Social consequences of multiple sclerosis. Part 2. Divorce and separation: a historical prospective cohort study

Background: There is a need for follow-up studies of the familial situation of multiple sclerosis (MS) patients. Objectives: To evaluate the probability of MS patients to remain in marriage or relationship with the same partner after onset of MS in comparison with the population. Patients and methods: All 2538 Danes with onset of MS 1980—1989, retrieved from the Danish MS-Registry, and 50,760 matched and randomly drawn control persons were included. Information on family status was retrieved from Statistics Denmark. Cox analyses were used with onset as starting point. Results: Five years after onset, the cumulative probability of remaining in the same relationship was 86% in patients vs. 89% in controls. The probabilities continued to deviate, and at 24 years, the probability was 33% in patients vs. 53% in the control persons ( p < 0.001). Among patients with young onset (< 36 years of age), those with no children had a higher risk of divorce than those having children less than 7 years (Hazard Ratio 1.51; p < 0.0001), and men had a higher risk of divorce than women (Hazard Ratio 1.33; p < 0.01). Conclusion: MS significantly affects the probability of remaining in the same relationship compared with the background population.

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The U-Shaped Association between Bilirubin and Diabetic Retinopathy Risk: A Five-Year Cohort Based on 5323 Male Diabetic Patients

Journal of Diabetes Research ◽

10.1155/2018/4603087 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Miao Liu ◽

Jianhua Wang ◽

Yao He

Keyword(s):

Diabetic Retinopathy ◽

Cohort Study ◽

Risk Model ◽

Continuous Variable ◽

Hazard Ratio ◽

Diabetic Patients ◽

Lower Baseline ◽

The Impact ◽

Chinese Male

Aims. This study aimed at assessing the impact of baseline bilirubin (TBiL) on the incidence of diabetic retinopathy (DR) based on a five-year cohort study which consisted of 5323 Chinese male diabetic patients.Methods. A cohort study based on 5323 male diabetic patients was conducted in Beijing, from 2009 to 2013. Both baseline TBiL and follow-up changes were measured. Cox proportional risk model was used to calculate the hazard ratio (HR) of TBiL for DR risk.Results. During the follow-up period, there were 269 new DR cases. The incidence of five-year follow-up was 5.1% (95% CI: 4.5%~5.6%). The TBiL level of those who had diabetic retinopathy was lower than that of those without (12.51+ 1.20 mol/L and 13.11+ 1.32μmol/L,P=0.033). And more interestingly, along with the quintiles of baseline TBiL, there showed a U-shaped curve with DR incidence. And the RRs were 0.928 (95% CI: 0.646–1.331), 0.544 (95% CI: 0.365–0.811), 0.913 (95% CI: 0.629–1.324), and 1.035 (95% CI: 0.725–1.479) for the second, third, fourth, and fifth quintiles of baseline TBiL levels, respectively, compared with the first quintile. For follow-up TBiL changes, after being adjusted for related covariables and baseline TBiL levels (as continuous variable) in the model, the RRs for DR were 1.411 (95% CI: 1.081–1.842) for those who had decreased TBiL level and 0.858 (95% CI: 0.770–0.947) for those who had increased TBiL level during follow-up. And this association was more prominent among those with lower baseline TBiL level.Conclusions. Serum TBiL had a U-shaped relationship with DR incidence, which was independent of control status of diabetes and other related covariates.

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Cancer Development and Mortality Differences in Patients with Glomerulonephritis after Renal Biopsy: A Single Center Retrospective Cohort Study

10.21203/rs.3.rs-19316/v1 ◽

2020 ◽

Author(s):

Hyunjin Ryu ◽

Kipyo Kim ◽

Jiwon Ryu ◽

Hyung-Eun Son ◽

Ji-Young Ryu ◽

...

