scholarly journals Young Women Had More Strokes Than Young Men in a Large, United States Claims Sample

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3352-3355 ◽  
Author(s):  
Michelle H. Leppert ◽  
P. Michael Ho ◽  
James Burke ◽  
Tracy E. Madsen ◽  
Dawn Kleindorfer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Incidence Rate ◽  
Young Women ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Age Groups ◽  
Stroke Rate ◽  
Index Stroke ◽  
Time Varying Covariates

Background and Purpose: Cardiovascular risk factors, which are overall more prevalent in men, are considered the major risk factors for strokes among young adults. However, recent European data found the incidence of strokes to be higher in young women. Using a large US claims sample, we examined sex differences in the index stroke rate of young adults. Methods: We performed a retrospective cohort study of enrollees in a 10% random sample of PharMetrics, a nationally representative claims database of insured Americans from 2001 to 2014. Outcomes were index ischemic stroke events, based on inpatient admissions using International Classification of Diseases-Ninth Revision codes. The index stroke rate was estimated from Poisson rate models with time varying covariates for 2-year periods, stratified by sex and age groups. Results: We identified 20 554 index strokes (50.4% women; mean age 63) including 5198 in young adults ages 15 to 54. There was no difference by sex in the index stroke rate in the extremes of age groups 15 to 24 and ≥75 years old. However, in the 25 to 34 and 35 to 44 year age groups, more women had strokes than men (incidence rate ratio: men:women, 0.70 [95% CI, 0.57–0.86]; 0.87 [95% CI, 0.78–0.98], respectively). In contrast, in the 45 to 54, 55 to 64, and 65 to 74 year age groups, more men had strokes (incidence rate ratio, 1.25 [95% CI, 1.16–1.33]; 1.41 [95% CI, 1.18–1.34]; 1.18 [95% CI, 1.12–125], respectively). Conclusions: More young women than men have strokes, suggesting possible importance of sex-mediated etiologies of stroke. Understanding these drivers is critical to stroke treatment and prevention efforts in young adults.

scholarly journals Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Catherine Arnaud ◽  
Virginie Ehlinger ◽  
Malika Delobel-Ayoub ◽  
Dana Klapouszczak ◽  
Oliver Perra ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Incidence Rate ◽  
Gestational Age ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Incidence Rate Ratio ◽  
Age Groups ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Preterm Born

Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups.Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models.Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks.Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.

scholarly journals Trends in incident acute myocardial infarction in Norway: An updated analysis to 2014 using national data from the CVDNOR project

2018 ◽  
Vol 25 (10) ◽  
pp. 1031-1039 ◽  
Author(s):  
Gerhard Sulo ◽  
Jannicke Igland ◽  
Stein Emil Vollset ◽  
Marta Ebbing ◽  
Grace M Egeland ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Age Groups ◽  
Incidence Rates ◽  
Myocardial Infarctions ◽  
Men And Women

Background We updated the information on trends of incident acute myocardial infarction in Norway, focusing on whether the observed trends during 2001–2009 continued throughout 2014. Methods All incident (first) acute myocardial infarctions in Norwegian residents age 25 years and older were identified in the Cardiovascular Disease in Norway 1994–2014 project. We analysed overall and age group-specific (25–64 years, 65–84 years and 85 + years) trends by gender using Poisson regression analyses and report the average annual changes in rates with their 95% confidence intervals. Results During 2001–2014, 221,684 incident acute myocardial infarctions (59.4% men) were identified. Hospitalised cases accounted for 79.9% of all incident acute myocardial infarctions. Overall, incident acute myocardial infarction rates declined on average 2.6% per year (incidence rate ratio 0.974, 95% confidence interval 0.972–0.977) in men and 2.8% per year (incidence rate ratio 0.972, 95% confidence interval 0.971–0.974) in women, contributed by declining rates of hospitalisations (1.8% and 1.9% per year in men and women, respectively) and deaths (6.0% and 5.8% per year in men and women, respectively). Declining rates were observed in all three age groups. The overall acute myocardial infarction incidence rates continued to decline from 2009 onwards, with a steeper decline compared to 2001–2009. During 2009–2014, gender-adjusted acute myocardial infarction incidence among adults age 25–44 years declined 5.3% per year, contributed mostly by declines in hospitalisation rates (5.1% per year). Conclusion Acute myocardial infarction incidence rates continued to decline after 2009 in Norway in both men and women. The decline started to involve individuals aged 25–44 years, marking a turning point in the previously reported stagnation of rates during 2001–2009.

