma: a UK population-based matched cohort study

2020 ◽  
pp. 2001251
Author(s):  
Christos V. Chalitsios ◽  
Tricia M. McKeever ◽  
Dominick E. Shaw
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Cox Regression ◽  
Inhaled Corticosteroids ◽  
Fragility Fractures ◽  
Practice Research ◽  
Research Database ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
The Impact

BackgroundOsteoporosis and fragility fractures (FF) are associated with corticosteroids which are the mainstay treatment for asthma; however, these bone comorbidities within asthma need to be better described.MethodsA matched cohort study was conducted using the Clinical Practice Research Database (CPRD). Adults with an incident asthma code were identified and matched, with up to four randomly selected people without asthma, by age, gender, and practice. Osteoporosis and FF incidence rates were calculated, and Cox regression was performed comparing hazard rates to the general population. We report the impact of age, gender, glucocorticoids, and the risk of specific fractures.ResultsPatients with asthma had a higher risk of osteoporosis (aHR=1.18, 95% CI: 1.13–1.23) and were 12% (aHR=1.12, 95% CI: 1.07–1.16) more likely to sustain FF than the general population. Age modified the effect of asthma on osteoporosis and FF, such that effect to be stronger in younger people (pinteraction<0.0001). Vertebral (aHR=1.40, 95% CI: 1.33–1.48), and forearm-wrist (aHR=1.27, 95% CI: 1.22–1.32) were the sites linked with a larger incidence. A dose-response relationship between oral corticosteroids (OCS) and osteoporosis was observed, whereas the risk of FF increased in those with 6 or more OCS courses per year. Regular use of inhaled corticosteroids (ICS) increased the risk of both bone conditions.ConclusionPatients with asthma are more likely to develop osteoporosis or sustain FF than the general population with a particular concern in younger people and those more frequently using OCS and ICS.

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