Abstract WMP60: Temporal Trends in Incidence, Prevalence and Epidemiological Characteristics of Cerebral Venous Thrombosis in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fadar Otite ◽  
Smit Patel ◽  
Richa Sharma ◽  
Pushti Khandwala ◽  
Devashish Desai ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cerebral Venous Thrombosis ◽  
The United States ◽  
P Value ◽  
Joinpoint Regression ◽  
The Us ◽  
Epidemiological Characteristics ◽  
Over Time ◽  
Age And Sex

Background: The primary aim of this study is to describe current trends in racial-, age- and sex-specific incidence, clinical characteristics and burden of cerebral venous thrombosis (CVT) in the United States (US). Methods: Validated International Classification of Disease codes were used to identify all adult new cases of CVT (n=5,567) in the State Inpatients Database of New York and Florida (2006-2016) and all cases of CVT in the entire US from the National Inpatient Sample 2005-2016 (weighted n=57,315). Incident CVT counts were combined with annual US Census data to compute age and sex-specific incidence of CVT. Joinpoint regression was used to evaluate trends in incidence over time. Results: From 2005-2016, 0.47%-0.80% of all strokes in the US were CVTs but this proportion increased by 70.4% over time. Of all CVTs over this period, 66.7% were in females but this proportion declined over time (p<0.001). Pregnancy/puerperium (27.4%) and cancer (11.8%) were the most common risk factors in women, while cancer (19.5%) and central nervous trauma (11.3) were the most common in men. Whereas the prevalence of pregnancy/puerperium declined significantly over time in women, that of cancer, inflammatory conditions and trauma increased over time in both sexes. Annual age and sex-standardized incidence of CVT in cases/million population ranged from 13.9-20.2, but incidence varied significantly by sex (women: 20.3-26.9; men 6.8-16.8) and by age/sex (women 18-44yo: 24.0-32.6%; men: 18-44yo: 5.3-12.8). Age and sex-standardized incidence also differed by race (Blacks:18.6-27.2; whites: 14.3-18.5; Asians: 5.1-13.8). On joinpoint regression, incidence increased across 2006-2016 but most of this increase was driven by increase in all age groups of men (combined annualized percentage change (APC) 9.2%, p-value <0.001), women 45-64 yo (APC 7.8%, p-value <0.001) and women ≥65 yo (APC 7.4%, p-value <0.001). Incidence in women 18-44 yo remained unchanged over time . Conclusion: The epidemiological characteristics of CVT patients in the US is changing. Incidence increased significantly over the last decade. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or artefactual increase from improved detection.

scholarly journals Trends in incidence and epidemiologic characteristics of cerebral venous thrombosis in the United States

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2200-e2213 ◽  
Author(s):  
Fadar Oliver Otite ◽  
Smit Patel ◽  
Richa Sharma ◽  
Pushti Khandwala ◽  
Devashish Desai ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Census Data ◽  
Age Groups ◽  
The United States ◽  
Joinpoint Regression ◽  
Over Time ◽  
Age And Sex

ObjectiveTo test the hypothesis that race-, age-, and sex-specific incidence of cerebral venous thrombosis (CVT) has increased in the United States over the last decade.MethodsIn this retrospective cohort study, validated ICD codes were used to identify all new cases of CVT (n = 5,567) in the State Inpatients Databases (SIDs) of New York and Florida (2006–2016). A new CVT case was defined as first hospitalization for CVT in the SID without prior CVT hospitalization. CVT counts were combined with annual Census data to compute incidence. Joinpoint regression was used to evaluate trends in incidence over time.ResultsFrom 2006 to 2016, annual age- and sex-standardized incidence of CVT in cases per 1 million population ranged from 13.9 to 20.2, but incidence varied significantly by sex (women 20.3–26.9, men 6.8–16.8) and by age/sex (women 18–44 years of age 24.0–32.6, men 18–44 years of age 5.3–12.8). Incidence also differed by race (Blacks: 18.6–27.2; Whites: 14.3–18.5; Asians: 5.1–13.8). On joinpoint regression, incidence increased across 2006 to 2016, but most of this increase was driven by an increase in all age groups of men (combined annualized percentage change [APC] 9.2%, p < 0.001), women 45 to 64 years of age (APC 7.8%, p < 0.001), and women ≥65 years of age (APC 7.4%, p < 0.001). Incidence in women 18 to 44 years of age remained unchanged over time.ConclusionCVT incidence is disproportionately higher in Blacks compared to other races. New CVT hospitalizations increased significantly over the last decade mainly in men and older women. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or an artifactual increase from improved detection.

