scholarly journals Transmission of SARS-CoV-2 considering shared chairs in outpatient dialysis: a real-world case-control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ravi Thadhani ◽  
Joanna Willetts ◽  
Catherine Wang ◽  
John Larkin ◽  
Hanjie Zhang ◽  
...  
Keyword(s):  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Positive Patient ◽  
Transmission Risk ◽  
Sensitivity Analyses ◽  
Retrospective Case ◽  
Control Pair ◽  
Logistic Regression Models ◽  
Control Study

Abstract Background SARS-CoV-2 can remain transiently viable on surfaces. We examined if use of shared chairs in outpatient hemodialysis associates with a risk for indirect patient-to-patient transmission of SARS-CoV-2. Methods We used data from adults treated at 2,600 hemodialysis facilities in United States between February 1st and June 8th, 2020. We performed a retrospective case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) treated in the same dialysis shift. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count. For each case-control pair, we traced backward 14 days to assess possible prior exposure from a ‘shedding’ SARS-CoV-2 positive patient who sat in the same chair immediately before the case or control. Conditional logistic regression models tested whether chair exposure after a shedding SARS-CoV-2 positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient. Results Among 170,234 hemodialysis patients, 4,782 (2.8 %) tested positive for SARS-CoV-2 (mean age 64 years, 44 % female). Most facilities (68.5 %) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30 % (95 %CI 0.90 %, 1.87 %) of cases and 1.39 % (95 %CI 0.97 %, 1.97 %) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR = 0.94; 95 %CI 0.57 to 1.54; p = 0.80). Results remained consistent in adjusted and sensitivity analyses. Conclusions The risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low.

scholarly journals Transmission of SARS-CoV-2 Considering Shared Chairs in Outpatient Dialysis: A Real-World Case-Control Study

2021 ◽  
Author(s):  
Ravi Thadhani ◽  
Joanna Willetts ◽  
Catherine Wang ◽  
John Larkin ◽  
Hanjie Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Case Control Study ◽  
The United States ◽  
Hemodialysis Patients ◽  
Case Control ◽  
Positive Patient ◽  
Sensitivity Analyses ◽  
Real World Data ◽  
World Data ◽  
Control Study

AbstractBackgroundSARS-CoV-2 is primarily transmitted through aerosolized droplets; however, the virus can remain transiently viable on surfaces.ObjectiveWe examined transmission within hemodialysis facilities, with a specific focus on the possibility of indirect patient-to-patient transmission through shared dialysis chairs.DesignWe used real-world data from hemodialysis patients treated between February 1st and June 8th, 2020 to perform a case-control study matching each SARS-CoV-2 positive patient (case) to a non-SARS-CoV-2 patient (control) in the same dialysis shift and traced back 14 days to capture possible exposure from chairs sat in by SARS-CoV-2 patients. Cases and controls were matched on age, sex, race, facility, shift date, and treatment count.Setting2,600 hemodialysis facilities in the United States.PatientsAdult (age ≥18 years) hemodialysis patients.MeasurementsConditional logistic regression models tested whether chair exposure after a positive patient conferred a higher risk of SARS-CoV-2 infection to the immediate subsequent patient.ResultsAmong 170,234 hemodialysis patients, 4,782 (2.8%) tested positive for SARS-CoV-2 (mean age 64 years, 44% female). Most facilities (68.5%) had 0 to 1 positive SARS-CoV-2 patient. We matched 2,379 SARS-CoV-2 positive cases to 2,379 non-SARS-CoV-2 controls; 1.30% (95%CI 0.90%, 1.87%) of cases and 1.39% (95%CI 0.97%, 1.97%) of controls were exposed to a chair previously sat in by a shedding SARS-CoV-2 patient. Transmission risk among cases was not significantly different from controls (OR=0.94; 95%CI 0.57 to 1.54; p=0.80). Results remained consistent in adjusted and sensitivity analyses.LimitationAnalysis used real-world data that could contain errors and only considered vertical transmission associated with shared use of dialysis chairs by symptomatic patients.ConclusionsThe risk of indirect patient-to-patient transmission of SARS-CoV-2 infection from dialysis chairs appears to be low.Primary Funding SourceFresenius Medical Care North America; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK130067)

scholarly journals Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Zhang ◽  
Lin Zhang ◽  
Qiu Wang ◽  
Jingwei Zhao ◽  
Jia Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Retrospective Case ◽  
Factors Associated ◽  
Control Study

