Epidemiology and Management of Immune Thrombocytopenia: A Nationwide Population-Based Study in Korea

Abstract The epidemiology of immune thrombocytopenia (ITP) is not well characterized in the general Korean population. ITP patients from 2010 to 2014 were identified using the Korean Health Insurance Review and Assessment Service (HIRA) database. Patients with diagnosis codes for secondary thrombocytopenia or secondary ITP were excluded if those codes coexisted with ITP code of D693.0 or D693.8. The prevalent cases before 1st July 2010 and incident cases from 1st July 2014 were also excluded to calculate the exact incidence of ITP. Overall age-standardized incidence rates of ITP were 5.42/100,000 person-years (95% CI: 5.33-5.51; women, 6.17 [95% CI, 6.03-6.30]; men, 4.69 [95% CI, 4.57-4.81]).The overall incidence rates of ITP appeared to have a bimodal distribution, with peaks among children (< 10 years) and in those > 70 years of age. Among adults, the age-specific incidence rates increased with age for man, but those were observed to be constant for women (figure 1). Overall, 75.2% of patients needed treatment with the median time from the diagnosis to treatment of 1.7 months (range, 0-53.3 months). First-line therapy consisted of steroids and/or immunoglobulin in 83.6%, immunoglobulin only in 14.5%, and other immunosuppressive agents such as cyclosporine A, azathioprine, mycophenolate mofetil, and danazol in 1.9%. Only 1.0% of patients underwent splenectomy and laparoscopic procedure accounted for 90.5% of these 108 patients. The median age was 46 years (range, 9-77 years) at the time of splenectomy, and 77.8% of patients were female. 58.8% of patients received treatment beyond 6months after initial therapy. Among these patients, the most frequently used therapy was steroid and/or immunoglobulin in 92.6% followed by other immunosuppressive agents in 6.9% and immunoglobulin in 0.5%. Platelet transfusions were given 13.7% of patients and the median numbers of platelets transfused were 12 units (range, 1-2,484 units) during study periods. The usage of thrombopoietin receptor agonists or rituximab couldn't be analyzed because these drugs have not been reimbursed for the treatment of ITP before 2016 in Korea. This population-based study firstly describes the incidence rates of ITP and treatment reality for patients with ITP in Korea. Figure Age/gender-specific incidence of ITP in Korea during the period from mid-2010 to mid-2014. Figure. Age/gender-specific incidence of ITP in Korea during the period from mid-2010 to mid-2014. Disclosures No relevant conflicts of interest to declare.

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The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

The Journal of Rheumatology ◽

10.3899/jrheum.170806 ◽

2017 ◽

Vol 45 (4) ◽

pp. 574-579 ◽

Cited By ~ 45

Author(s):

Mohanad M. Elfishawi ◽

Nour Zleik ◽

Zoran Kvrgic ◽

Clement J. Michet ◽

Cynthia S. Crowson ◽

...

Keyword(s):

New York ◽

Population Based ◽

Incidence Rates ◽

Comorbid Conditions ◽

Population Based Study ◽

Significant Public Health ◽

Public Health Challenge ◽

Rising Incidence ◽

Adjusted Incidence ◽

Incident Cases

Objective.To examine the incidence of gout over the last 20 years and to evaluate possible changes in associated comorbid conditions.Methods.The medical records were reviewed of all adults with a diagnosis of incident gout in Olmsted County, Minnesota, USA, during 2 time periods (January 1, 1989–December 31, 1992, and January 1, 2009–December 31, 2010). Incident cases had to fulfill at least 1 of 3 criteria: the American Rheumatism Association 1977 preliminary criteria for gout, the Rome criteria, or the New York criteria.Results.A total of 158 patients with new-onset gout were identified during 1989–1992 and 271 patients during 2009–2010, yielding age- and sex-adjusted incidence rates of 66.6/100,000 (95% CI 55.9–77.4) in 1989–1992 and 136.7/100,000 (95% CI 120.4–153.1) in 2009–2010. The incidence rate ratio was 2.62 (95% CI 1.80–3.83). At the time of their first gout flare, patients diagnosed with gout in 2009–2010 had higher prevalence of comorbid conditions compared with 1989–1992, including hypertension (69% vs 54%), diabetes mellitus (25% vs 6%), renal disease (28% vs 11%), hyperlipidemia (61% vs 21%), and morbid obesity (body mass index ≥ 35 kg/m2; 29% vs 10%).Conclusion.The incidence of gout has more than doubled over the recent 20 years. This increase together with the more frequent occurrence of comorbid conditions and cardiovascular risk factors represents a significant public health challenge.