Changing Trends in Age and Sex Distributions of Lyme Disease—United States, 1992-2016

2021 ◽  
pp. 003335492110267
Author(s):  
Kiersten J. Kugeler ◽  
Paul S. Mead ◽  
Amy M. Schwartz ◽  
Alison F. Hinckley
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Disease Incidence ◽  
Age Distribution ◽  
Relative Size ◽  
The United States ◽  
Male Predominance ◽  
Age Related ◽  
Over Time ◽  
Age And Sex

Lyme disease is the most common vector-borne disease in the United States and is characterized by a bimodal age distribution and male predominance. We examined trends in reported cases during a 25-year period to describe changes in the populations most affected by Lyme disease in the United States. We examined demographic characteristics of people with confirmed cases of Lyme disease reported to the Centers for Disease Control and Prevention during 1992-2016 through the National Notifiable Diseases Surveillance System. We grouped cases into 5-year periods (1992-1996, 1997-2001, 2002-2006, 2007-2011, 2012-2016). We calculated the average annual incidence by age and sex and used incidence rate ratios (IRRs) to describe changes in Lyme disease incidence by age and sex over time. We converted patient age at time of illness into patient birth year to ascertain disease patterns according to birth cohorts. The incidence of Lyme disease in the United States doubled from 1992-1996 to 2012-2016 (IRR = 1.74; 95% CI, 1.70-1.78) and increased disproportionately among males; IRRs were 39%-89% higher among males than among females for most age groups. During the study period, children aged 5-9 years were most frequently and consistently affected. In contrast, the average age of adults with Lyme disease increased over time; of all adults, people born during 1950-1964 were the most affected by Lyme disease. Our findings suggest that age-related behaviors and susceptibilities may drive infections among children, and the shifting peak among adults likely reflects a probability proportional to the relative size of the baby boom population. These findings can inform targeted and efficient public health education and intervention efforts.

The Democratic Deficit of United States Federalism? Red State, Blue State, Purple?

2018 ◽  
Vol 46 (4) ◽  
pp. 645-667
Author(s):  
Vicki C Jackson
Keyword(s):  
United States ◽  
State Legislatures ◽  
The United States ◽  
State Legislature ◽  
Democratic Deficit ◽  
The Us ◽  
The 1960S ◽  
Us Senate ◽  
The One ◽  
Over Time

Aspects of an entrenched constitution that were essential parts of founding compromises, and justified as necessary when a constitution was first adopted, may become less justifiable over time. Is this the case with respect to the structure of the United States Senate? The US Senate is hardwired in the Constitution to consist of an equal number of Senators from each state—the smallest of which currently has about 585,000 residents, and the largest of which has about 39.29 million. As this essay explains, over time, as population inequalities among states have grown larger, so too has the disproportionate voting power of smaller-population states in the national Senate. As a result of the ‘one-person, one-vote’ decisions of the 1960s that applied to both houses of state legislatures, each state legislature now is arguably more representative of its state population than the US Congress is of the US population. The ‘democratic deficit’ of the Senate, compared to state legislative bodies, also affects presidential (as compared to gubernatorial) elections. When founding compromises deeply entrenched in a constitution develop harder-to-justify consequences, should constitutional interpretation change responsively? Possible implications of the ‘democratic’ difference between the national and the state legislatures for US federalism doctrine are explored, especially with respect to the ‘pre-emption’ doctrine. Finally, the essay briefly considers the possibilities of federalism for addressing longer term issues of representation, polarisation and sustaining a single nation.

The Adverse Consequences of the Politics of Agency Design for Presidential Management in the United States: The Relative Durability of Insulated Agencies

2004 ◽  
Vol 34 (3) ◽  
pp. 377-404 ◽  
Author(s):  
DAVID E. LEWIS
Keyword(s):  
United States ◽  
Public Policies ◽  
The United States ◽  
Executive Branch ◽  
Us Congress ◽  
The Us ◽  
Presidential Management ◽  
Agency Design ◽  
Over Time ◽  
Expected Duration

The US Congress has often sought to limit presidential influence over certain public policies by designing agencies that are insulated from presidential control. Whether or not insulated agencies persist over time has important consequences for presidential management. If those agencies that persist over time are also those that are the most immune from presidential direction, this has potentially fatal consequences for the president's ability to manage the executive branch. Modern presidents will preside over a less and less manageable bureaucracy over time. This article explains why agencies insulated from presidential control are more durable than other agencies and shows that they have a significantly higher expected duration than other agencies. The conclusion is that modern American presidents preside over a bureaucracy that is increasingly insulated from their control.

