Abstract TP493: Herpes Zoster Vaccine Live And Risk For Stroke Among Medicare Beneficiaries: Population Based Matched Cohort Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Quanhe YANG ◽  
Anping Chang ◽  
Xin Tong ◽  
Robert Merritt
Keyword(s):  
Herpes Zoster ◽  
Hemorrhagic Stroke ◽  
Population Based ◽  
Racial Groups ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Zoster Vaccine ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of

Introduction: Herpes zoster (HZ) is associated with increased risk of stroke, and Zoster Vaccine Live (ZVL) reduces risk of HZ. No study examined the association between ZVL and risk for stroke. The present study examined this association among US older population. Methods: We included 1,382,051 Medicare fee-for-service beneficiaries age ≥66 years without a history of stroke and who received ZVL during 2008-2014, and 1,382,051 matched controls (using a comprehensive list of matching variables) without ZVL followed from ZVL receipt to December 31 2016. We used Cox proportional hazard models to examine the association between ZVL and composite fatal/non-fatal incident stroke outcomes. Results: During a median of 3.9 years follow-up (interquartile range 2.7-5.4), we documented 42,267 stroke events including 33,510 acute ischemic strokes (AIS) and 4,318 hemorrhagic strokes among beneficiaries who received ZVL over 5,890,113 person years. The corresponding numbers for controls were 48,139, 39,334, and 4,713 during 5,693,943 person years. Crude incidence comparing beneficiaries with and without ZVL were 7.18 vs. 8.45 per 1000 person years for all stroke, 5.40 vs. 6.53 for AIS, and 0.73 vs. 0.82 for hemorrhagic stroke (p<0.001 for difference). Adjusted hazard ratios comparing beneficiaries with ZVL to controls were 0.84 (95% CI 0.83-0.85), 0.82 (0.81-0.83), and 0.88 (0.84-0.91) for all stroke, AIS and hemorrhagic stroke respectively. The association between ZVL and risk for stroke appeared to be stronger among beneficiaries 66-79 years compared to those ≥80 years of age (p=0.020 for interaction), but largely consistent across sex, and racial groups. Conclusion: Among Medicare beneficiaries, receipt of ZVL was associated with lower incidence of stroke. Further study is needed to confirm our findings.

scholarly journals Herpes Zoster Vaccine Live and Risk of Stroke Among Medicare Beneficiaries

Stroke ◽  
2021 ◽  
Vol 52 (5) ◽  
pp. 1712-1721 ◽  
Author(s):  
Quanhe Yang ◽  
Anping Chang ◽  
Xin Tong ◽  
Robert Merritt
Keyword(s):  
Ischemic Stroke ◽  
Herpes Zoster ◽  
Acute Ischemic Stroke ◽  
Low Income ◽  
Hemorrhagic Stroke ◽  
Racial Groups ◽  
Fee For Service ◽  
Zoster Vaccine ◽  
Income Status ◽  
Increased Risk

Background and Purpose: Herpes zoster (HZ) is associated with increased risk of stroke, and zoster vaccine live (ZVL, Zostavax) reduces the risk of HZ. No study has examined the association between ZVL (Zostavax) and risk of stroke. Present study examined association between receipt of ZVL (Zostavax) and risk of stroke among older US population. Methods: Our study included 1 603 406 US Medicare fee-for-service beneficiaries aged ≥66 years without a history of stroke and who received ZVL (Zostavax) during 2008 to 2014, and 1 603 406 propensity score-matched unvaccinated beneficiaries followed through to December 31, 2017. We used Cox proportional hazard models to examine association between ZVL (Zostavax) and composite fatal or nonfatal incident stroke outcomes. Results: During a median of 5.1 years follow-up (interquartile range, 3.9–6.7), we documented 64 635 stroke events, including 43 954 acute ischemic strokes and 6727 hemorrhagic strokes, among vaccinated beneficiaries during 8 755 331 person-years. The corresponding numbers among unvaccinated beneficiaries were 73 023, 50 476, and 7276, respectively, during 8 517 322 person-years. Incidence comparing vaccinated to unvaccinated beneficiaries were 7.38 versus 8.57 per 1000 person-years for all stroke, 5.00 versus 5.90 for acute ischemic stroke, and 0.76 versus 0.84 for hemorrhagic stroke ( P <0.001 for all difference). Adjusted hazard ratios comparing vaccinated to unvaccinated beneficiaries were 0.84 (95% CI, 0.83–0.85), 0.83 (0.82–0.84), and 0.88 (0.85–0.91) for all stroke, acute ischemic stroke, and hemorrhagic stroke, respectively. The association between ZVL (Zostavax) and risk of stroke appeared to be stronger among younger beneficiaries, beneficiaries who did not take antihypertensive or statin medications and who had fewer comorbid conditions ( P <0.05 for interaction) but largely consistent across sex, low-income status, and racial groups. Conclusions: Among Medicare fee-for-service beneficiaries, receipt of ZVL (Zostavax) was associated with lower incidence of stroke. Our findings may encourage people to get vaccinated against HZ to reduce HZ and HZ-associated stroke risk.