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It is Different the Survival of Primary Extranodal Non Hodgkin Lymphoma?.

Blood ◽

10.1182/blood.v114.22.5028.5028 ◽

2009 ◽

Vol 114 (22) ◽

pp. 5028-5028

Author(s):

Pilar Giraldo ◽

Esther Franco-Garcia ◽

Ramiro Alvarez ◽

Gloria Garcia-Carpintero ◽

Carmen Martos

Keyword(s):

Conflicts Of Interest ◽

Epidemiological Studies ◽

Population Based ◽

Incidence Rates ◽

European Population ◽

Rank Test ◽

Hematological Disorders ◽

Non Hodgkin Lymphoma ◽

Hematologic Cancer ◽

Incident Cases

Abstract Abstract 5028 Introduction There are few studies that evaluate the difference in incidence and survival of primary extranodal lymphomas (PEL) as compared to nodal lymphomas. In the Population Based Cancer Registry of Zaragoza (PCRZ) working since 1960, all incident cases of hematologic and non hematologic cancer are including. PCRZ is a data source for epidemiological studies. Objectives 1. Review and reclassify cases of NHL diagnosed during the period 1992-2004. 2. Define the incidence of PEL in PCRZ during this period. 3. Analyze the survival of the PEL and compare it with that of nodal NHL. Materials and methods Based on the data PCRZ, we have reviewed and reclassified the patients with NHL according to REAL classification and the new WHO classification (2008), diagnosed during the period 1992-2004, to determine location and histology. The follow-up period of cases was completed by December 31, 2007 Data sources: medical records, histological reports and discharged hospital reports. Population at risk: 9,255,818 person-years. We have calculated crude incidence rates (IR) and standardized by age (SIR), using the European population as standard. For the calculation of survival and confidence intervals (95%) had used the Kaplan-Meier method and the log-rank test was used to compare survival curves. Results During the period of study a total of 4,570 primary hematological disorders were included in the PCRZ; 1,987 (43.4%) were NHL (IR: 19×105 person-years), 331 (16.6%) of them were classified as PEL, which represented a 2.7 SIR x105 person-years (male: 183 cases (55.2%), mean age 59.2 years, SIR: 3.1 ×105 person-years and women 148 cases (44.7%), mean age 66.8 years, SIR: 2,4 ×105 person-years. Only 10% of cases will be reclassified related to histology or location. The most common site was gastrointestinal tract (50.4%), skin (19.8%), glands (10.0%), oral cavity and pharynx (7.9%), lung (2.9%), CNS (2.4%), orbit (2.1%) and other locations (4.5%). Histological types: MALT 60.2%, BDLCNHL: 18.3%, FNHL: 4.7%, MCNHL: 3.2%, MZNHL: 6.5%, T-NHL: 7.1%. Median survival for PEL was 6.61 years (95% CI: 3.7-9.5) and 5.01 years for nodal lymphomas (95% CI: 4.1-5.9). The survival at 5 years was 53.5% and 50% respectively. There were no statistically significant differences between PEL group and the nodal NHL, according to the location or by gender. The differences in survival were associated with histological subtype of lymphoma. These results were similar to those in the data EUROCARE. Conclusions No differences in incidence in PEL and nodal NHL were observed according to gender and age. There were no statistically significant differences between the survival of the PEL and nodal NHL, survival is more influenced by histology than by location. This work partially funded by the project HAEMACARE Disclosures No relevant conflicts of interest to declare.

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Incidence and Trends of the Leading Cancers with Elevated Incidence Among American Indian and Alaska Native Populations, 2012–2016

American Journal of Epidemiology ◽

10.1093/aje/kwaa222 ◽

2020 ◽

Author(s):

Stephanie C Melkonian ◽

Hannah K Weir ◽

Melissa A Jim ◽

Bailey Preikschat ◽

Donald Haverkamp ◽

...

Keyword(s):

