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

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.

scholarly journals Poisoning substances taken by young people: a population-based cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e703-e710 ◽  
Author(s):  
Edward G Tyrrell ◽  
Denise Kendrick ◽  
Kapil Sayal ◽  
Elizabeth Orton
Keyword(s):  
Cohort Study ◽  
Young People ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Self Harm ◽  
Harm Prevention ◽  
Rate Ratios

BackgroundGlobally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.AimTo assess poisoning substance patterns and trends among 10–24-year-olds across EnglandDesign and settingOpen cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.MethodPoisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.ResultsIn total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).ConclusionIt is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

scholarly journals Risk and Prognosis of Bacteremia and Fungemia among Peritoneal Dialysis Patients: A Population-Based Cohort Study

2016 ◽  
Vol 36 (6) ◽  
pp. 647-654 ◽  
Author(s):  
Lars Skov Dalgaard ◽  
Mette Nørgaard ◽  
Johan Vestergaard Povlsen ◽  
Bente Jespersen ◽  
Søren Jensen-Fangel ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Population Based ◽  
Incidence Rates ◽  
Dialysis Patients ◽  
Comparison Cohort ◽  
Causative Agents ◽  
Rate Ratios ◽  
Population Controls

Background The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). Objective The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. Methods Design: Observational cohort study. Setting: Central and North Denmark regions. Participants: patients who initiated PD during 1995 – 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. Main outcome Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. Results Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 – 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 – 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 – 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 – 31.0) and 20.7% (95% CI, 16.3 – 25.9) among PD patients and population controls, respectively. Conclusions Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts.

scholarly journals Reduced risk of skin cancer and internal malignancies in vitiligo patients: a retrospective population-based cohort study in Taiwan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu-Ching Weng ◽  
Hsiu J. Ho ◽  
Yi-Ling Chang ◽  
Yun-Ting Chang ◽  
Chun-Ying Wu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cell Carcinoma ◽  
Systemic Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Research Database ◽  
Hazard Ratios ◽  
History Of ◽  
Rate Ratios

AbstractThe relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.

scholarly journals Increased Cardiovascular and Metabolic Morbidity in Patients With 21-Hydroxylase Deficiency: A Swedish Population-Based National Cohort Study

2015 ◽  
Vol 100 (9) ◽  
pp. 3520-3528 ◽  
Author(s):  
Henrik Falhammar ◽  
Louise Frisén ◽  
Angelica Linden Hirschberg ◽  
Christina Norrby ◽  
Catarina Almqvist ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Hydroxylase Deficiency ◽  
Swedish Population ◽  
National Cohort ◽  
21 Hydroxylase Deficiency

scholarly journals Clinically Diagnosed Insomnia and Risk of All-Cause and Diagnosis-Specific Disability Pension: A Nationwide Cohort Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Catarina Jansson ◽  
Kristina Alexanderson ◽  
Göran Kecklund ◽  
Torbjörn Åkerstedt
Keyword(s):  
Cohort Study ◽  
Outpatient Care ◽  
Disability Pension ◽  
Cox Regression ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Swedish Population ◽  
Icd 10 ◽  
Specific Incident ◽  
Rate Ratios

Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension.Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17–64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis of disorders of initiating and maintaining sleep (insomnias) (ICD-10: G47.0) during 2000/2001–2005 were compared to those with no such inpatient/outpatient care. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox regression.Results. In models adjusted for prior sickness absence, sociodemographic factors, and inpatient/specialized outpatient care, associations between insomnia and increased risks of all-cause disability pension (IRR 1.35, 95% CI 1.09–1.67) and disability pension due to mental diagnoses (IRR 1.86, 95% CI 1.38–2.50) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of disability pension due to cancer, circulatory, or musculoskeletal diagnoses were observed.Conclusion. Insomnia seems to be positively associated with all-cause disability pension and disability pension due to mental diagnoses.

Autoimmune diseases in patients with multiple sclerosis and their first-degree relatives: a nationwide cohort study in Denmark

2008 ◽  
Vol 14 (6) ◽  
pp. 823-829 ◽  
Author(s):  
NM Nielsen ◽  
M Frisch ◽  
K Rostgaard ◽  
J Wohlfahrt ◽  
H Hjalgrim ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Ulcerative Colitis ◽  
Cohort Study ◽  
Autoimmune Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Registration System ◽  
Civil Registration ◽  
First Degree Relatives ◽  
Increased Risk