Effect of herpes zoster vaccine and antiviral treatment on risk of ischemic stroke

Neurology ◽  
2020 ◽  
Vol 95 (6) ◽  
pp. e708-e717
Author(s):  
Quanhe Yang ◽  
Mary G. George ◽  
Anping Chang ◽  
Xin Tong ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Herpes Zoster ◽  
Antiviral Treatment ◽  
Case Series ◽  
Effect Modification ◽  
Fee For Service ◽  
Zoster Vaccine ◽  
Increased Risk ◽  
Group Sex ◽  
Rate Ratios

ObjectiveTo determine whether increased risk of acute ischemic stroke (AIS) following herpes zoster (HZ) might be modified by the status of zoster vaccine live (ZVL) vaccination and antiviral treatment following HZ.MethodsWe included 87,405 Medicare fee-for-service beneficiaries aged ≥66 years diagnosed with HZ and AIS from 2008 to 2017. We used a self-controlled case series design to examine the association between HZ and AIS, and estimated incidence rate ratios (IRRs) by comparing incidence of AIS in risk periods vs control periods. To examine effect modification by ZVL and antiviral treatment, beneficiaries were classified into 4 mutually exclusive groups: (1) no vaccination and no antiviral treatment; (2) vaccination only; (3) antiviral treatment only; and (4) both vaccination and antiviral treatment. We tested for interaction to examine changes in IRRs across 4 groups.ResultsAmong 87,405 beneficiaries with HZ and AIS, 22.0%, 2.0%, 70.1%, and 5.8% were in groups 1 to 4, respectively. IRRs in 0–14, 15–30, 31–90, and 91–180 days following HZ were 1.89 (95% confidence interval [CI], 1.77–2.02), 1.58 (95% CI, 1.47–1.69), 1.36 (95% CI, 1.31–1.42), and 1.19 (95% CI, 1.15–1.23), respectively. There was no evidence of effect modification by ZVL and antiviral treatment on AIS (p = 0.067 for interaction). The pattern of association between HZ and risk for AIS was largely consistent across age group, sex, and race.ConclusionsRisk of AIS increased significantly following HZ, and this increased risk was not modified by ZVL and antiviral treatment. Our findings suggest the importance of following recommended HZ vaccination in prevention of HZ and HZ-associated AIS.

scholarly journals Cancer and the risk of COVID-19 diagnosis, hospitalisation, and death: a population-based multi-state cohort study including 4,618,377 adults in Catalonia, Spain

2021 ◽  
Author(s):  
Elena Roel ◽  
Andrea Pistillo ◽  
Martina Recalde ◽  
Sergio Fernandez-Bertolin ◽  
Maria Aragon ◽  
...  
Keyword(s):  
Cohort Study ◽  
Smoking Status ◽  
Population Based ◽  
High Risk Population ◽  
Cancer Type ◽  
Non Melanoma Skin Cancer ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
One Year

Objectives: To investigate the associations between cancer and risk of outpatient COVID-19 diagnosis, hospitalisation, and COVID-19-related death, overall and by years since cancer diagnosis (<1-year, 1-5-years, >5-years), sex, age, and cancer type. Design: Population-based cohort study Setting: Primary care electronic health records including ~80% of the population in Catalonia, Spain, linked to hospital and mortality records between 1 March and 6 May 2020. Participants: Individuals aged ≥18 years with at least one year of prior medical history available from the general population. Cancer was defined as any prior diagnosis of a primary invasive malignancy excluding non-melanoma skin cancer. Main outcome measures: Cause-specific hazard ratios (aHR) with 95% confidence intervals for each outcome. Estimates were adjusted by age, sex, deprivation, smoking status, and comorbidities. Results: We included 4,618,377 adults, of which 260,667 (5.6%) had a history of cancer. Patients with cancer were older and had more comorbidities than cancer-free patients. A total of 98,951 individuals (5.5% with cancer) were diagnosed and 6,355 (16.4% with cancer) were directly hospitalised (no prior diagnosis) with COVID-19. Of those diagnosed, 6,851 were subsequently hospitalised (10.7% with cancer) and 3,227 died without being hospitalised (18.5% with cancer). Among those hospitalised, 1,963 (22.5% with cancer) died. Cancer was associated with an increased risk of COVID-19 diagnosis (aHR: 1.08; 95% confidence interval [1.05-1.11]); direct COVID-19 hospitalisation (1.33 [1.24-1.43]); and death following a COVID-19 hospitalisation (1.12 [1.01-1.25]). These associations were stronger for patients recently diagnosed with cancer, aged <70 years, and with haematological cancers. Conclusions: Patients recently diagnosed with cancer, aged <70 years, or with haematological cancers are a high-risk population for COVID-19 diagnosis and severity. These patients should be prioritised in COVID-19 vaccination campaigns and continued non-pharmaceutical interventions.