Abdominal aortic aneurysm is associated with subarachnoid hemorrhage

2020 ◽  
pp. neurintsurg-2020-016757 ◽  
Author(s):  
D Andrew Wilkinson ◽  
Badih J Daou ◽  
Jeffrey L Nadel ◽  
Neeraj Chaudhary ◽  
Joseph J Gemmete ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Claims Data ◽  
Incidence Rate Ratio ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

BackgroundAlthough intracranial aneurysms (IA) and abdominal aortic aneurysms (AAA) share similar risk factors, little is known about the relationship between them. Previous studies have shown an increased incidence of IA in patients with AAA, though the rate of subarachnoid hemorrhage (SAH) in patients with AAA has not been described.ObjectiveTo use claims data with longitudinal follow-up, to evaluate the incidence of aneurysmal SAH in patients diagnosed with AAA.MethodsWe examined longitudinally linked medical claims data from a large private insurer to determine rates of aneurysmal SAH (aSAH) and secured aSAH (saSAH) in 2004–2014 among patients with previously diagnosed AAA.ResultsWe identified 62 910 patients diagnosed with AAA and compared them 5:1 with age- and sex-matched controls. Both populations were predominantly male (70.9%), with an average age of 70.8 years. Rates of hypertension (69.7% vs 50.6%) and smoking (12.8% vs 4.1%) were higher in the AAA group (p<0.0001) than in controls. Fifty admissions for aSAH were identified in patients with AAA (26/100 000 patient-years, 95% CI 19 to 44) and 115 admissions for aSAH in controls (7/100 000 years, 95% CI 6 to 9), giving an incidence rate ratio (IRR) of 3.6 (95% CI 2.6 to 5.0, p<0.0001) and a comorbidity-adjusted incidence rate ratio (IRR) of 2.8 (95% CI 1.9 to 3.9) for patients with AAA. The incidence of secured aneurysmal SAH was proportionally even higher in patients with AAA, 7 vs 2/100 000 years, IRR 4.5 (95% CI 3.2 to 6.3, p<0.0001).ConclusionSAH rate was elevated in patients with AAA, even after adjustment for comorbidities. Among risk factors evaluated, AAA was the strongest predictor for SAH. The relative contributions of common genetic and environmental risk factors to both diseases should be investigated.

Abstract P305: Incidence of Coronary Artery Calcification and Its Association With Eicosapentaenoic Acids From The ERA JUMP Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Akira Sekikawa ◽  
Hirotsugu Ueshima ◽  
David J Curb ◽  
Sunghee Lee ◽  
Chol Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fatty Acids ◽  
Coronary Artery ◽  
Incidence Rate ◽  
Coronary Artery Calcification ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
White Men ◽  
The Difference

