Incidence, prevalence and risk of stroke in patients with Takayasu arteritis: a nationwide population-based study in South Korea

BackgroundTakayasu arteritis (TAK) is a disease associated with increased risk of cardiovascular complications. We aimed to evaluate the incidence, prevalence and risk of stroke in patients with TAK.MethodsData from 1065 patients were obtained from a national database (2010–2018). The annual incidence and prevalence per 100 000 persons were estimated using the registration population in the midst of every year, and the standardised incidence ratio (SIR) of stroke was compared with the general population based on the data from the 2006 national report for cardiovascular and cerebrovascular diseases. Age-adjusted incidence rate ratio (IRR) of stroke based on the time interval after diagnosis was also calculated. A time-dependent Cox regression was conducted to investigate predictive factors of stroke.ResultsThe overall incidence rate of TAK ranged between 0.2 and 0.3/100 000 person-years annually; the prevalence of TAK gradually increased, reaching 3.25/100 000 person-years in 2018. Seventy-three (6.9%) patients experienced stroke during follow-up, and the risk of developing stroke was higher than the general population (overall SIR 7.39, 95% CI 5.79 to 9.29; men: SIR 5.70, 95% CI 2.84 to 10.20; women: SIR 7.06, 95% CI 5.41 to 9.05). Most stroke events (90.9%) were cerebral infarction for men, whereas the proportion of cerebral infarction was lower (62.9%) in women. Over half of stroke events occurred within 6 months after diagnosis, and stroke was more common within 6 months of diagnosis compared with after 3 years in women (IRR 13.46, 95% CI 6.86 to 26.40). In Cox regression analysis, age was the sole predictor of stroke (adjusted HR 1.02, 95% CI 1.00 to 1.04, p=0.043).ConclusionsThe annual incidence of TAK was similar to the previous studies from Asia, and the risk of stroke increased in TAK. Different patterns of subtype and incidence of stroke were found according to sex, although age was the only predictor.

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Incidence and predictors of severe infections in ANCA-associated vasculitis: a population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keaa699 ◽

2020 ◽

Author(s):

Jens Rathmann ◽

David Jayne ◽

Mårten Segelmark ◽

Göran Jönsson ◽

Aladdin J Mohammad

Keyword(s):

Disease Activity ◽

Incidence Rate ◽

Cox Regression ◽

Damage Index ◽

Severe Infection ◽

Organ Damage ◽

Population Based ◽

Cox Regression Analysis ◽

Anca Associated Vasculitis ◽

Severe Infections

Abstract Objective To determine the incidence rate, predictors and outcome of severe infections in a population-based cohort of ANCA-associated vasculitis (AAV). Methods The study included 325 cases of AAV (152 female) diagnosed from 1997 through 2016 from a defined geographic area in Sweden. All severe infection events (requiring hospitalization and treatment with intravenous antimicrobials) were identified. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity, and organ damage was assessed using the vasculitis damage index (VDI). Patients were followed from time of AAV diagnosis to death or December 2017. Results A total of 129 (40%) patients suffered at least one severe infection. In 2307 person-years (PY) of follow-up, 210 severe infections were diagnosed. The incidence rate of severe infections was 9.1/100 PY and was highest during the first year following AAV diagnosis at 22.1/100 PY (P < 0.001). Pneumonia, sepsis and urinary tract infection were the most common infections. Opportunistic infections constituted only 6% of all severe infections. In Cox regression analysis age and BVAS at diagnosis were the only factors independently predicting severe infection [hazard ratio: 1.54 (P < 0.001) and 1.27 (P = 0.001), respectively]. Severe infection was associated with poorer prognosis with respect to median VDI score 12 months post-AAV diagnosis, renal survival and mortality. Severe infections were the cause of death in 32 patients (22% of all deaths). Conclusion . Severe infection is a common problem in AAV, with the most important prognostic factors being older age and high disease activity at diagnosis. Severe infections are associated with permanent organ damage and high mortality.

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P1409HIP FRACTURE TRENDS IN SWEDISH GENERAL POPULATION AND DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1409 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Ken Iseri ◽

Juan Jesus Carrero ◽

Marie Evans ◽

Li Felländer-Tsai ◽

Hans Berg ◽

...