Keyword(s):

Cohort Study ◽

Renal Biopsy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

De Novo ◽

Hazard Ratio ◽

Cancer Development ◽

De Novo Cancer

Abstract Background: The association between glomerulonephritis (GN) and cancer has been well known for decades. However, studies evaluating long-term de novo cancer development in patients with GN are limited. This study aimed to evaluate the incidence of cancer development among patients with renal biopsy-proven GN during post-biopsy follow-up and the differences in outcomes according to cancer occurrence. Methods: We conducted a retrospective cohort study of adult patients who underwent renal biopsy at Seoul National Bundang Hospital between 2003 and 2017. After excluding 671 patients who are inappropriate for the analysis, 929 patients were included in the analysis. Data on baseline clinical characteristics, renal biopsy results, and types and doses of immunosuppressant agents used during follow-up were collected from electronic medical records. The incidence of cancer was censored on the date when the first cancer was diagnosed. We evaluated rates of mortality and end-stage renal disease (ESRD) development during follow-up. Results: During a mean follow-up period of 52.4 (range: 1.0–166.7) months, 49 subjects (5.3%) developed de novo cancer. A comparison of clinical characteristics between subjects who did and did not develop cancer revealed that cancer patients were older and had higher comorbidities and immunosuppressant use. Overall, patients with GN had an elevated standardized incidence ratio (SIR) of 7.17 (95% confidence interval (CI): 5.3–9.51) relative to the general population. In particular, the SIR was significantly higher in GNs such as membranous nephropathy (MN), IgA nephropathy, lupus nephritis, and focal segmental glomerulosclerosis. Multivariable Cox proportional hazard model adjusted for confounding variables revealed that patients with a pathologic diagnosis of MN had an increased risk of cancer development, with a hazard ratio of 2.6 [95% CI: 1.32–5.30]. Patients with MN who developed cancer had a significantly higher risk of mortality (hazard ratio: 5.95; 95% CI: 1.36–26.09, P=0.018) than those without cancer, but there was a non-significant difference in ESRD development. Conclusions: Patients with GN without concurrent cancer, particularly those with MN, have significantly higher risks of cancer development and subsequent mortality and should remain aware of the potential development of malignancy during follow-up.

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Pre-eclampsia and risk of later kidney disease: nationwide cohort study

BMJ ◽

10.1136/bmj.l1516 ◽

2019 ◽

pp. l1516 ◽

Cited By ~ 22

Author(s):

Jonas H Kristensen ◽

Saima Basit ◽

Jan Wohlfahrt ◽

Mette Brimnes Damholt ◽

Heather A Boyd

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Outcome Measure ◽

Cox Regression ◽

Hazard Ratio ◽

Hazard Ratios ◽

Gestational Age At Delivery ◽

History Of

ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.

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Dealing with Treatment-confounder Feedback and Sparse Follow-up in Longitudinal studies - Application of a Marginal Structural Model in a Multiple Sclerosis Cohort

American Journal of Epidemiology ◽

10.1093/aje/kwaa243 ◽

2020 ◽

Author(s):

Mohammad Ehsanul Karim ◽

Helen Tremlett ◽

Feng Zhu ◽

John Petkau ◽

Elaine Kingwell

Keyword(s):

Multiple Sclerosis ◽

Disease Progression ◽

Multiple Imputation ◽

Structural Model ◽

Potential Effect ◽

Hazard Ratio ◽

Survival Advantage ◽

Marginal Structural Model ◽

Beta Interferon

Abstract The beta-interferons are widely prescribed platform therapies for patients with multiple sclerosis (MS). We accessed a cohort of patients with relapsing onset MS from British Columbia, Canada (1995-2013) to examine the potential survival advantage associated with beta-interferon exposure using a marginal structural model. Accounting for potential treatment-confounder feedback between comorbidity, MS disease progression and beta-interferon exposure, we found an association between beta-interferon exposure of at least 6 contiguous months and improved survival (hazard ratio (HR) = 0.63, 95% confidence interval 0.47-0.86). We also assessed potential effect modifications by sex, baseline age or baseline disease duration, and found these factors to be important effect modifiers. Sparse follow-up due to variability in patient contact with the health system is one of the biggest challenges in longitudinal analyses. We considered several single-level and multi-level multiple imputation approaches to deal with sparse follow-up and disease progression information; both types of approach produced similar estimates. Compared to ad hoc imputation approaches, such as linear interpolation (HR: 0.63), and last observation carried forward (HR: 0.65), all multiple imputation approaches produced a smaller hazard ratio (HR: 0.53), although the direction of effect and conclusions drawn concerning the survival advantage remained the same.

