Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers

Background: Patients with multiple sclerosis (MS) are potentially at high risk of fracture due to falls and osteoporosis. Objective: To estimate incidence rates of fractures in MS patients, stratified by fracture type, sex and age, and to compare these rates with controls. Methods: The case population consisted of all patients with an accepted diagnosis of MS in the Danish MS Registry (1949–2007). Data were linked to the National Hospital Discharge Register (1977–2007). Patients with MS ( n = 11,157) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Incidence rates of fracture were estimated as the number of fractures per 1000 person-years. Incidence rate ratios (IRRs) were calculated by dividing fracture rates in MS patients by fracture rates in controls. Results: Among patients with MS, the incidence rate of any fracture yielded 22.8 per 1000 person-years. The IRR of any fracture between MS patients and controls was 1.40 (95% CI 1.33–1.46). In particular, IRRs of tibia fracture (3.36 [2.75–4.11]), femur fracture (6.66 [5.06–8.76]) and hip fracture (3.20 [2.83–3.62]) were elevated in MS patients versus controls. Conclusion: Fractures occurred more often in patients with MS, especially fractures of the tibia, hip and femur.

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Abstract P214: Twenty-five Years Trends in Stroke Incidence in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.129.suppl_1.p214 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Silvia Koton ◽

Andrea L Schneider ◽

Wayne D Rosamond ◽

Rebecca F Gottesman ◽

Josef Coresh

Keyword(s):

African Americans ◽

Incidence Rate ◽

Poisson Regression ◽

Incidence Rates ◽

Age Group ◽

Calendar Time ◽

Stroke Incidence ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Rate Ratios

Introduction: Prior studies have shown a decrease in stroke mortality rates, but data on validated stroke incidence and trends by race are more limited. We aimed to study trends in stroke incidence by age and race in the Atherosclerosis Risk in Communities (ARIC) population from 1987 to 2010. Hypothesis: We assessed the hypothesis that total stroke incidence rates are decreasing over calendar time in all age groups, and in whites and African-Americans. Methods: ARIC participants were recruited in 1987-1989 and followed until 2010. A computer algorithm and physician reviewers identified and adjudicated definite and probable stroke as ischemic, intracerebral hemorrhage and subarachnoid hemorrhage (total stroke). A person-years (PY) approach using 5-year periods for age and calendar time was used for studying rates of total stroke incidence and trends. Poisson regression modeled calendar time in 5-year periods and linearly per decade, adjusted for 5-year age group. Results: From 1987 to 2010, 994 strokes occurred over 274,837 PY in 14,145 participants free of stroke at baseline. Total stroke incidence rates by age and calendar time increased with age and generally decreased with time ( Table ). Poisson regression adjusted for age group showed incidence rate ratios of 2.28 (95% CI 2.01-2.59) for African-Americans, compared to whites. Using the 1992-1996 as reference period, incidence rate ratios were 0.90 (0.70-1.16) for 1987-1991, 0.84 (0.69-1.02) for 1997-2001, 0.69 (0.56-0.85) for 2002-2006, and 0.59 (0.46-0.75) for 2007-2010. Analysis stratified by race shows an incidence rate ratio decrease per decade of -27% (-13% to - 39%) in whites and -22% (-5% to -34%) in African-Americans. Conclusions: Validated total stroke incidence rates decreased over calendar time from 1992 to 2010 in the ARIC cohort in both whites and African-Americans, after taking the aging of the cohort into account. Cohorts like ARIC only represent a limited age range but provide an ability to use validated events in updating stroke incidence trends.

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Incidence of malignancy in multiple sclerosis: A cohort study in the Danish Multiple Sclerosis Registry

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/20552173211053939 ◽

2021 ◽

Vol 7 (4) ◽

pp. 205521732110539

Author(s):

Mette Nørgaard ◽

Katalin Veres ◽

Finn T Sellebjerg ◽

Lise S Svingel ◽

Caroline Foch ◽

...

