The Epidemiology of Venous Thromboembolism in the Elderly: a Population-Based Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2980-2980 ◽  
Author(s):  
Vicky Tagalakis ◽  
Susan Kahn
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Service ◽  
Census Data ◽  
The Elderly ◽  
Elderly Persons ◽  
Incidence Trends ◽  
Hospital Acquired ◽  
Over Time ◽  
Age And Sex

Abstract 2980 Poster Board II-954 Background. There are few studies that examine incidence trends of venous thromboembolism (VTE) among the elderly, and moreover data on changes in the prevalence over time of VTE risk factors such as hospitalization are limited. Objectives. Using the Province of Québec's administrative health claims (“RAMQ”) and hospitalization (“MED ECHO”) databases, we determined among individuals 65 years of age and older the trend in annual VTE incidence over a ten-year period, and examined the prevalence of hospital vs. community acquired VTE over time. Methods. Using RAMQ medical service and prescription claims data, we identified a cohort of elderly persons with incident VTE between 1983 and 1994. All individuals 65 years of age and older between January 1, 1994 and December 31, 2004 with at least one medical service (i.e. physician) claim linked to a VTE ICD-9 code in conjunction with a prescription claim for an anticoagulant in the subsequent 60 days, and who had no prior VTE-coded claim between 1983 and 1994 were included in the cohort. The first (incident) VTE-coded claim (index claim) during the period between January 1, 1994 and December 31, 2004 defined entry into the cohort. Using Québec population census data, we determined annual VTE incidence estimates, adjusting for the population's age and sex distribution as per 1999 census data. An index VTE event that occurred during a hospitalization and up to 90 days following hospital discharge was defined as hospital-acquired VTE, otherwise it was considered to be community-acquired. Results. A total of 27 758 persons were included in our cohort. The age and sex adjusted annual VTE incidence among individuals 65 years of age and older was 2.1, 2.7, and 2.8 per 1000 population in 1994, 1999 and 2004, respectively (p trend < 0.001 (across years)). The incidence rates increased with age and were slightly higher in men than women. Overall, 35% of VTE events were hospital-acquired (n=9598) and 65% occurred in the community (n=18160). There was a significant trend over time of an increase in the proportion of VTE associated with hospitalization with 32% of VTE being hospital acquired in 1994 and 39% in 2004. Conclusion. In a general population of individuals 65 years of age and older, VTE is a common problem, and its overall annual incidence has increased over time. Our results suggest that hospital admission and recent hospitalization are increasingly important risk factors for VTE occurrence in this population, and that efforts are needed to improve and optimize VTE preventative strategies in the hospitalized elderly. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Reasons for the persistent incidence of venous thromboembolism

2017 ◽  
Vol 117 (02) ◽  
pp. 390-400 ◽  
Author(s):  
John A. Heit ◽  
Aneel A. Ashrani ◽  
Daniel J. Crusan ◽  
Robert D. McBane ◽  
Tanya M. Petterson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Poisson Regression ◽  
Incidence Rates ◽  
Olmsted County ◽  
Incidence Trends ◽  
Prevalence Of Obesity ◽  
Age And Sex ◽  
Active Cancer

SummaryReasons for trends in venous thromboembolism (VTE) incidence are uncertain. It was our objective to determine VTE incidence trends and risk factor prevalence, and estimate population-attributable risk (PAR) trends for each risk factor. In a population-based cohort study of all residents of Olmsted County, Minnesota from 1981–2010, annual incidence rates were calculated using incident VTE cases as the numerator and age- and sex-specific Olmsted County population estimates as the denominator. Poisson regression models were used to assess the relationship of crude incidence rates to year of diagnosis, age at diagnosis, and sex. Trends in annual prevalence of major VTE risk factors were estimated using linear regression. Poisson regression with time-dependent risk factors (person-years approach) was used to model the entire population of Olmsted County and derive the PAR. The age- and sex-adjusted annual VTE incidence, 1981–2010, did not change significantly. Over the time period, 1988–2010, the prevalence of obesity, surgery, active cancer and leg paresis increased. Patient age, hospitalisation, surgery, cancer, trauma, leg paresis and nursing home confinement jointly accounted for 79 % of incident VTE; obesity accounted for 33 % of incident idiopathic VTE. The increasing prevalence of obesity, cancer and surgery accounted in part for the persistent VTE incidence. The PAR of active cancer and surgery, 1981–2010, significantly increased. In conclusion, almost 80 % of incident VTE events are attributable to known major VTE risk factors and one-third of incident idiopathic VTE events are attributable to obesity. Increasing surgery PAR suggests that concurrent efforts to prevent VTE may have been insufficient.Supplementary Material to this article is available online at www.thrombosis-online.com.