Objectives: To compare incidence of coronary artery calcification (CAC) between men in Japan and the US and to examine whether marine n-3 fatty acids contribute to the difference in the incidence. Methods: The ERA JUMP Study is a population-based longitudinal study which has examined the progression of subclinical atherosclerosis in Japanese, Japanese American and white men aged 40-49 at baseline in 2002-2007. Incident cases of CAC were defined as those with CAC score=zero at baseline (n=278: 167 Japanese and 111 whites) and CAC score ≥10 at follow-up. Mean follow-up years were 6.2 for Japanese and 4.6 for whites. Stepwise robust logistic regression was used to determine baseline predictors of CAC incidence in each group. Generalized linear model was used to examine whether the difference in risk factors and marine n-3 fatty acids at baseline between Japanese and whites contributed to the difference in incidence rates. Results: Baseline characteristics show that levels of risk factors were similar between the two groups including LDL-C and BP. Exceptions were higher rates of smoking in Japanese (49 vs. 7%) and higher levels of HDL-C in Japanese (54 vs. 49 mg/dL). Levels of marine n-3 fatty acids were 100+% higher in Japanese. Incidence rate was significantly lower in Japanese than in whites (0.9 for Japanese vs. 2.9 for whites (per 100 person years) p<0.01). Logistic regression analyses showed that predictors of CAC incidence were HDL-C, BMI, and triglycerides for whites and BP and eicosapentaenoic acids (EPA) for Japanese. Generalized linear model showed that incidence rate ratio was 0.606 after adjusting for age, follow-up time, BMI, BP, HDL-C, LDL-C, and smoking (p<0.01), which remained significant after further adjusting for other risk factors. However, after further adjusting for EPA, the statistical significance disappeared (p=0.07). ( Table ) Conclusions: CAC incidence is significantly lower in Japanese than in white men. The data suggest that high levels of EPA contribute to the lower CAC incidence in Japanese. Table. Incidence rate ratio of coronary artery calcification between Japanese men and white men (n=278) Incidence rate ratio between two groups (95% CI) (Japanese vs. whites) p -value Model I 0.606 (0.427, 0.861) <0.01 Model II 0.571 (0.392, 0.830) <0.01 Model III 0.669 (0.431, 1.038) 0.07 Model I: Adjusted for age, follow-up time, BMI, BP sys, HDL-C pack-years of smoking and LDL-C Model II: Further adjusted for triglycerides, glucose, hypertension medication, lipid medication, CRP and alcohol Model III: Further adjusted for EPA (eicosapentaenoic acid)

Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

2021 ◽  
Author(s):  
Susanna Scharrer ◽  
Christian Primas ◽  
Sabine Eichinger ◽  
Sebastian Tonko ◽  
Maximilian Kutschera ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Fatal Bleeding ◽  
Adjusted Incidence Rate ◽  
Inflammatory Bowel ◽  
Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

scholarly journals Secrets of the hospital underbelly: abundance of antimicrobial resistance genes in hospital wastewater reflects hospital antimicrobial use and inpatient length of stay

2019 ◽  
Author(s):  
Meghan R. Perry ◽  
Bram van Bunnik ◽  
Luke McNally ◽  
Bryan Wee ◽  
Patrick Munk ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Length Of Stay ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Clinical Activity ◽  
Hospital Wastewater ◽  
Antimicrobial Consumption ◽  
Gene Abundance ◽  
Class Level

ABSTRACTIntroductionHospital wastewater is a potential major source of antimicrobial resistance (AMR). This study uses metagenomics to ask how abundances of AMR genes in hospital wastewater are related to clinical activity.MethodsSewage was collected over a 24-hour period from multiple wastewater collection points representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. AMR gene abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates.FindingsMicrobiota and AMR gene composition varied between each collection point and overall AMR gene abundance was higher in hospital wastewater than in community influent. The composition of AMR genes correlated with microbiota composition (Procrustes analysis, p=0.002). Increased antimicrobial consumption at a class level was associated with higher AMR gene abundance within that class in wastewater (incidence rate ratio 2.80, C.I. 1.2-6.5, p=0.016). Prolonged average patient length of stay was associated with higher total AMR gene abundance in wastewater (incidence rate ratio 2.05, C.I. 1.39-3.01, p=0.0003). AMR gene abundance at a class level within hospital wastewater did not reflect resistance patterns in the 181 clinical isolates grown from hospital inpatients over the time of wastewater sampling.ConclusionsHospital antimicrobial consumption and patient length of stay are important drivers of AMR gene outflow into the environment. Using metagenomics to identify the full range of AMR genes in hospital wastewater could represent a useful surveillance tool to monitor hospital AMR gene outflow and guide environmental policy on AMR.