Keyword(s):

Hip Fracture ◽

General Population ◽

Incidence Rate ◽

Recent Decade ◽

Population Based ◽

Fracture Incidence ◽

National Database ◽

Dialysis Patients ◽

Annual Percent Change ◽

Hip Fracture Incidence

Abstract Background and Aims Hip fracture incidence rate is higher in dialysis patients than in general population. We investigated and compared temporal changes in age-standardized hip fracture incidence rate (ASRhip fracture) 2007-2016 in men and women in the dialysis population and in the general population. Method We used the population-based Swedish national database of fractures and the Swedish Renal Registry of ESRD patients to retrieve data on ASRhip fracture in the general population and among dialysis patients. The average annual percent change of the hip fracture incidence trend was evaluated by join-point regression analysis according to gender in the two databases. Results ASRhip fracture was about three times higher in Swedish dialysis patients as compared to the Swedish general population. In dialysis patients, rates have steadily declined during the recent decade when assessed in both sexes combined, and when analysed in women and men separately. A similar trend was also seen in the general population; however, the rate of decline was steeper in dialysis patients than in the general population. The most recent data on ASRhip fracture (for 2016) show that ASRhip fracture was similar among female and male dialysis patients whereas ASRhip fracture in the general population was higher in women than in men. Conclusion Hip fracture incidence is declining in the general population and even more so in dialysis patients. In contrast to the general population where hip fracture incidence in 2016 is higher among women than in men, there was no such difference between the two sexes among dialysis patients.

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Older Age and High Α-fetoprotein Predict Higher Risk of Hepatocellular Carcinoma in Chronic Hepatitis B-Related Cirrhotic Patients Receiving Nucleos(T)ide Analogue Therapy: A Retrospective Cohort Study

10.21203/rs.3.rs-668622/v1 ◽

2021 ◽

Author(s):

Ching-Chih Hu ◽

Cheng-Hao Weng ◽

Chih-Lang Lin ◽

Pei-Hung Chang ◽

Man-Chin Hua ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Incidence Rate ◽

Chronic Hepatitis B ◽

Cox Regression ◽

Annual Incidence ◽

Cox Regression Analysis ◽

Cirrhotic Patients

Abstract Background: Nucleos(t)ide analogues (NUCs) were proved to reduce hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) infection, but data was limited on the efficacy in the CHB patients with cirrhosis. Methods: We retrospectively analyzed data from 447 patients with CHB-related cirrhosis, who initiated tenofovir/entecavir therapy during April 2007 and August 2013. They were divided into HCC (n=48) and non-HCC (n=399) groups. The mean follow-up period was 63.2 ± 34.2 months.Results: Forty-eight patients (10.7%) developed HCC during surveillance. The annual incidence rate of HCC was 2.04 (95% CI: 1.52–2.68) per 100 person-year. The cumulative incidence of HCC was 0.9%, 9.8% and 22.1% at the 1, 5 and 10 years, respectively. Significant predictors for HCC identified using multiple Cox regression analysis were age ≥50 years (hazard ratio [HR]: 2.34, 95% confidence interval [CI] = 1.08–5.1) and α-fetoprotein (AFP) ≥8 ng/ml (HR: 2.05, 95% CI = 1.1–3.84). The incidence rate of HCC was further analyzed in subgroups according to the risk factors identified by multivariate cox regression. The incidence rate of HCC was 8.67-fold higher in patients with age ≥50 years and AFP ≥8 ng/ml (3.14 per 100 person-year, 95% CI = 1.99–4.72) than those with age <50 years and AFP <8 ng/ml (0.36 per 100 person-year, 95% CI = 0.06–1.19).Conclusion: The cirrhotic CHB patients with age <50 years and AFP <8 ng/ml have the lowest annual incidence of HCC. However, the cirrhotic patients with age ≥50 years or/and AFP ≥8 ng/ml have significantly higher risk for HCC and warrant careful surveillance schedule for HCC development.

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Long-term clinical outcomes of patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study

Blood ◽

10.1182/blood-2010-10-312819 ◽

2011 ◽

Vol 117 (13) ◽

pp. 3514-3520 ◽

Cited By ~ 69

Author(s):

Mette Nørgaard ◽

Annette Ø. Jensen ◽

Malene C. Engebjerg ◽

Dóra K. Farkas ◽

Reimar W. Thomsen ◽

...