Background Multiple sclerosis (MS) and other autoimmune diseases might cluster. Our aim was to estimate the relative risk (RR) of other autoimmune diseases among MS patients and their first-degree relatives in a population-based cohort study. Methods Using the Danish Multiple Sclerosis Register, the Danish Hospital Discharge Register, and the Danish Civil Registration System, we estimated RRs for 42 different autoimmune diseases in a population-based cohort of 12 403 MS patients and 20 798 of their first-degree relatives. Ratios of observed to expected numbers of autoimmune diseases, based on national sex-, age-, and period-specific incidence rates, served as measures of the RRs. Results Compared with the general population, MS patients were at an increased risk of developing ulcerative colitis (RR = 2.0 (95% confidence interval (CI): 1.4–2.8), n = 29) and pemphigoid (RR = 15.4 (CI: 8.7–27.1), n = 12) but at reduced risk of rheumatoid arthritis (RR = 0.5 (CI: 0.4–0.8), n = 28) and temporal arteritis (RR = 0.5 (CI: 0.3–0.97), n = 11). First-degree relatives of MS patients were at increased risks of Crohn’s disease (RR = 1.4 (CI: 1.04–1.9), n = 44), ulcerative colitis (RR = 1.3 (CI: 0.99–1.7), n = 51), Addison’s disease (RR = 3.4 (CI: 1.3–9.0), n = 4), and polyarteritis nodosa (RR = 3.7 (CI: 1.4–10.0), n = 4). Conclusion Patients with MS and their first-degree relatives seem to be at an increased risk of acquiring certain other autoimmune diseases.

scholarly journals Incidence, aetiology and related comorbidities of cirrhosis: a Swedish population-based cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Juan Vaz ◽  
Berne Eriksson ◽  
Ulf Strömberg ◽  
David Buchebner ◽  
Patrik Midlöv
Keyword(s):  
Cohort Study ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Recent Decade ◽  
Population Based ◽  
Incidence Rates ◽  
Swedish Population ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Abstract Background The incidence of cirrhosis for individuals in Sweden has previously been reported as stable/low among European countries. However, Swedish population-based studies are scarce and none of them included data from the most recent decade (2010–2019). We aimed to describe the incidence and aetiology of cirrhosis in the Halland region from 2011 to 2018, and to describe the severity and prevalence of liver-related complications and other primary comorbidities at the time of cirrhosis diagnosis. Methods We conducted a retrospective cohort study of all patients with cirrhosis in Halland, which has a population of 310,000 inhabitants. Medical records and histopathology registries were reviewed. Results A total of 598 patients with cirrhosis were identified. The age-standardised incidence was estimated at 23.2 per 100,000 person-years (95% CI 21.3–25.1), 30.5 (95% CI 27.5–33.8) for men and 16.4 (95% CI 14.3–18.7) for women. When stratified by age, the highest incidence rates were registered at age 60–69 years. Men had a higher incidence rate for most age groups when compared to women. The most common aetiology was alcohol (50.5%), followed by cryptogenic cirrhosis (14.5%), hepatitis C (13.4%), and non-alcoholic fatty liver disease (5.7%). Most patients had at least one liver-related complication at diagnosis (68%). The most common comorbidities at diagnosis were arterial hypertension (33%), type 2 diabetes (29%) and obesity (24%). Conclusions Based on previous Swedish studies, our results indicate that the incidence of cirrhosis in Sweden might be considerably higher than previously reported. It is uncertain if the incidence of cirrhosis has previously been underestimated or if an actual increment has occurred during the course of the most recent decade. The increased incidence rates of cirrhosis reported in Halland are multifactorial and most likely related to higher incidence rates among the elderly. Pre-obesity and obesity are common in cirrhosis and non-alcoholic fatty liver disease has become an important cause of cirrhosis in Halland.

scholarly journals Association of Age at First Severe Respiratory Syncytial Virus Disease With Subsequent Risk of Severe Asthma: A Population-Based Cohort Study

2018 ◽  
Vol 220 (4) ◽  
pp. 550-556 ◽  
Author(s):  
Nusrat Homaira ◽  
Nancy Briggs ◽  
Ju-Lee Oei ◽  
Lisa Hilder ◽  
Barbara Bajuk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Syncytial Virus ◽  
Virus Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Severe Respiratory Syncytial Virus ◽  
Respiratory Syncytial Virus Disease ◽  
Syncytial Virus ◽  
Rate Ratios ◽  
Subsequent Risk

Abstract Objective In a population-based cohort study, we determined the association between the age at first severe respiratory syncytial virus (RSV) disease and subsequent asthma. Methods Incidence rates and rate ratios of the first asthma-associated hospitalization after 2 years of age in children hospitalized for RSV disease at <3 months, 3 to <6 months, 6 to <12 months, and 12–24 months of age were calculated. Results The incidence of asthma-associated hospitalization per 1000 child-years among children hospitalized for RSV disease at <3 months of age was 0.5 (95% confidence interval [CI], .2–.7); at 3 to <6 months of age, 0.9 (95% CI,.5–1.3); at 6 to <12 months of age, 2.0 (95% CI, 1.4–2.7); and at 12–24 months of age, 1.7 (95% CI, 1.0–2.5). The rate ratio of hospitalization for asthma was 2–7-fold greater among children hospitalized for RSV disease at ages ≥6 months than that among those hospitalized for RSV disease at ages 0 to <6 months. Conclusions Although the burden of RSV disease is highest in children aged <6 months, the burden of subsequent asthma is higher in children who develop RSV disease at ages ≥6 months.

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