scholarly journals Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1625
Author(s):  
Chia-Wen Li ◽  
Yen-Chin Chen ◽  
Nan-Yao Lee ◽  
Po-Lin Chen ◽  
Ming-Chi Li ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Past History ◽  
Treated Group ◽  
Population Based ◽  
Insurance Premium ◽  
Control Group ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
Southern Taiwan

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

scholarly journals Neurodegenerative disease is associated with increased incidence of epilepsy: a population based study of older adults

2020 ◽  
Author(s):  
Leah J Blank ◽  
Emily K Acton ◽  
Dylan Thibault ◽  
Allison W Willis
Keyword(s):  
Neurodegenerative Disease ◽  
Cox Regression ◽  
Control Sample ◽  
Disease Status ◽  
Population Based ◽  
Medicare Beneficiaries ◽  
Alzheimer Dementia ◽  
Increased Risk ◽  
History Of ◽  
New Diagnosis

Abstract Objective To determine the incidence of epilepsy among Medicare beneficiaries with a new diagnosis of Alzheimer dementia (AD) or Parkinson disease (PD). Methods Retrospective cohort study of Medicare beneficiaries with an incident diagnosis of AD or PD in the year 2009. The 5-year incidence of epilepsy was examined by sociodemographic characteristics, comorbidities and neurodegenerative disease status. Cox regression models examined the association of neurodegenerative disease with incident epilepsy, adjusting for demographic characteristics and medical comorbidities. Results We identified 178,593 individuals with incident AD and 104,157 individuals with incident PD among 34,054,293 Medicare beneficiaries with complete data in 2009. Epilepsy was diagnosed in 4.45% (7,956) of AD patients and 4.81% (5,010) of PD patients between 2009 and 2014, approximately twice as frequently as in the control sample. Minority race/ethnicity was associated with increased risk of incident epilepsy. Among individuals with AD and PD, stroke was associated with increased epilepsy risk. Traumatic brain injury (TBI) was associated with increased epilepsy risk for individuals with PD. Depression was also associated with incident epilepsy (AD adjusted hazard ratio (AHR): 1.23 (1.17–1.29), PD AHR: 1.45 (1.37–1.54)). In PD only, a history of hip fracture (AHR, 1.35 (1.17–1.57)) and diabetes (AHR, 1.11 (1.05–1.18) were also associated with increased risk of epilepsy. Conclusion Incident epilepsy is more frequently diagnosed among neurodegenerative disease patients, particularly when preceded by a diagnosis of depression, TBI or stroke. Further studies into the differences in epilepsy risk between these two populations may help elucidate different mechanisms of epileptogenesis.

Overall and cancer-specific survival of breast, colon, and lung cancer in patients with and without chronic lymphocytic leukemia: A SEER population-based study of over 1 million patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6571-6571
Author(s):  
Benjamin Maurice Solomon ◽  
Kari G. Rabe ◽  
Susan L Slager ◽  
Jerry D Brewer ◽  
James R. Cerhan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Lymphocytic Leukemia ◽  
Population Based ◽  
Lymphocytic Leukemia ◽  
Cancer Site ◽  
Cancer Specific Survival ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
Age And Sex