Keyword(s):

Multiple Sclerosis ◽

Skin Cancer ◽

General Population ◽

Incidence Rates ◽

Disease Modifying Therapy ◽

Non Melanoma Skin Cancer ◽

General Population Cohort ◽

Disease Modifying ◽

Rate Ratios ◽

Melanoma Skin

Background The association between multiple sclerosis and malignancy is controversial and a current appraisal is needed. Objective To determine the incidence of malignancy in patients with multiple sclerosis compared with the general population and in relation to disease-modifying therapy. Methods Patients with multiple sclerosis (1995 – 2015) were matched by birth year and sex to individuals without multiple sclerosis in the general population. Patients with multiple sclerosis initiating disease-modifying therapy were evaluated using landmark period analysis. Malignancy risk was assessed by incidence rates, incidence rate ratios, and standardised incidence ratios. Results The standardised incidence ratio of any malignancy (excluding non-melanoma skin cancer) in patients with multiple sclerosis ( n = 10,557) was 0.96 (95% CI 0.88 – 1.06), and there was no increased incidence of specific malignancy types compared with the general population cohort ( n = 103,761). At the 48-month landmark period, the age-adjusted incidence per 100,000 person-years of any malignancy (excluding non-melanoma skin cancer) was 436.7 (95% CI 361.0 – 512.4) in patients newly treated with immunomodulator-only and 675.1 (95% CI 130.4 – 1219.9) in patients newly treated with immunosuppressant-only. Conclusions There was no increased incidence of malignancy overall or by type in patients with multiple sclerosis compared neither with the general population nor in relation to disease-modifying therapy.

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Injury Incidence Across the Menstrual Cycle in International Footballers

Frontiers in Sports and Active Living ◽

10.3389/fspor.2021.616999 ◽

2021 ◽

Vol 3 ◽

Author(s):

Dan Martin ◽

Kate Timmins ◽

Charlotte Cowie ◽

Jon Alty ◽

Ritan Mehta ◽

...

Keyword(s):

Menstrual Cycle ◽

Incidence Rate ◽

Luteal Phase ◽

Incidence Rates ◽

Follicular Phase ◽

Tendon Injuries ◽

Cycle Phase ◽

Injury Incidence ◽

Rate Ratios ◽

Late Follicular Phase

Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers.Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type.Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses.Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.

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Incidence of rhegmatogenous retinal detachment in France from 2010 to 2016: seasonal and geographical variations

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318457 ◽

2021 ◽

pp. bjophthalmol-2020-318457

Author(s):

Inès Ben Ghezala ◽

Anne Sophie Mariet ◽

Eric Benzenine ◽

Pierre-Henry Gabrielle ◽

Florian Baudin ◽

...

Keyword(s):

Incidence Rate ◽

French Guiana ◽

Rhegmatogenous Retinal Detachment ◽

Geographical Location ◽

Incidence Rates ◽

Regional Hospital ◽

Administrative Database ◽

First Episode ◽

National Hospital ◽

Geographical Variations

AimsTo investigate the annual and monthly hospital incidence rate of rhegmatogenous retinal detachments (RRDs) from 2010 to 2016 in France at the national and regional levels.MethodsIn this nationwide database study, we identified hospital and clinic admissions of French residents for a first episode of RRD in France during 2010–2016 from the national administrative database. The annual and monthly hospital incidence rates of RRD per 100 000 population were calculated for the whole country and for each region.ResultsThe average annual national hospital incidence rate of RRD was 21.97±1.04 per 100 000 population. The annual national hospital incidence rate of RRD was the lowest in 2010 (20.91 per 100 000 population) after which it increased until 2015 (23.55 per 100 000 population). The average monthly national RRD hospital incidence rate was the highest in June (2.03±0.12 per 100 000 population) and the lowest in August (1.60±0.09). The average annual age-standardised and sex-standardised regional hospital incidence rate was the highest in Guadeloupe and Pays de la Loire (28.30±2.74 and 26.13±0.84 per 100 000 population, respectively) and the lowest in French Guiana and Martinique (15.51±3.50 and 17.29±2.12 per 100 000 population, respectively).ConclusionsThe average annual national hospital incidence rate of RRD increased from 2010 to 2015. The hospital incidence rate of RRD seemed to vary according to season and geographical location.

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Descriptive Epidemiology of Injuries in Professional Ultimate Frisbee Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-269-18 ◽

2020 ◽

Vol 55 (2) ◽

pp. 195-204 ◽

Cited By ~ 2

Author(s):

Matthew C. Hess ◽

David I. Swedler ◽

Christine S. Collins ◽

Brent A. Ponce ◽

Eugene W. Brabston

Keyword(s):