Keyword(s):

General Population ◽

Immune Thrombocytopenia ◽

Cox Regression ◽

Hematologic Malignancy ◽

Hematologic Malignancies ◽

Population Based ◽

Cox Regression Analysis ◽

Chronic Itp ◽

Chronic Immune Thrombocytopenia

AbstractFew data exist on the long-term prognosis of patients with chronic primary chronic immune thrombocytopenia (ITP). We examined the risk of infections, hemorrhage resulting in hospitalization, hematologic malignancies, and total and cause-specific mortality among patients with ITP compared with the general population. We used population-based medical databases to identify 407 patients with primary chronic ITP diagnosed during 1996 to 2007 and 4069 general population members individually matched on age, sex, and comorbidity level. We used Cox regression analysis to estimate rate ratios (RRs) adjusted for age (≤ 60 or > 60 years), sex, calendar year, and level of comorbidity. The adjusted 1-year RR of infection was 4.5 (95% confidence interval [CI], 3.3-6.1) for patients with chronic ITP compared with the general population cohort. The adjusted RR decreased to 1.8 (95% CI, 1.3-2.5) for the second to fifth year of follow-up. The adjusted 5-year RR was 3.2 (95% CI, 1.2-9.0) for hospitalized intracranial hemorrhage, 4.4 (95% CI, 2.3-8.3) for other hospitalized hemorrhages, and 4.7 (95% CI, 1.7-12.7) for hematologic malignancy. The 5-year all-cause mortality RR was 2.3 (95% CI, 1.8-3.0). In summary, primary chronic ITP was associated with substantially increased long-term risk of infections, hemorrhagic episodes requiring hospitalization, hematologic malignancies, and mortality.

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Risk of Burn Injury in Patients With Narcolepsy: A Nationwide Population-Based Cohort Study

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa004 ◽

2020 ◽

Vol 41 (3) ◽

pp. 663-667 ◽

Cited By ~ 2

Author(s):

En-Ting Chang ◽

Cheng-Li Lin ◽

Shih-Fen Chen ◽

Yu-Chih Shen

Keyword(s):

Incidence Rate ◽

Cox Regression ◽

Burn Injury ◽

Population Based ◽

Research Database ◽

Brain Disorder ◽

Cox Regression Analysis ◽

Increased Risk ◽

Prevention Interventions ◽

Lower Incidence Rate

Abstract Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan’s National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13–3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions.

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The Association between Temporomandibular Disorder and Sleep Apnea—A Nationwide Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176311 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6311

Author(s):

Ju-Hui Wu ◽

Kun-Tsung Lee ◽

Chia-Yu Kuo ◽

Chih-Hung Cheng ◽

Jih-Yu Chiu ◽

...

Keyword(s):

Cohort Study ◽

Sleep Apnea ◽

Incidence Rate ◽

Large Scale ◽

Cox Regression ◽

Temporomandibular Disorder ◽

Population Based ◽

Research Database ◽

Cox Regression Analysis ◽

Control Subjects

An increased incidence of temporomandibular disorders (TMD) among patients with sleep apnea (SA) has been reported. However, the association between TMD and SA has not been demonstrated in a large-scale study. This population-based cohort study with the Taiwan National Health Insurance (NHI) Research Database aimed to understand the association between SA and TMD. We identified adult patients with suspected SA (identified with diagnostic codes) and excluded those diagnosed with TMD prior to SA. Patients with SA diagnosis after polysomnography were also identified as probable SA patients. The index dates were the dates of their initial SA diagnosis. Ten control subjects were matched, by age and sex, to each SA patient, and were assigned the same index dates as the SA patients. In total, 10,408 suspected SA patients (including 4105 probable SA patients) matched to 104,080 control subjects (including 41,050 subjects matched to the probable SA patients) in this study. The TMD incidence rate was significantly higher in the SA patients than in the control subjects (2.8 vs. 1.0 per thousand-patient-year in probable SA patients vs. the corresponding control subjects, with an adjusted incidence rate ratio [95% confidence interval] = 2.5 [2.3–2.7], p < 0.0001). SA patients significantly showed a higher cumulative incidence of TMD than the corresponding control subjects (p < 0.0001). Multivariable Cox regression analysis revealed SA as an independent risk factor for the development of TMD (adjusted hazard ratio = 2.5 [1.7–3.7], p < 0.0001). In summary, this study confirmed an increased TMD incidence in the SA patients. While treating TMD patients, dentists should pay careful attention to the potential underlying SA.

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Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.243.pag ◽

2015 ◽

Vol 24 (3) ◽

pp. 287-292 ◽

Cited By ~ 5

Author(s):

Petra A. Golovics ◽

Laszlo Lakatos ◽

Michael D. Mandel ◽

Barbara D. Lovasz ◽

Zsuzsanna Vegh ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cox Regression ◽

Diagnostic Procedures ◽

Population Based ◽

Disease Course ◽

Inception Cohort ◽

Disease Extent ◽

Cox Regression Analysis ◽

Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

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Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1716324 ◽

2020 ◽

Author(s):

Julia Götte ◽

Armin Zittermann ◽

Kavous Hakim-Meibodi ◽

Masatoshi Hata ◽

Rene Schramm ◽

...