Abstract Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

scholarly journals Impact of opportunistic screening on squamous cell and adenocarcinoma of the cervix in Germany: A population-based case-control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253801
Author(s):  
Luana F. Tanaka ◽  
Dirk Schriefer ◽  
Kathrin Radde ◽  
Gunther Schauberger ◽  
Stefanie J. Klug
Keyword(s):  
Cervical Cancer ◽  
Squamous Cell ◽  
Case Control Study ◽  
Precancerous Lesions ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Case Control ◽  
Logistic Regression Models ◽  
Incident Cases ◽  
Control Study

Background We investigated the uptake of opportunistic cervical cancer screening (CCS) and other risk factors and their association with cervical cancer in Germany in a case-control study. Methods and findings We recruited incident cases of cervical cancer (ICD-10 C53) diagnosed between 2012 and 2016 and matched with three population-based controls, based on age and region of residence. Cases and controls reported their CCS participation during the past ten years (frequent: every three years; no or infrequent: less than every three years) and other relevant variables. We fitted conditional logistic regression models, reporting odds ratios (OR) and 95% confidence intervals (95% CI). We report overall and stratified analyses by histologic group (squamous cell–SCC, and adenocarcinoma–AC), T category (T1 and T2+), and age (<50 and ≥50 years). We analysed 217 cases and 652 matched controls. 53.0% of cases and 85.7% of controls attended CCS frequently. In the overall adjusted model, no or infrequent participation in CCS (OR 5.63; 95% CI 3.51 to 9.04), having had more than one sexual partner (OR 2.86; 95%CI 1.50 to 5.45) and obesity (OR 1.69; 95% CI 1.01 to 2.83) were associated with cervical cancer. Twelve years of schooling (OR 0.37; 95% CI 0.23 to 0.60) and a net monthly income of €3000 or more (OR 0.50; 95% CI 0.30 to 0.82) were protective factors. In the stratified analyses, no or infrequent participation was associated with T1 (OR 4.37; 95% CI 2.48 to 7.71), T2+ (OR 10.67; 95% CI 3.83 to 29.74), SCC (OR 6.88; 95% CI 4.08 to 11.59) and AC (OR 3.95; 95% CI 1.47 to 10.63). Conclusion Although women who frequently attended CCS were less likely to develop cervical cancer, especially larger tumours, the high proportion of cases who had been frequently screened prior to diagnosis underscores the need to investigate the quality of cytology and treatment of precancerous lesions in Germany.

scholarly journals Incidence and Risk of Severe Ileus After Orthopedic Surgery: A Case-Control Study

2019 ◽  
Vol 16 (S2) ◽  
pp. 272-279 ◽  
Author(s):  
Lisa A. Mandl ◽  
Mayu Sasaki ◽  
Jingyan Yang ◽  
Sara Choi ◽  
Kelianne Cummings ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
International Classification Of Diseases ◽  
Case Control ◽  
Orthopedic Procedures ◽  
Retrospective Case ◽  
Full Diet ◽  
Increased Risk ◽  
Control Study

Abstract Background Post-operative ileus (POI) is common and can be associated with significant morbidity. Questions/Purposes We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. Methods We conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. Results Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. Conclusions In this retrospective case–control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.

scholarly journals Sulfadiazine plasma concentrations in women with pregnancy-acquired compared to ocular toxoplasmosis under pyrimethamine and sulfadiazine therapy: a case–control study

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Ingrid Reiter-Owona ◽  
Harald Hlobil ◽  
Martin Enders ◽  
Ute Klarmann-Schulz ◽  
Barbara Gruetzmacher ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Folinic Acid ◽  
Case Control Study ◽  
Plasma Concentrations ◽  
Case Control ◽  
Ocular Toxoplasmosis ◽  
Transmission Risk ◽  
Retrospective Case ◽  
Drug Concentrations ◽  
Control Study