The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

2007 ◽  
Vol 6 (1) ◽  
pp. 20-26
Author(s):  
Alastair Proudfoot ◽  
◽  
Derek Bell ◽  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Clinical Presentation ◽  
Diagnostic Assessment ◽  
Evidence Based ◽  
Suspected Pulmonary Embolism ◽  
The Subject ◽  
Adjusted Incidence ◽  
Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

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.

Risk Factors Associated with Hospital-Acquired Venous Thromboembolism in the Pediatric Intensive Care Unit

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2313-2313
Author(s):  
Minh Q Tran ◽  
Steven L Shein ◽  
Hong Li ◽  
Sanjay P Ahuja
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Odds Ratio ◽  
Pediatric Intensive Care ◽  
Primary Diagnosis ◽  
Factors Associated ◽  
Hospital Acquired

Abstract Introduction: Venous thromboembolism (VTE) in Pediatric Intensive Care Unit (PICU) patients is associated with central venous catheter (CVC) use. However, risk factors for VTE development in PICU patients with CVCs are not well established. The impact of Hospital-Acquired VTE in the PICU on clinical outcomes needs to be studied in large multicenter databases to identify subjects that may benefit from screening and/or prophylaxis. Method: With IRB approval, the Virtual Pediatric Systems, LLC database was interrogated for children < 18yo admitted between 01/2009-09/2014 who had PICU length of stay (LOS) <1 yr and a CVC present at some point during PICU care. The exact timing of VTE diagnosis was unavailable in the database, so VTE-PICU was defined as an "active" VTE that was not "present at admission". VTE-prior was defined as a VTE that was "resolved," "ongoing" or "present on admission." Variables extracted from the database included demographics, primary diagnosis category, and Pediatric Index of Mortality (PIM2) score. PICU LOS was divided into quintiles. Chi squared and Wilcoxon rank-sum were used to identify variables associated with outcomes, which were then included in multivariate models. Our primary outcome was diagnosis of VTE-PICU and our secondary outcome was PICU mortality. Children with VTE-prior were included in the mortality analyses, but not the VTE-PICU analyses. Data shown as median (IQR) and OR (95% CI). Results: Among 143,524 subjects, the median age was 2.8 (0.47-10.31) years and 55% were male. Almost half (44%) of the subjects were post-operative. The median PIM2 score was -4.11. VTE-prior was observed in 2498 patients (1.78%) and VTE-PICU in 1741 (1.2%). The incidence of VTE-PICU were 852 (1.7%) in patients ≤ 1 year old, 560 (0.9%) in patients 1-12 years old, and 303 (1.1%) in patients ≥ 13 years old (p < 0.0001). In univariate analysis, variables associated with a diagnosis of VTE-PICU were post-operative state, four LOS quintiles (3-7, 7-14, and 14-21 and >21 days) and several primary diagnosis categories: cardiovascular, gastrointestinal, infectious, neurologic, oncologic, genetic, and orthopedic. Multivariate analysis showed increased risk of VTE with cardiovascular diagnosis, infectious disease diagnosis, and LOS > 3 d (Table 1). The odds increased with increasing LOS: 7 d < LOS ≤ 14 d (5.18 [4.27-6.29]), 14 d < LOS ≤ 21 d (7.96 [6.43-9.82]), and LOS > 21 d (20.73 [17.29-24.87]). Mortality rates were 7.1% (VTE-none), 7.2% (VTE-prior), and 10.1% (VTE-PICU) (p < 0.0001). In the multivariate model, VTE-PICU (1.25 [1.05-1.49]) and VTE-prior (1.18 [1.002-1.39]) were associated with death vs. VTE-none. PIM2 score, trauma, and several primary diagnosis categories were also independently associated with death (Table 2). Conclusion: This large, multicenter database study identified several variables that are independently associated with diagnosis of VTE during PICU care of critically ill children with a CVC. Children with primary cardiovascular or infectious diseases, and those with PICU LOS >3 days may represent specific populations that may benefit from VTE screening and/or prophylaxis. Hospital-Acquired VTE in PICU was independently associated with death in our database. Additional analysis of this database, including adding specific diagnoses and secondary diagnoses, may further refine risk factors for Hospital-Acquired VTE among PICU patients with a CVC. Table 1. Multivariate analysis of Factors Associated with VTE-PICU. Factors Odds Ratio 95% Confidence Interval 3d < LOS ≤ 7d vs LOS ≤ 3d 2.19 1.78-2.69 7d < LOS ≤ 14d vs LOS ≤ 3d 5.18 4.27-6.29 14d < LOS ≤ 21d vs LOS ≤ 3d 7.95 6.44-9.82 LOS > 21d vs LOS ≤ 3d 20.73 17.29-24.87 Age 1.00 0.99-1.01 Post-operative 0.89 0.80-0.99 PIM2 Score 1.47 1.01-1.07 Primary Diagnosis: Cardiovascular 1.50 1.31-1.64 Primary Diagnosis: Infectious 1.50 1.27-1.77 Primary Diagnosis: Genetics 0.32 0.13-0.78 Table 2. Multivariate Analysis of Factors Associated with PICU Mortality. Factors Odds Ratio 95% ConfidenceInterval VTE-prior 1.18 1.00-1.39 VTE-PICU 1.25 1.05-1.49 PIM2 Score 2.08 2.05-2.11 Trauma 1.92 1.77-2.07 Post-operative 0.45 0.42-0.47 Primary Diagnosis: Genetic 2.07 1.63-2.63 Primary Diagnosis: Immunologic 2.45 1.51-3.95 Primary Diagnosis: Hematologic 1.63 1.30-2.06 Primary Diagnosis: Metabolic 0.71 0.58-0.87 Primary Diagnosis: Infectious 1.47 1.36-1.59 Primary Diagnosis: Neurologic 1.37 1.27-1.47 Disclosures No relevant conflicts of interest to declare.