Incidence of and Risk Factors for Nosocomial Bloodstream Infections in Adults in the United States, 2003

2009 ◽  
Vol 30 (11) ◽  
pp. 1036-1044 ◽  
Author(s):  
Omar M. AL-Rawajfah ◽  
Frank Stetzer ◽  
Jeanne Beauchamp Hewitt
Keyword(s):  
United States ◽  
Risk Factors ◽  
Case Fatality Rate ◽  
Nationwide Inpatient Sample ◽  
Hospital Admissions ◽  
Case Fatality ◽  
The United States ◽  
Fatality Rate ◽  
The Us ◽  
National Estimates

Background.Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported.Objective.The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample.Methods.This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI.Results.The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R2 was 0.22.Conclusions.The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

scholarly journals The Changing Shape of the World Automobile Industry: A Multilayer Network Analysis of International Trade in Components and Parts

2022 ◽  
Author(s):  
Margherita Russo ◽  
◽  
Fabrizio Alboni ◽  
Jorge Carreto Sanginés ◽  
Manlio De Domenico ◽  
...  
Keyword(s):  
United States ◽  
Network Analysis ◽  
Trade Agreement ◽  
The United States ◽  
Trade Network ◽  
Trade Relations ◽  
Automotive Components ◽  
The Us ◽  
The World ◽  
Over Time

In 2018, after 25 years of the North America Trade Agreement (NAFTA), the United States requested new rules which, among other requirements, increased the regional con-tent in the production of automotive components and parts traded between the three part-ner countries, United States, Canada and Mexico. Signed by all three countries, the new trade agreement, USMCA, is to go into force in 2022. Nonetheless, after the 2020 Presi-dential election, the new treaty's future is under discussion, and its impact on the automo-tive industry is not entirely defined. Another significant shift in this industry – the acceler-ated rise of electric vehicles – also occurred in 2020: while the COVID-19 pandemic largely halted most plants in the automotive value chain all over the world, at the reopen-ing, the tide is now running against internal combustion engine vehicles, at least in the an-nouncements and in some large investments planned in Europe, Asia and the US. The definition of the pre-pandemic situation is a very helpful starting point for the analysis of the possible repercussions of the technological and geo-political transition, which has been accelerated by the epidemic, on geographical clusters and sectorial special-isations of the main regions and countries. This paper analyses the trade networks emerg-ing in the past 25 years in a new analytical framework. In the economic literature on inter-national trade, the study of the automotive global value chains has been addressed by us-ing network analysis, focusing on the centrality of geographical regions and countries while largely overlooking the contribution of countries' bilateral trading in components and parts as structuring forces of the subnetwork of countries and their specific position in the overall trade network. The paper focuses on such subnetworks as meso-level structures emerging in trade network over the last 25 years. Using the Infomap multilayer clustering algorithm, we are able to identify clusters of countries and their specific trades in the automotive internation-al trade network and to highlight the relative importance of each cluster, the interconnec-tions between them, and the contribution of countries and of components and parts in the clusters. We draw the data from the UN Comtrade database of directed export and import flows of 30 automotive components and parts among 42 countries (accounting for 98% of world trade flows of those items). The paper highlights the changes that occurred over 25 years in the geography of the trade relations, with particular with regard to denser and more hierarchical network gener-ated by Germany’s trade relations within EU countries and by the US preferential trade agreements with Canada and Mexico, and the upsurge of China. With a similar overall va-riety of traded components and parts within the main clusters (dominated respectively by Germany, US and Japan-China), the Infomap multilayer analysis singles out which com-ponents and parts determined the relative positions of countries in the various clusters and the changes over time in the relative positions of countries and their specialisations in mul-tilateral trades. Connections between clusters increase over time, while the relative im-portance of the main clusters and of some individual countries change significantly. The focus on US and Mexico and on Germany and Central Eastern European countries (Czech Republic, Hungary, Poland, Slovakia) will drive the comparative analysis.

scholarly journals Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Qiuchen Yang ◽  
Ellen Siobhan Mitchell ◽  
Annabell S. Ho ◽  
Laura DeLuca ◽  
Heather Behr ◽  
...  
Keyword(s):  
United States ◽  
Weight Loss ◽  
United Kingdom ◽  
New Zealand ◽  
Mixed Models ◽  
Linear Mixed Models ◽  
The United States ◽  
Weight Loss Intervention ◽  
The Us ◽  
Over Time

Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P &lt; 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.

scholarly journals Trends and Risk Factors for Leishmaniasis among Reproductive Aged Women in the United States