6571 Background: Chronic lymphocytic leukemia (CLL) is associated with an increased risk of developing second cancers. However, it is unknown whether CLL alters the natural history of these cancers once they occur. Methods: All patients with breast (n=583,838), colon (n=412,932), prostate (n=632,922), lung (n=489,290), kidney (n=95,902), pancreas (n=82,121) and ovarian (n=61,958) cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program from 1990 to 2007 were identified. Overall survival (OS; death due to any cause) and cancer-specific survival (death due to cancer site of interest) were examined, comparing patients with or without pre-existing CLL. Age- and sex-adjusted hazard ratios (HRs) were calculated. Results: OS for patients with pre-existing CLL was inferior for patients with breast (HR=1.61; p<0.001), colon (HR=1.65; p<0.001), kidney (HR=1.41; p<0.001), prostate (HR=1.75; p<0.001), and lung (HR=1.22; p<0.001) cancer after adjusting for age and sex. After excluding CLL-related deaths, OS remained shorter among patients with breast (p<0.001), colon (p<0.001), kidney (p=0.03), prostate (p<0.001), and lung (p<0.001) cancer. Cancer-specific survival was inferior for patients with breast (HR=1.29; p=0.03), colon (HR=1.75; p<0.001), and lung cancer (HR=1.17; p<0.001) who had pre-existing CLL after adjusting for age and sex. Conclusions: Several common cancers, including breast, colon, and lung, have inferior overall and cancer-specific survival when there is coexistent CLL. [Table: see text]

scholarly journals Cardiovascular fitness in males at age 18 and risk of serious depression in adulthood: Swedish prospective population-based study

2012 ◽  
Vol 201 (5) ◽  
pp. 352-359 ◽  
Author(s):  
Maria A. I. Åberg ◽  
Margda Waern ◽  
Jenny Nyberg ◽  
Nancy L. Pedersen ◽  
Ylva Bergh ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Population Based ◽  
Cardiovascular Fitness ◽  
National Hospital ◽  
Population Based Study ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
Future Risk ◽  
Swedish Cohort

BackgroundStudies suggest a role for cardiovascular fitness in the prevention of affective disorders.AimsTo determine whether cardiovascular fitness at age 18 is associated with future risk of serious affective illness.MethodPopulation-based Swedish cohort study of male conscripts (n = 1 117 292) born in 1950–1987 with no history of mental illness who were followed for 3–40 years. Data on cardiovascular fitness at conscription were linked with national hospital registers to calculate future risk of depression (requiring in-patient care) and bipolar disorder.ResultsIn fully adjusted models low cardiovascular fitness was associated with increased risk for serious depression (hazard ratios (HR)=1.96, 95%, CI 1.71–2.23). No such association could be shown for bipolar disorder (HR=1.11, 95% CI 0.84–1.47).ConclusionsLower cardiovascular fitness at age 18 was associated with increased risk of serious depression in adulthood. These results strengthen the theory of a cardiovascular contribution to the aetiology of depression.

Risk of cataract and glaucoma in patients with multiple sclerosis

2011 ◽  
Vol 18 (5) ◽  
pp. 628-638 ◽  
Author(s):  
Marloes T Bazelier ◽  
Sigrid Mueller-Schotte ◽  
Hubert GM Leufkens ◽  
Bernard MJ Uitdehaag ◽  
Tjeerd van Staa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
General Practice Research Database ◽  
Population Based ◽  
Practice Research ◽  
Research Database ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
The Uk ◽  
Hospital Registry

Background: The aim of the study was to evaluate whether multiple sclerosis (MS) is associated with risk of cataract or glaucoma. Methods: We conducted a population-based cohort study utilizing the UK General Practice Research Database (1987–2009) linked to the national hospital registry of England (1997–2008). Incident MS patients (5576 cases) were identified and each was matched to six patients without MS (controls) by age, gender, and practice. Cox proportional hazard models were used to estimate hazard ratios (HRs) of incident cataract and glaucoma in MS. Time-dependent adjustments were made for age, history of diseases and drug use. Results: MS patients had no overall increased risk of cataract, adjusted (adj.) HR 1.15 (95% CI 0.94–1.41) or glaucoma, adj. HR 1.02 (95% CI 0.78–1.33). Risk of cataract (adj. HR 2.45 (95% CI 1.56–3.86)) and glaucoma (adj. HR 1.70 (95% CI 1.01–2.86)) was significantly greater in patients < 50 years, particularly in men < 50 years: cataract, adj. HR 4.23 (95% CI 2.22–8.05) and glaucoma, adj. HR 2.76 (95% CI 1.28–5.93). Conclusion: This is the first study which showed that the risk of cataract and glaucoma is elevated in MS patients younger than 50 years, particularly men.

Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kim ◽  
H Jung ◽  
P.S Yang ◽  
H.T Yu ◽  
T.H Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Middle Age ◽  
Population Based ◽  
Entire Cohort ◽  
Incident Dementia ◽  
Increased Risk ◽  
Diagnosis Of Dementia ◽  
History Of ◽  
The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p&lt;0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p&lt;0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

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