scholarly journals Mental distress among young adults – gender differences in the role of social support

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rune Johansen ◽  
Mari Nicholls Espetvedt ◽  
Heidi Lyshol ◽  
Jocelyne Clench-Aas ◽  
Ingri Myklestad
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Gender Differences ◽  
Young Adults ◽  
Young Women ◽  
Sense Of Coherence ◽  
Protective Factor ◽  
Mental Distress ◽  
Age Groups ◽  
Regular Physical Activity

Abstract Background The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people. Methods This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter of 2015–2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18–24 years old (n = 624), 25–31 (n = 582), and 32–38 years old (n = 795). Results Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association between low social support and mental distress was significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis. Conclusion Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.

Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

2021 ◽  
pp. 1-11
Author(s):  
Benjamin T. Schumacher ◽  
John Bellettiere ◽  
Michael J. LaMonte ◽  
Kelly R. Evenson ◽  
Chongzhi Di ◽  
...  
Keyword(s):  
Physical Function ◽  
Older Women ◽  
Incidence Rate ◽  
Fall Risk ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Steps Per Day ◽  
Falls In Older Adults ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

Thirteen-Year Trends in Cardiovascular Risk in Men and Women with Chronic Coronary Syndrome

2021 ◽  
Author(s):  
Kevin Kris Warnakula Olesen ◽  
Esben Skov Jensen ◽  
Christine Gyldenkerne ◽  
Morten Würtz ◽  
Martin Bødtker Mortensen ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Incidence Rate ◽  
Cardiac Death ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Men And Women ◽  
Coronary Syndrome ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Adjusted Incidence

Abstract Aims To examine combined and sex-specific temporal changes in risks of adverse cardiovascular events and coronary revascularization in patients with chronic coronary syndrome undergoing coronary angiography. Methods We included all patients with stable angina pectoris and coronary artery disease examined by coronary angiography in Western Denmark from 2004 to 2016. Patients were stratified by examination year interval: 2004-2006, 2007-2009, 2010-2012, and 2013-2016. Outcomes were two-year risk of myocardial infarction, ischemic stroke, cardiac death, and all-cause death estimated by adjusted incidence rate ratios using patients examined in 2004-2006 as reference. Results A total of 29,471 patients were included, of whom 70% were men. The two-year risk of myocardial infarction (2.8% versus 1.9%, adjusted incidence rate ratio 0.65, 95% CI 0.53-0.81), ischemic stroke (1.8% versus 1.1%, adjusted incidence rate ratio 0.48, 95% CI 0.37-0.64), cardiac death (2.1% versus 0.9%, adjusted incidence rate ratio 0.38, 95% CI 0.29-0.51), and all-cause death (5.0% versus 3.6%, adjusted incidence rate ratio 0.65, 95% CI 0.55-0.76) decreased from the first examination interval (2004-2006) to the last examination interval (2013-2016). Coronary revascularizations also decreased (percutaneous coronary intervention: 51.6% versus 42.5%; coronary artery bypass grafting: 24.6% versus 17.5%). Risk reductions were observed in both men and women, however, women had a lower absolute risk. Conclusion The risk for adverse cardiovascular events decreased substantially in both men and women with chronic coronary syndrome from 2004 to 2016. These results most likely reflect the cumulative effect of improvements in the management of chronic coronary artery disease.

Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial

2021 ◽  
Author(s):  
Kieran S O’Brien ◽  
Ahmed M Arzika ◽  
Ramatou Maliki ◽  
Abdou Amza ◽  
Farouk Manzo ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Causal Effect ◽  
Controlled Trial ◽  
Effect Analysis ◽  
Intention To Treat ◽  
Average Causal Effect ◽  
Cluster Randomized ◽  
Complier Average Causal Effect

Abstract Background Biannual azithromycin distribution to children 1–59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings. Methods The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression. Results In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities. Conclusions As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.

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