2021 ◽  
Vol 10 (2) ◽  
pp. 166-173
Author(s):  
Chioma Ikedionwu ◽  
Deepa Dongarwar ◽  
Courtney Williams ◽  
Evelyn Odeh ◽  
Maylis Nkeng Peh ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Global Health ◽  
Protective Factor ◽  
Private Insurance ◽  
The United States ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
The Us ◽  
Clinical Awareness

Background and Objective: Leishmaniasis, a neglected tropical disease, is endemic in several regions globally, but commonly regarded as a disease of travelers in the United States (US). The literature on leishmaniasis among hospitalized women in the US is very limited. The aim of this study was to explore trends and risk factors for leishmaniasis among hospitalized women of reproductive age within the US. Methods: We analyzed hospital admissions data from the 2002-2017 Nationwide Inpatient Sample among women aged 15-49 years. We conducted descriptive statistics and bivariate analyses for factors associated with leishmaniasis. Utilizing logistic regression, we assessed the association between sociodemographic and hospital characteristics with leishmaniasis disease among hospitalized women of reproductive age in the US. Joinpoint regression was used to examine trends over time. Results: We analyzed 131,529,239 hospitalizations; among these, 207 cases of leishmaniasis hospitalizations were identified, equivalent to an overall prevalence of 1.57 cases per million during the study period. The prevalence of leishmaniasis was greatest among older women of reproductive age (35-49 years), Hispanics, those with Medicare, and inpatient stay in large teaching hospitals in the Northeast of the US. Hispanic women experienced a statistically significant increased odds of leishmaniasis diagnosis (OR, 1.80; 95% CI, 1.19-4.06), compared to Non-Hispanic (NH) White women. Medicaid and Private Insurance appeared to serve as a protective factor in both unadjusted and adjusted models. We did not observe a statistically significant change in leishmaniasis rates over the study period. Conclusion and Global Health Implications: Although the prevalence of leishmaniasis among women of reproductive age appears to be low in the US, some risk remains. Thus, appropriate educational, public health and policy initiatives are needed to increase clinical awareness and timely diagnosis/treatment of the disease.   Copyright © 2021 Ikedionwu, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals THE COMPETITIVENESS OF INDONESIA'S EXPORT TO UNITED STATES, 1986-2003: A SHIFT-SHARE ANALYSIS

2007 ◽  
Vol 8 (1) ◽  
pp. 36
Author(s):  
Ahmad Helmy Fuady
Keyword(s):  
United States ◽  
Economic Crisis ◽  
The United States ◽  
The Other ◽  
Republic Of Korea ◽  
Single Digit ◽  
The Us ◽  
Asian Economies ◽  
Changes Over Time ◽  
Over Time

The objective of this paper is to examine the competitiveness of Indonesia's exports to the United States (US) market, compared to other Asian economies, namely Thailand, Malaysia, Singapore, China, Republic of Korea and India, over the period of 1986-2003. A shift-share method is applied to single digit SITC US imports data from those countries. It found that the competitiveness of Indonesia's exports changes over time. The Indonesia's exports reached its best performance in the period 1992-1997. However, after the 1997 economic crisis, Indonesia faces a serious problem, since none of its export has competitiveness in the US market, compared to the reference economy. The analysis also shows that China has consistently posed a serious pressure not only for Indonesia, but also for the other Asian economies.

scholarly journals Comments on Luke Nottage's Paper

2005 ◽  
Vol 36 (4) ◽  
pp. 859
Author(s):  
Meredith Kolsky Lewis
Keyword(s):  
United States ◽  
The United States ◽  
Good Faith ◽  
Narrow Scope ◽  
Doing Business ◽  
The Us ◽  
International Sale Of Goods ◽  
Uncertainty Of Outcome ◽  
Over Time

The author comments on Luke Nottage's paper found in this volume (Luke Nottage "Who's Afraid of the Vienna Sales Convention (CISG)? A New Zealander's View from Australia and Japan" (2005) 36 VUWLR 815). The author first identifies additional factors as to why the Convention on Contracts for the International Sale of Goods ('CISG') may be opted out of in the United States: its lack of a duty of good faith, its narrow scope, and its uncertainty of outcome. However, the author argues that we should be more optimistic about the use of the CISG in the US. First, the US is an original signatory. Secondly, Americans may come to accept the CISG more as their exposure to it grows. Thirdly, a lack of reported US cases involving the CISG does not necessarily mean it is not being used – it purely indicates a lack of litigation. Fourthly, the CISG not being used may speak more about who the US are doing business with. Finally, the numbers show that the CISG is being used frequently. The author therefore concludes that we should be optimistic about the use of the CISG in the United States, and expects its use will increase over time.

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