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Anti-Kir4.1 Antibodies in Multiple Sclerosis: Specificity and Pathogenicity

International Journal of Molecular Sciences ◽

10.3390/ijms21249632 ◽

2020 ◽

Vol 21 (24) ◽

pp. 9632

Author(s):

Michie Imamura ◽

Osamu Higuchi ◽

Yasuhiro Maeda ◽

Akihiro Mukaino ◽

Mitsuharu Ueda ◽

...

Keyword(s):

Multiple Sclerosis ◽

Potassium Channels ◽

Potassium Channel ◽

Neurological Diseases ◽

Initial Study ◽

Research Groups ◽

Antibody Testing ◽

Follow Up Studies ◽

Immune Target

The glial cells in the central nervous system express diverse inward rectifying potassium channels (Kir). They express multiple Kir channel subtypes that are likely to have distinct functional roles related to their differences in conductance, and sensitivity to intracellular and extracellular factors. Dysfunction in a major astrocyte potassium channel, Kir4.1, appears as an early pathological event underlying neuronal phenotypes in several neurological diseases. The autoimmune effects on the potassium channel have not yet been fully described in the literature. However, several research groups have reported that the potassium channels are an immune target in patients with various neurological disorders. In 2012, Srivastava et al. reported about Kir4.1, a new immune target for autoantibodies in patients with multiple sclerosis (MS). Follow-up studies have been conducted by several research groups, but no clear conclusion has been reached. Most follow-up studies, including ours, have reported that the prevalence of Kir4.1-seropositive patients with MS was lower than that in the initial study. Therefore, we extensively review studies on the method of antibody testing, seroprevalence of MS, and other neurological diseases in patients with MS. Finally, based on the role of Kir4.1 in MS, we consider whether it could be an immune target in this disease.

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Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

American Journal of Epidemiology ◽

10.1093/aje/kwaa060 ◽

2020 ◽

Vol 189 (10) ◽

pp. 1114-1123

Author(s):

Marcel Ballin ◽

Anna Nordström ◽

Peter Nordström

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Confidence Interval ◽

Cardiorespiratory Fitness ◽

Military Service ◽

Lower Risk ◽

Hazard Ratio ◽

Familial Factors ◽

All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

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Associations between Parenting Style and Mental Health in Children and Adolescents Aged 11–17 Years: Results of the KiGGS Cohort Study (Second Follow-Up)

Children ◽

10.3390/children8080672 ◽

2021 ◽

Vol 8 (8) ◽

pp. 672

Author(s):

Özge Azman ◽

Elvira Mauz ◽

Matthias Reitzle ◽

Raimund Geene ◽

Heike Hölling ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Children And Adolescents ◽

Parenting Style ◽

Parenting Styles ◽

Family Status ◽

Migration Status ◽

Using Data ◽

Emotional Distancing

Few studies from Germany have investigated the associations between parenting style and children’s and adolescents’ health. Little attention has been directed to whether these associations vary with familial socioeconomic or migration status. The aim of this analysis was to investigate the association between parenting style and the mental health of children and adolescents aged 11–17 years using data from the KiGGS cohort study (second follow-up). We calculated mean Strengths and Difficulties Questionnaire (SDQ) total difficulties scores stratified by parenting style (authoritative, permissive, demanding–controlling, emotional distancing). Linear regression analyses adjusted for age, gender, socioeconomic status, migration status, and family status were performed. We also analyzed moderating effects of socioeconomic and migrations status on associations between parenting style and SDQ scores. There were only small differences between the permissive and the authoritative parenting styles. Significantly higher mean scores were observed for the demanding–controlling and emotional distancing styles for both the mother and father. These associations persisted after full adjustment and did not vary by socioeconomic or migration status. Parenting behavior is an important predictor of children’s and adolescents’ mental health. The promotion of good relationships within families and improving parenting skills offer promising approaches for health promotion in young people.