American Indian ◽

Cancer Incidence ◽

Alaska Native ◽

Cancer Registries ◽

Population Based ◽

Incidence Rates ◽

Breast Cancers ◽

Age Adjusted Rates ◽

Incident Cases ◽

Hispanic White

Abstract Cancer incidence varies among American Indian and Alaska Native (AI/AN) populations, as well as between AI/AN and White populations. This study examined trends for cancers with elevated incidence among AI/AN compared with non-Hispanic White populations and estimated potentially avoidable incident cases among AI/AN populations. Incident cases diagnosed during 2012–2016 were identified from population-based cancer registries and linked with the Indian Health Service patient registration databases to improve racial classification of AI/AN populations. Age-adjusted rates (per 100,000) and trends were calculated for cancers with elevated incidence among AI/AN compared with non-Hispanic White populations (rate ratio >1.0), by region. Trends were estimated using joinpoint regression analyses. Expected cancers were estimated by applying age-specific cancer incidence rates among non-Hispanic White populations to population estimates for AI/AN populations. Excess cancer cases among AI/AN populations were defined as observed minus expected cases. Liver, stomach, kidney, lung, colorectal and female breast cancers had higher incidence rate among AI/AN populations across most regions. Between 2012 and 2016, nearly 5,200 excess cancers were diagnosed among AI/AN populations, with the largest number of excess cancers (1,925) occurring in the Southern Plains region. Culturally informed efforts may reduce cancer disparities associated with these and other cancers among AI/AN populations.

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POS0803 TRENDS IN THE INCIDENCE OF GIANT CELL ARTERITIS ACROSS SEVEN DECADES AND CHANGES IN DIAGNOSTIC MODALITIES: A POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1415 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 654.1-654

Author(s):

T. Garvey ◽

C. S. Crowson ◽

M. Koster ◽

K. J. Warrington

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Population Based ◽

Incidence Rates ◽

Large Vessel ◽

Vessel Imaging ◽

Group 3 ◽

Group 2 ◽

Diagnostic Modalities ◽

Incident Cases

Background:Diagnostic methods for giant cell arteritis (GCA) have evolved over recent decades, and large vessel imaging plays an increasing role in disease detection.Objectives:This study aims to estimate the incidence of GCA over the past 10 years in a population and compare it to preceding incidence estimates. It also explores trends in the diagnostic modalities used to identify GCA.Methods:A pre-existing population-based cohort of patients diagnosed with GCA between 1950 and 2009 was extended with incident cases from 2010 to 2019. The diagnosis of GCA was confirmed by review of medical records of patients with ICD9/10 codes for GCA between 1/1/2010 and 12/31/2019. Incident cases that met either one of the following sets of inclusion criteria were added to the cohort: one, American College of Rheumatology 1990 GCA classification criteria; or two, patients aged ≥50 years with elevation of erythrocyte sedimentation rate or C-reactive protein and radiographic evidence of large vessel vasculitis attributed to GCA. Incident cases were classified into one of three groups: group 1, temporal artery biopsy (TAB) positive; group 2, TAB negative or not done with positive large-vessel imaging; or group 3, clinical diagnosis of GCA.Results:The study cohort included 305 patients diagnosed with GCA from 1950 until 2019. Fifty-five incident cases were diagnosed between 2010 and 2019; 37 females (67%) and 18 males (33%). The age and sex adjusted incidence rates (95% CI) per 100,000 between 2010 and 2019 for females, males, and the total population were 13.0 (8.8, 17.3), 8.6 (4.6, 12.7), and 10.8 (8.0, 13.7), respectively. The corresponding incidence rates from 2000-2009 were 28.0 (21.0, 35.1), 10.2 (5.0, 15.5), and 20.5 (15.9, 25.1), respectively. This represents a significant decline in the incidence rates in females (p<0.001) and the total group (p<0.001) between the 2000-2009 and 2010-2019 cohorts but no change in males (p=0.64). Of the 55 patients diagnosed between 2010 and 2019, there were 37 (67%) in group 1, 10 (18%) in group 2, and 8 (15%) in group 3. In contrast, of the 250 patients diagnosed between 1950 and 2009 there were 209 (84%) in group 1, 4 (2%) in group 2, and 37 (15%) in group 3. There was a significant difference between the 1950-2009 and 2010-2019 cohorts in the composition of these groups (p<0.001).Conclusion:In this population-based cohort of patients with GCA diagnosed over a 70-year period, the incidence of GCA has declined in recent years. The total decline is driven by a decline in females but not in males. The reasons for this are unclear but should be followed over time and investigated in other population-based cohorts. There has also been a shift in the diagnostic modalities for GCA. In recent years, there are fewer TAB positive patients, and more patients diagnosed with large vessel imaging. This is the first population-based incidence cohort demonstrating a trend towards increased use of large vessel imaging for the diagnosis of GCA.References:[1]Chandran AK, et al. Incidence of Giant Cell Arteritis in Olmsted County, Minnesota, over a 60-year period 1950-2009. Scand J Rheumatol. 2015;44(3):215-218.[2]Gonzalez-Gay MA, et al. Giant cell arteritis: is the clinical spectrum of the disease changing? BMC Geriatr. 2019; Jul 29;19(1):200.[3]Rubenstein E, et al. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systemic literature review and meta-analysis. Rheumatology (Oxford). 2020 May 1:59(5):1011-1020.Figure 1.Trends in the incidence of GCA in Olmsted County by sex (1950-2019).Acknowledgements:This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01 AG034676, and CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.Disclosure of Interests:Thomas Garvey: None declared, Cynthia S. Crowson: None declared, Matthew Koster: None declared, Kenneth J Warrington Grant/research support from: Clinical research support from Eli Lilly and Kiniksa

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Rising incidence rates and unaltered survival for primary upper urinary tract urothelial carcinoma: a Dutch population‐based study from 1993 to 2017.