High Plasma Concentration of Factor VIIIc Is a Major Risk Factor for Venous Thromboembolism

2000 ◽  
Vol 83 (01) ◽  
pp. 5-9 ◽  
Author(s):  
Pieternella in 't Anker ◽  
Marianne Koopman ◽  
Pieter Reitsma ◽  
Martin Prins ◽  
Abraham van den Ende ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Plasma Levels ◽  
Family Study ◽  
High Plasma ◽  
Elevated Plasma ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Recurrent Venous Thromboembolism ◽  
Over Time

SummaryEstablished risk factors, including deficiencies of protein C, protein S or antithrombin and the factor V Leiden and prothrombin mutation, are present in about one third of unselected patients with venous thromboembolism. In addition to these inherited thrombophilic defects, elevated plasma levels of factor VIIIc have been suggested to be important in the pathogenesis of (recurrent) venous thromboembolism. The objective of this study was to assess the relevance of factor VIIIc plasma concentration in consecutive patients with venous thromboembolism.We studied the prevalence of elevated plasma levels of factor VIIIc in 65 patients with a proven single episode and in 60 matched patients with documented recurrent venous thromboembolism. The reference group consisted of 60 ageand sex-matched patients who were referred for suspected venous thromboembolism, which was refuted by objective testing and longterm clinical follow-up. To minimalize the influence of the acute phase, blood was obtained at least 6 months after the thromboembolic event and results were adjusted for fibrinogen and C-reactive protein. Factor VIIIc was re-determined several years after the first measurement in a subset of patients to evaluate the variability over time. To study a possible genetic cause, a family study was done.In the control, single and recurrent episode group, the prevalences of plasma levels of factor VIIIc above 175 IU/dl (90th percentile of controls) were 10% (95% CI: 4 to 21%), 19% (95% CI: 10 to 30%) and 33% (95% CI: 22 to 47%), respectively. For each 10 IU/dl increment of factor VIIIc, the risk for a single and recurrent episode of venous thrombosis increased by 10% (95% CI: 0.9 to 21%) and 24% (95% CI: 11 to 38%), respectively. Both low and high plasma levels of factor VIIIc were consistent over time (R = 0.80, p = 0.01). A family study indicated a high concordance for elevated factor VIIIc plasma concentrations among first degree family members. Adjustment for fibrinogen, C-reactive protein and known thrombophilic risk factors did not change the observed association of elevated factor VIIIc with thrombosis.Elevated plasma levels of factor VIIIc are a significant, prevalent, independent and dose-dependent risk factor for venous thromboembolism. It also predisposes to recurrent venous thromboembolism.