Abstract Background Dosing recommendations for the treatment of pregnancy-acquired toxoplasmosis are empirical and widely based on experimental data. There are no pharmacological data on pregnant women with acute Toxoplasma gondii infection under treatment with pyrimethamine (PY) and sulfadiazine (SA) and our study intends to tighten this gap. Methods In this retrospective case–control study, we included 89 pregnant women with primary Toxoplasma infection (PT) treated with PY (50 mg first dose, then 25 mg/day), SA (50 mg/kg of body weight/day), and folinic acid (10–15 mg per week). These were compared to a group of 17 women with acute ocular toxoplasmosis (OT) treated with an initial PY dose of 75 mg, thereafter 25 mg twice a day but on the same SA and folinic acid regimen. The exact interval between drug intake and blood sampling and co-medication had not been recorded. Plasma levels of PY and SA were determined 14 ± 4 days after treatment initiation using liquid chromatography–mass spectrometry and compared using the Mann–Whitney U test at a p < 0.05 level. Results In 23 PT patients (26%), SA levels were below 20 mg/l. Fifteen of these 23 patients (17% of all patients) in parallel presented with PY levels below 700 µg/l. Both drug concentrations differed remarkably between individuals and groups (PY: PT median 810 µg/l, 95% CI for the median [745; 917] vs. OT 1230 µg/l [780; 1890], p = 0.006; SA: PT 46.2 mg/l [39.9; 54.4] vs. OT 70.4 mg/l [52.4; 89], p = 0.015) despite an identical SA dosing scheme. Conclusions SA plasma concentrations were found in the median 34% lower in pregnant women with PT compared to OT patients and fell below a lower reference value of 50 mg/l in a substantial portion of PT patients. The interindividual variability of plasma concentrations in combination with systematically lower drug levels and possibly a lower compliance in pregnant women may thus account for a still not yet supportable transmission risk. Systematic drug-level testing in PT under PY/SA treatment deserves to be considered.

scholarly journals Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247163
Author(s):  
Priyamadhaba Behera ◽  
Binod Kumar Patro ◽  
Arvind Kumar Singh ◽  
Pradnya Dilip Chandanshive ◽  
Ravikumar S. R. ◽  
...  
Keyword(s):  
Vitamin C ◽  
Healthcare Workers ◽  
Case Control Study ◽  
Infection Type ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Logistic Regression Models ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Background Ivermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers. Methods A hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection. Results Ivermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15–0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18–7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection. Conclusion Two-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.

scholarly journals Risk Factors Associated with Ischemic Stroke in a Young Non-Diabetic and Non-Hypertensive Population: A Retrospective Case-Control Study

2020 ◽  
Author(s):  
Nan Zhang ◽  
Lin Zhang ◽  
Qiu Wang ◽  
Jingwei Zhao ◽  
Jia Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Retrospective Case ◽  
Factors Associated ◽  
Control Study

Abstract Background: Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes.Methods: This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models.Results: We recruited 60 IS patients and 180 controls with mean ages of 44.37±4.68 and 44.31±4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P< 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165-1.977, P= 0.002 and OR 2.418, 95%CI 1.061-5.511, P=0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000-0.083, P=0.003 and OR 0.053, 95%CI 0.008-0.326, P=0.002, respectively).Conclusion: In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

scholarly journals Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Habiba Kapaya ◽  
Roslyn Williams ◽  
Grace Elton ◽  
Dilly Anumba
Keyword(s):  
Risk Factors ◽  
Umbilical Artery ◽  
Case Control Study ◽  
Fetal Monitoring ◽  
Case Control ◽  
Retrospective Case ◽  
Predictive Capacity ◽  
Perinatal Medicine ◽  
Logistic Regression Models ◽  
Control Study