BJU International ◽

10.1111/bju.15389 ◽

2021 ◽

Author(s):

Thomas van Doeveren ◽

Marianne van der Mark ◽

Pim J. van Leeuwen ◽

Joost L. Boormans ◽

Katja K.H. Aben

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

Population Based ◽

Upper Urinary Tract ◽

Incidence Rates ◽

Dutch Population ◽

Population Based Study ◽

Rising Incidence ◽

Urinary Tract Urothelial Carcinoma

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Aplastic Anemia in Thailand: Incidence and Treatment Outcome from a Prospective Nationwide Population-Based Study

Blood ◽

10.1182/blood-2020-137047 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 8-9

Author(s):

Lalita Norasetthada ◽

Somchai Wongkhantee ◽

Jindaratn Chaipokam ◽

Kanyaporn Charoenprasert ◽

Suporn Chuncharunee ◽

...

Keyword(s):

Aplastic Anemia ◽

Anabolic Steroid ◽

Real World ◽

Conflicts Of Interest ◽

Bone Marrow Failure ◽

Population Based ◽

Annual Incidence ◽

Severe Aplastic Anemia ◽

Treatment Modalities ◽

Population Based Study

Background: Incidence of Aplastic Anemia (AA) in Asia tends to be higher than in western countries, but contemporary real-world incidence and outcomes of AA in Asia remain limited. This study aimed to explore the incidence across the country regions and to evaluate the patient outcomes according to age, the severity of disease, and treatment modalities. Method: This is a prospective multicenter nationwide population-based observational study of patients with AA aged over 15 years old, diagnosed between August 1st, 2014 to July 31st, 2016, with a longitudinal follow-up period over 2 years, from 30 medical centers. Patients with suspected hypocellular MDS and congenital bone marrow failure syndrome were excluded. Results: During the study period of 2 years, there were 348 newly diagnosed patients with aplastic anemia, giving the annual incidence of 4.6 per million inhabitants. There was a higher annual incidence of severe (SAA) and very severe aplastic anemia (VSAA) (3.8 per million) than non-severe aplastic anemia (NSAA) (0.8 per million). The incidence was greater among older patients with a peak incidence in patients aged 60-89 years old. (Figure 1) There was a high variation in the geographic incidences across country regions, ranging from 2.6 to 6.6 per million per year. (Figure 2) The 2-year overall survival (OS) for NSAA, SAA, and VSAA were 65.5%, 49.3%, and 20.1%, respectively (P < 0.001). Patients aged older than 60 years had the worst OS (42.6% as compared with 47.7% for the age 41-60 years and 64.5% for the age 15-40 years, P = 0.002). Among patients with SAA and VSAA (n = 280), the overall response rate (ORR) among patients treated with rabbit anti-thymocyte globulin and/or cyclosporin A (rATG±CsA) was significantly superior than those treated with CsA-based therapy and those treated with anabolic steroid (44.4% vs. 36.4% and 31.2%, respectively, P < 0.001). Among evaluable patients, ORR after the 1st treatment with rATG±CsA at 3, 6, 12 and 24 months were 23.9%, 43.8%, 68.4% and 89.2%, respectively. The 2-year OS among SAA/VSAA patients treated with rATG±CsA, CsA-based therapy, and anabolic steroid were 54.8%, 54.5%, and 37.6% (P = 0.037), respectively (Figure 3). From multivariate analysis, age > 60 years (HR 1.63, 95%CI, 1.14-2.33, P = 0.007), VSAA (HR 2.24, 95% CI, 1.45-3.46, P < 0.001) and not receiving immunosuppressive therapy or anabolic steroid (HR 4.96, 95%CI, 2.88-8.54, P <0.001), were independently associated with inferior OS among patients with SAA/VSAA. Conclusion: The incidence rate of AA in Thailand from this contemporary nationwide population-based study is high, especially in the elderly. Patients treated with rATG±CsA had superior survival than those receiving anabolic steroid. The real-world outcome of patients with SAA/VSAA, especially in those aged over 60 years, is substantially poor. Figure 1 Disclosures No relevant conflicts of interest to declare.

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