Incidence Rate ◽

Epidemiologic Study ◽

Incidence Rates ◽

Thigh Muscle ◽

Surveillance Program ◽

Injury Incidence ◽

Descriptive Epidemiology ◽

Injury Rates ◽

Ultimate Frisbee ◽

Rate Ratios

Context Injuries in professional ultimate Frisbee (ultimate) athletes have never been described. Objective To determine injury rates, profiles, and associated factors using the first injury-surveillance program for professional ultimate. Design Descriptive epidemiology study. Setting American Ultimate Disc League professional ultimate teams during the 2017 season. Patients or Other Participants Sixteen all-male teams. Main Outcome Measure(s) Injury incidence rates (IRs) were calculated as injuries per 1000 athlete-exposures (AEs). Incidence rate ratios were determined to compare IRs with 95% confidence intervals, which were used to calculate differences. Results We observed 299 injuries over 8963 AEs for a total IR of 33.36 per 1000 AEs. Most injuries affected the lower extremity (72%). The most common injuries were thigh-muscle strains (12.7%) and ankle-ligament sprains (11.4%). Running was the most frequent injury mechanism (32%). Twenty-nine percent of injuries involved collisions; however, the concussion rate was low (IR = 0.22 per 1000 AEs). Injuries were more likely to occur during competition and in the second half of games. An artificial turf playing surface did not affect overall injury rates (Mantel-Haenszel incidence rate ratio = 1.28; 95% confidence interval = 0.99, 1.67). Conclusions To our knowledge, this is the first epidemiologic study of professional ultimate injuries. Injury rates were comparable with those of similar collegiate- and professional-level sports.

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Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis: results from a national register-based cohort study

Rheumatology ◽

10.1093/rheumatology/keaa692 ◽

2020 ◽

Author(s):

Karin Bengtsson ◽

Helena Forsblad-d'Elia ◽

Anna Deminger ◽

Eva Klingberg ◽

Mats Dehlin ◽

...

Keyword(s):

Incidence Rate ◽

Incidence Rates ◽

The Other ◽

Population Register ◽

Swedish Population ◽

National Patient Register ◽

National Patient ◽

Rate Ratios ◽

Strength Of Association

Abstract Objectives To estimate the incidence and strength of association of extra-articular manifestations [EAMs, here: anterior uveitis (AU), IBD and psoriasis] in patients with AS, undifferentiated SpA (uSpA) and PsA, compared with controls. Methods Three mutually exclusive cohorts of patients aged 18–69 years with AS (n = 8517), uSpA (n = 10 245) and PsA (n = 22 667) were identified in the Swedish National Patient Register 2001–2015. Age-, sex- and geography-matched controls were identified from the Swedish Population Register. Follow-up began 1 January 2006, or six months after the first SpA diagnosis, whichever occurred later, and ended at the first date of the EAM under study, death, emigration, 70 years of age, and 31 December 2016. Incidence rates (IRs) and incidence rate ratios were calculated for each EAM, and stratified by sex and age. Results Incidence rate ratios for incident AU, IBD and psoriasis were significantly increased in AS (20.2, 6.2, 2.5), uSpA (13.6, 5.7, 3.8) and PsA (2.5, 2.3, n.a) vs controls. Men with AS and uSpA had significantly higher IRs per 1000 person-years at risk for incident AU than women with AS (IR 15.8 vs 11.2) and uSpA (IR 10.1 vs 6.0), whereas no such sex difference was demonstrated in PsA or for the other EAMs. Conclusions AU, followed by IBD and psoriasis, is the EAM most strongly associated with AS and uSpA. Among the SpA subtypes, AS and uSpA display a largely similar pattern of EAMs, whereas PsA has a considerably weaker association with AU and IBD.

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Non-infectious comorbidity in patients with multiple sclerosis: A national cohort study in Sweden

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217320947761 ◽

2020 ◽

Vol 6 (3) ◽

pp. 205521732094776

Author(s):

Anna Castelo-Branco ◽

Flaminia Chiesa ◽

Camilla E Bengtsson ◽

Sally Lee ◽

Neil N Minton ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cohort Study ◽

Improve Patient Care ◽

Bowel Dysfunction ◽

Population Based ◽

Incidence Rates ◽

Swedish Population ◽

Comorbidity Burden ◽

National Cohort ◽

Rate Ratios

Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.

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The risk of fracture in incident multiple sclerosis patients: The Danish National Health Registers

Multiple Sclerosis Journal ◽

10.1177/1352458512442755 ◽

2012 ◽

Vol 18 (11) ◽

pp. 1609-1616 ◽

Cited By ~ 18

Author(s):

Marloes T Bazelier ◽

Joan Bentzen ◽

Peter Vestergaard ◽

Egon Stenager ◽

Hubert GM Leufkens ◽

...