Background. Despite major advances in perinatal medicine, intrapartum asphyxia remains a leading and potentially preventable cause of perinatal mortality and long-term morbidity. The umbilical cord pH is considered an essential criteria for the diagnosis of acute intrapartum hypoxic events. The purpose of this study was to evaluate whether obstetric risk factors are associated with fetal acidaemia at delivery. Methodology. In a case-control study, 294 women with term singleton pregnancies complicated by an umbilical artery cord pH < 7.20 at birth were individually matched by controls with umbilical artery cord pH > 7.20. Groups were compared for differences in maternal, obstetric, and fetal characteristics using logistic regression models presented as odds ratio (OR) with 95% confidence intervals (CI). Results. The study showed pregestational diabetes (PGDM) [OR: 5.31, 95% CI: 1.15- 24.58, P = 0.018], urinary tract infection (UTI) [OR: 3.21, 95% CI: 1.61- 6.43, P < 0.001], and low Apgar scores to be significantly associated with acidaemia, whereas low maternal BMI [OR: 0.19, 95% CI: 0.04-0.87, P = 0.032], pyrexia in labour [OR 0.23; 95% CI 0.12-0.53; P < 0.001], electronic fetal monitoring (EFM) [OR 0.65; 95% CI 0.43-0.99; P = 0.042), and emergency caesarean section [OR 0.42; 95% CI 0.26-0.66; P < 0.001] were found to be protective of acidaemia. Conclusion. Certain obstetric risk factors before and during labour can identify newborns at risk of developing acidaemia. Further research is needed to gain quantitative insight into the predictive capacity of these risks that can inform obstetric clinical management for improved outcomes.

scholarly journals COVID-19 Infection in Pregnancy: PCR Cycle Thresholds, Placental Pathology, and Perinatal Outcomes

Viruses ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1884
Author(s):  
Estibalitz Laresgoiti-Servitje ◽  
Jorge Arturo Cardona-Pérez ◽  
Rosa Gabriela Hernández-Cruz ◽  
Addy Cecilia Helguera-Repetto ◽  
María Yolotzin Valdespino-Vázquez ◽  
...  
Keyword(s):  
Mexico City ◽  
Regression Models ◽  
Universal Screening ◽  
Case Control Study ◽  
Perinatal Outcomes ◽  
Case Control ◽  
Placental Pathology ◽  
Retrospective Case ◽  
Logistic Regression Models ◽  
Control Study

(1) This study aimed to evaluate characteristics, perinatal outcomes, and placental pathology of pregnant women with or without SARS-CoV-2 infection in the context of maternal PCR cycle threshold (CT) values. (2) This was a retrospective case-control study in a third-level health center in Mexico City with universal screening by RT-qPCR. The association of COVID-19 manifestations, preeclampsia, and preterm birth with maternal variables and CT values were assessed by logistic regression models and decision trees. (3) Accordingly, 828 and 298 women had a negative and positive test, respectively. Of those positive, only 2.6% of them presented mild to moderate symptoms. Clinical characteristics between both groups of women were similar. No associations between CT values were found for maternal features, such as pre-gestational BMI, age, and symptomatology. A significantly higher percentage of placental fibrinoid was seen with women with low CTs (<25; p < 0.01). Regarding perinatal outcomes, preeclampsia was found to be significantly associated with symptomatology but not with risk factors or CT values (p < 0.01, aOR = 14.72). Moreover, 88.9% of women diagnosed with COVID-19 at <35 gestational weeks and symptomatic developed preeclampsia. (4) The data support strong guidance for pregnancies with SARS-CoV-2 infection, in particular preeclampsia and placental pathology, which need further investigation.

scholarly journals Methotrexate and relative risk of dementia amongst patients with Rheumatoid Arthritis: a multi-national multi-database case-control study

2019 ◽  
Author(s):  
Danielle Newby ◽  
Daniel Prieto-Alhambra ◽  
Talita Duarte-Salles ◽  
David Ansell ◽  
Lars Pedersen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Odds Ratio ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Logistic Regression Models ◽  
The United Kingdom ◽  
Dementia Risk ◽  
Inflammatory Processes ◽  
Control Study

Abstract Inflammatory processes have been shown to play a role in dementia. To understand this role we selected two anti-inflammatory drugs (methotrexate and sulfasalazine) to study their association with dementia risk.METHODS A retrospective matched case-control study, of patients over 50 with rheumatoid arthritis (486 dementia cases and 641 controls) were identified from electronic health records in the United Kingdom, Spain, Denmark and the Netherlands. Conditional logistic regression models were fitted to estimate risk of dementia.RESULTS Prior methotrexate use was associated with dementia (OR: 0.71 95% CI 0.52-0.98). Methotrexate use was strongest with therapy longer than 4 years (odds ratio: 0.37 95% CI 0.17-0.79). Sulfasalazine use was not associated with dementia (odds ratio: 0.88 95% CI 0.57-1.37).CONCLUSIONS Further studies are still required to clarify the relationship between prior methotrexate use and duration as well as biological treatments with dementia risk.

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