scholarly journals Cataract: A major secondary diabetic complication

2012 ◽  
Vol 1 (7) ◽  
pp. 180-185 ◽  
Author(s):  
Piyush M Patel ◽  
Nurudin Jivani ◽  
Shailesh Malaviya ◽  
Tushar Gohil ◽  
Yagnik Bhalodia
Keyword(s):  
Risk Factors ◽  
Antioxidant Properties ◽  
Crystalline Lens ◽  
The Elderly ◽  
Pharmaceutical Journal ◽  
Diabetic Complication ◽  
Present Review ◽  
Elderly Persons ◽  
Pharmacological Prevention ◽  
Day By Day

Cataract is a visual impairment occurs due to the opacification of crystalline lens. It affects around 17 billion peoples worldwide, although incidence of cataracts is increasing day by day among the elderly persons. Still today except surgery no other effective treatment have been successfully developed so far, thus this present review is focused to highlights the etiological aspects, risk factors along with possible pharmacological prevention and animal models which are widely used for screening anticataract activity. The present review includes the list of plants and their phytoconstituents which have been evaluated pharmacologically for the treatment of cataract. From the review it can be concluded that antioxidant properties of plants phytochemicals are responsible for the anticataract activity.DOI: http://dx.doi.org/10.3329/icpj.v1i7.10813International Current Pharmaceutical Journal 2012, 1(7): 180-185

scholarly journals Prospective Validation of the Peds Clot Clinical Decision Rule [Pdcr] in Hospital-Acquired Venous Thromboembolism: An Interim Analysis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3812-3812 ◽  
Author(s):  
Rachael F Schultz ◽  
Soyang Kwon ◽  
Anjali Sharathkumar ◽  
Rukhmi Bhat
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Decision Rule ◽  
Model Performance ◽  
Clinical Decision ◽  
Population Based ◽  
High Risk Population ◽  
Clinical Decision Rule ◽  
Interim Analyses ◽  
Hospital Acquired

Abstract Background: Venous thromboembolism (VTE) is an emerging hospital acquired complication in pediatric hospitals. Substantial efforts have been made to identify high-risk population based on exposure to risk-factors for VTE. Our group developed the PedsClot Clinical Decision Rule (Sharathkumar et al Journal of Thrombosis and Haemostasis, 10: 1326-1334) to identify this high-risk population based on a case-control study but this has not been validated yet. Objective: To validate thePedsClot Clinical Decision Rule [PDCR] through prospective collection of data in a tertiary pediatric hospital. This study reports our findings of interim analyses for process evaluation. Methods: This prospective data collection was performed using the Lurie Children's hospital automatic data import facility through the Enterprise Data Warehouse[study period: 02/01/2012-12/31/14]. Real time data was added to a research database of consecutive admissions based on following inclusion criteria: &gt; 48 hour stay in the Intensive Care (Pediatric, Cardiac, Neonatal), Hematology Oncology and Infectious Disease units. Following variables were included in the dataset: age, sex, ethnicity, date of admission and discharge, ICU admission, central venous catheter (CVC), blood stream infection, immobilization, oral contraceptives, mechanical ventilation&gt; 12hrs, and length of stay. Risk factors were weighed and scored as per PDCR rule. Chi-square tests were used to examine the association between the potential risk factors and VTE. PDCR model performance was evaluated by reporting the sensitivity and specificity. Results: A total of 1722 children were eligible for the interim analyses. The demographic and clinical features of the dataset analyses and the odds ratio [OR] are detailed in Table 1 and 2 respectively. Of 1722 patients, 57 (3.3%) were identified as VTE, 50% were admitted to the ICU and 51% had a CVC. VTE was associated with age ≥ 13 years (AOR=2.3; 95% CI=1.3, 4.0), ICU admission (AOR=2.4; 95% CI=1.3, 4.4), and CVC (AOR=1.9; 95% CI=1.1, 3.3). The model performance showed that at the cut off point of 3, the specificity of the PDCR in predicting VTE was 75% but had a low sensitivity (37%). Risk prediction variables such as assessment of immobilization, use of oral contraceptives and prediction of hospital stay required manual entry into the datasheet; this makes data-capture labor intensive, especially for larger datasets. Conclusions: This study utilized technological advances and database warehouse facility to validate PDCR. This interim data analyses indicates that in real life, PDCR has a high specificity but poor sensitivity in identifying children with predisposition for VTE. We are currently working to refine the risk model which may lead to a better model performance. Disclosures Sharathkumar: Bayer, Baxter, CSL Behring: Consultancy.