Keyword(s):

Multiple Sclerosis ◽

Hip Fracture ◽

National Health ◽

Osteoporotic Fracture ◽

Population Based ◽

Risk Of Fracture ◽

Increased Risk ◽

Disability Status ◽

Multiple Sclerosis Patients ◽

Health Registers

Background: Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling. Objective: To evaluate the risk of fracture in incident MS patients drawn from a dedicated MS registry compared with population-based controls. Methods: We conducted a population-based cohort study (1996–2007) utilising the Danish National Health Registers that were linked to the Danish MS Registry and the Danish MS Treatment Registry. Incident MS patients (2963 cases) were 1:6 matched by year of birth, gender, calendar time and region to persons without MS (controls). Cox proportional hazards models and logistic regression were used to estimate the risk of fracture in MS. Time-dependent adjustments were made for age, history of diseases and drug use. Results: Compared with controls, patients with MS had no overall increased risk of fracture (adjusted hazard ratio (adj. HR): 1.0, 95% CI: 0.9–1.2). However, the risk of femur/hip fracture (adj. HR: 1.9, 95% CI: 1.1–3.4) was significantly increased compared to controls. As compared with unexposed patients, MS patients who had been exposed to a short course of methylprednisolone in the prior year had no significantly increased risk of osteoporotic fracture (adj. HR: 1.2, 95% CI: 0.5–2.9). Disabled MS patients with Expanded Disability Status Scale [EDSS] scores between 6 and 10, had a 2.6-fold increased risk of osteoporotic fracture (adjusted odds ratio (adj. OR): 2.6, 95% CI: 1.0–6.6) compared to patients with an EDSS score between 0 and 3. Conclusion: Patients with MS had a higher risk of femur/hip fracture than controls. Disability status is probably more important than glucocorticoid use in the aetiology of MS and osteoporotic fracture.

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The initial impact of a national BNT162b2 mRNA COVID-19 vaccine rollout

10.1101/2021.04.26.21256087 ◽

2021 ◽

Author(s):

Ahmed Zaqout ◽

Joanne Daghfal ◽

Israa Alaqad ◽

Saleh A.N. Hussein ◽

Abdullah Aldushain ◽

...

Keyword(s):

Protective Effect ◽

Incidence Rate ◽

Confidence Intervals ◽

Poisson Regression ◽

Incidence Rates ◽

Post Vaccination ◽

Time Periods ◽

Rate Ratios ◽

Vaccination Period

AbstractObjectiveWe herein report the initial impact of a national BNT162b2 rollout on SARS-CoV-2 infections in Qatar.MethodsWe included all individuals who by 16 March 2021 had completed ≥14 days of follow up after the receipt of BNT162b2. We calculated incidence rates (IR) and their 95% confidence intervals (CI), during days 1–7, 8–14, 15–21, 22–28, and >28 days post-vaccination. Poisson regression was used to calculate incidence rate ratios (IRR) relative to the first 7-day post-vaccination period.ResultsWe included 199,219 individuals with 6,521,124 person-days of follow up. SARS-CoV-2 infection was confirmed in 1,877 (0.9%), of which 489 (26.1%) were asymptomatic and 123 (6.6%) required oxygen support. The median time from first vaccination to SARS-CoV-2 confirmation was 11.9 days (IQR 7.7–18.2). Compared with the first 7-day post-vaccination period, SARS-CoV-2 infections were lower by 65.8–84.7% during days 15–21, days 22–28, and >28 days (P <0.001 for each). For severe COVID-19, the incidence rates were 75.7– 93.3% lower (P <0.001 for each) during the corresponding time periods.ConclusionOur results are consistent with an early protective effect of BNT162b2 against all degrees of SARS-CoV-2 severity.

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Multiple Sclerosis incidence rate in southern Iran: A Bayesian epidemiological study

10.21203/rs.3.rs-34188/v4 ◽

2020 ◽

Author(s):

Naeimehossadat Asmarian ◽

Zahra Sharafi ◽

Amin Mousavi ◽

Reis Jacques ◽

Ibon Tamayo ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Vitamin D ◽

Relative Risk ◽

Incidence Rate ◽

Incidence Rates ◽

Vitamin D Supplementation ◽

Lower Percentage ◽

Fars Province ◽

Spatio Temporal

Abstract Background: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the effects of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions.Method: Data from 5,468 patients diagnosed with MS were collected, according to the McDonald’s criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province. Results: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS.Conclusion: Bayesian spatio-temporal analysis of MS incidence rate revealed that trend is less steep than the mean trend of this disease in the south and south east of Fars province, which is due to the association between the higher percentage of vitamin D supplementation intake and the lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.

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