Keyword(s):

Mitral Valve ◽

General Population ◽

Elderly Patients ◽

Cox Regression ◽

Functional Class ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

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Effects of marital status on overall and cancer-specific survival in laryngeal cancer patients: a population-based study

Scientific Reports ◽

10.1038/s41598-020-80698-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Zhao Ding ◽

Deshun Yu ◽

Hefeng Li ◽

Yueming Ding

Keyword(s):

Marital Status ◽

Cancer Patients ◽

Laryngeal Cancer ◽

Cox Regression ◽

Group Analysis ◽

Population Based ◽

Cancer Specific Survival ◽

Cox Regression Analysis ◽

Prognostic Effect ◽

The Difference

AbstractMarital status has long been recognized as an important prognostic factor for many cancers, however its’ prognostic effect for patients with laryngeal cancer has not been fully examined. We retrospectively analyzed 8834 laryngeal cancer patients in the Surveillance Epidemiology and End Results database from 2004 to 2010. Patients were divided into four groups: married, widowed, single, and divorced/separated. The difference in overall survival (OS) and cancer-specific survival (CSS) of the various marital subgroups were calculated using the Kaplan–Meier curve. Multivariate Cox regression analysis screened for independent prognostic factors. Propensity score matching (PSM) was also conducted to minimize selection bias. We included 8834 eligible patients (4817 married, 894 widowed, 1732 single and 1391 divorced/separated) with laryngeal cancer. The 5-year OS and CSS of married, widowed, single, and separated/divorced patients were examined. Univariate and multivariate analyses found marital status to be an independent predictor of survival. Subgroup survival analysis showed that the OS and CSS rates in widowed patients were always the lowest in the various American Joint Committee on Cancer stages, irrespective of sex. Widowed patients demonstrated worse OS and CSS in the 1:1 matched group analysis. Among patients with laryngeal cancer, widowed patients represented the highest-risk group, with the lowest OS and CSS.

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Lymphoproliferative malignancies in patients with neurofibromatosis 1

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01856-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Christina Bergqvist ◽

François Hemery ◽

Arnaud Jannic ◽

Salah Ferkal ◽

Pierre Wolkenstein

Keyword(s):

General Population ◽

Medical History ◽

Hodgkin Lymphoma ◽

Incidence Rate ◽

Population Based ◽

Neurofibromatosis 1 ◽

Population Based Study ◽

Non Hodgkin Lymphoma ◽

History Of

AbstractNeurofibromatosis 1 (NF1) is an inherited, autosomal-dominant, tumor predisposition syndrome with a birth incidence as high as 1:2000. A patient with NF1 is four to five times more likely to develop a malignancy as compared to the general population. The number of epidemiologic studies on lymphoproliferative malignancies in patients with NF1 is limited. The aim of this study was to determine the incidence rate of lymphoproliferative malignancies (lymphoma and leukemia) in NF1 patients followed in our referral center for neurofibromatoses. We used the Informatics for Integrated Biology and the Bedside (i2b2) platform to extract information from the hospital’s electronic health records. We performed a keyword search on clinical notes generated between Jan/01/2014 and May/11/2020 for patients aged 18 years or older. A total of 1507 patients with confirmed NF1 patients aged 18 years and above were identified (mean age 39.2 years; 57% women). The total number of person-years in follow-up was 57,736 (men, 24,327 years; women, 33,409 years). Mean length of follow-up was 38.3 years (median, 36 years). A total of 13 patients had a medical history of either lymphoma or leukemia, yielding an overall incidence rate of 22.5 per 100,000 (0.000225, 95% confidence interval (CI) 0.000223–0.000227). This incidence is similar to that of the general population in France (standardized incidence ratio 1.07, 95% CI 0.60–1.79). Four patients had a medical history leukemia and 9 patients had a medical history of lymphoma of which 7 had non-Hodgkin lymphoma, and 2 had Hodgkin lymphoma. Our results show that adults with NF1 do not have an increased tendency to develop lymphoproliferative malignancies, in contrast to the general increased risk of malignancy. While our results are consistent with the recent population-based study in Finland, they are in contrast with the larger population-based study in England whereby NF1 individuals were found to be 3 times more likely to develop both non-Hodgkin lymphoma and lymphocytic leukemia. Large-scale epidemiological studies based on nationwide data sets are thus needed to confirm our findings.

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