scholarly journals Risk factors and incidence over time for lower extremity amputations in people with type 1 diabetes: an observational cohort study of 46,088 patients from the Swedish National Diabetes Registry

Diabetologia ◽  
2021 ◽  
Author(s):  
Sara Hallström ◽  
Ann-Marie Svensson ◽  
Aldina Pivodic ◽  
Arndís F. Ólafsdóttir ◽  
Magnus Löndahl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Lower Extremity ◽  
Renal Dysfunction ◽  
Diabetes Registry ◽  
Male Sex ◽  
The Impact ◽  
Over Time ◽  
Age And Sex

Abstract Aims/hypothesis The aim of this work was to study the incidence over time of lower extremity amputations and determine variables associated with increased risk of amputations in people with type 1 diabetes. Methods Individuals with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1 January 1998 and followed to 2 October 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age- and sex-adjusted incidences were estimated over time. Results Of 46,088 people with type 1 diabetes with no previous amputation (mean age 32.5 years [SD 14.5], 25,354 [55%] male sex), 1519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The standardised incidence for any amputation in 1998–2001 was 2.84 (95% CI 2.32, 3.36) per 1000 person-years and decreased to 1.64 (95% CI 1.38, 1.90) per 1000 person-years in 2017–2019. The incidence for minor and major amputations showed a similar pattern. Hyperglycaemia and renal dysfunction were the strongest risk factors for amputation, followed by older age, male sex, cardiovascular comorbidities, smoking and hypertension. Glycaemic control and age- and sex-adjusted renal function improved during the corresponding time period as amputations decreased. Conclusions/interpretation The incidence of amputation and of the most prominent risk factors for amputation, including renal dysfunction and hyperglycaemia, has improved considerably during recent years for people with type 1 diabetes. This finding has important implications for quality of life, health economics and prognosis regarding CVD, indicating a trend shift in the treatment of type 1 diabetes. Graphical abstract

Still Feeling Better? Trends in Self-Rated Health of Older Adults in the U.S

2020 ◽  
pp. 016402752096365
Author(s):  
Esther O. Lamidi
Keyword(s):  
Older Adults ◽  
Age Groups ◽  
Later Life ◽  
The Elderly ◽  
Poor Health ◽  
Elderly Persons ◽  
Health Trends ◽  
Self Rated Health ◽  
Middle Aged Adults ◽  
Over Time

Previous analyses showed an overall pattern of improvement in self-rated health of U.S. older adults in the 1980s and the 1990s, but it was uncertain if the declining shares of elderly persons reporting fair or poor health would continue over the next decades. Using the 2000–2018 pooled data from the National Health Interview Survey, this study examined recent trends in self-rated health of adults aged 45 and older. The results showed important variations in self-rated health trends across age groups. Between 2000 and 2018, the shares of adults aged 60 and above reporting fair or poor health declined significantly while self-rated health trends for middle-aged adults worsened over time. Educational and racial/ethnic differentials in self-rated health persisted over time but there were important group variations. To further improve the health of the elderly population, it is important to consider changing health disparities in later life.

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