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Cyproterone Acetate and risk of Meningioma

10.1101/2020.12.29.20248395 ◽

2021 ◽

Author(s):

Anders P. Mikkelsen ◽

Iben K. Greiber ◽

Nikolai M. Scheller ◽

Malene Hilden ◽

Øjvind Lidegaard

Keyword(s):

Cumulative Dose ◽

Cyproterone Acetate ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Response Relationship ◽

Dose Response Relationship ◽

National Healthcare ◽

Background Population ◽

Increased Risk

AbstractCyproterone acetate (CPA) is a synthetic steroid hormone. We assessed the association between the use of CPA and the risk of developing meningioma.In a historical prospective cohort study, using Danish national healthcare registers we included a cohort of 5,730,654 individuals, among whom 1,982 were exposed to CPA. During follow-up, we identified 8,957 cases of meningioma, of which 16 were exposed to CPA. From 2013 to 2019 the number of new users increased from 18.1 to 62.3 new users per million, while the proportion of new users who were transgender increased from 18.4 to 68.3%. Analyses showed a significantly increased risk of meningioma according to cumulative dose of CPA; 0.1-10 grams of CPA, incidence rate 78.8 (95% CI 15.7-141.9) per 100.000 person years and adjusted hazard ratio 7.0 (3.1-15.6); >10 grams of CPA, incidence 187.5 (71.3-303.7) and adjusted hazard ratio 19.2 (10.3-35.8), as compared to the background population.In conclusion, the cumulative dose of CPA was associated with an increased incidence and hazard ratio of meningioma, showing a dose-response relationship. The number of new CPA users increased more than 3-fold from 2013 to 2019, primarily driven by new transgender users.

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Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study

BMJ ◽

10.1136/bmj.m1186 ◽

2020 ◽

pp. m1186 ◽

Cited By ~ 9

Author(s):

Björn Pasternak ◽

Viktor Wintzell ◽

Mads Melbye ◽

Björn Eliasson ◽

Ann-Marie Svensson ◽

...

Keyword(s):

Cohort Study ◽

Renal Replacement Therapy ◽

Dipeptidyl Peptidase ◽

Hazard Ratio ◽

Sglt2 Inhibitors ◽

Active Comparator ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Reduced Risk

AbstractObjectiveTo assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice.DesignCohort study using an active comparator, new user design and nationwide register data.SettingSweden, Denmark, and Norway, 2013-18.ParticipantsCohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years.ExposuresSGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat.Main outcome measuresThe main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome.ResultsThe mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference −3.6 (–4.4 to −2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark.ConclusionsIn this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.

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Social consequences of multiple sclerosis (1): early pension and temporary unemployment—a historical prospective cohort study

Multiple Sclerosis Journal ◽

10.1177/1352458509352196 ◽

2009 ◽

Vol 16 (1) ◽

pp. 121-126 ◽

Cited By ~ 78

Author(s):

Claudia Christina Hilt Pfleger ◽

Esben Meulengracht Flachs ◽

Nils Koch-Henriksen

Keyword(s):

Multiple Sclerosis ◽

Economic Status ◽

Disease Onset ◽

Social Consequences ◽

Economic Life ◽

Detailed Knowledge ◽

Registration System ◽

Civil Registration ◽

Starting Point ◽

Multiple Sclerosis Patients

Multiple sclerosis affects young and middle-aged people and often leads to physical and cognitive handicaps. There is a need for detailed knowledge of the social consequences of the disease. We aim here to describe the course of the working life and career of multiple sclerosis patients at the time of onset and thereafter, in terms of probability of early pension and income development. All 2538 patients with multiple sclerosis in Denmark with disease onset between 1980 and 1989, identified through the Danish MS-Registry, were included in this study. Twenty matched control persons per patient were randomly drawn from the civil registration system. Information on economic status was retrieved from Statistics Denmark. A survival analysis technique was used with onset as the starting point. We found that the probability of remaining without early pension was at 5 years 70% for patients and 97% for controls, and at 20 years 22% for patients and 86% for controls. Due to lower rates for early pension, gross income with time was lower in patients than controls. We conclude that multiple sclerosis seriously affects the economic life of multiple sclerosis patients, even within a few years of onset.

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