Temporal changes in cardiovascular disease and infections in dialysis across a 22-year period: a nationwide study

Abstract Background Cardiovascular diseases (CVD) and infections are recognized as serious complications in patients with end stage kidney disease. However, little is known about the change over time in incidence of these complications. This study aimed to investigate temporal changes in CVD and infective diseases across more than two decades in chronic dialysis patients. Methods All patients that initiated peritoneal dialysis (PD) or hemodialysis (HD) between 1996 and 2017 were identified and followed until outcome (CVD, pneumonia, infective endocarditis (IE) or sepsis), recovery of kidney function, end of dialysis treatment, death or end of study (December 31st, 2017). The calendar time was divided into 5 periods with period 1 (1996–2000) being the reference period. Adjusted rate ratios were assessed using Poisson regression. Results In 4285 patients with PD (63.7% males) the median age increased across the calendar periods from 65 [57–73] in 1996–2000 to 69 [55–76] in 2014–2017, (p < 0.0001). In 9952 patients with HD (69.2% males), the overall median age was 71 [61–78] without any changes over time. Among PD, an overall non-significant decreasing trend in rate ratios (RR) of CVD was found, (p = 0,071). RR of pneumonia increased significantly throughout the calendar with an almost two-fold increase of the RR in 2014–2017 (RR 1.71; 95% CI 1.46–2.0), (p < 0.001), as compared to the reference period. The RR of IE decreased significantly until 2009 (RR 0.43; 95% CI 0.21–0.87), followed by a return to the reference level in 2010–2013 (RR 0.87; 95% CI 0.47–1.60 and 2014–2017 (RR 1.1; 95% CI 0.59–2.04). A highly significant (p < 0.001) increase in sepsis was revealed across the calendar periods with an almost 5-fold increase in 2014–2017 (RR 4.69 95% CI 3.69–5.96). In HD, the RR of CVD decreased significantly (p < 0.001) from 2006 to 2017 (RR 0.85; 95% CI 0.79–0.92). Compared to the reference period, the RR for pneumonia was high during all calendar periods (p < 0.05). The RR of IE was initially unchanged (p = 0.4) but increased in 2010–2013 (RR 2.02; 95% CI 1.43–2.85) and 2014–2017 (RR 3.39; 95% CI 2.42–4.75). No significant changes in sepsis were seen. Conclusion Across the two last decades the RR of CVD has shown a decreasing trend in HD and PD patients, while RR of pneumonia increased significantly, both in PD and in HD. Temporal trends of IE in HD, and particularly of sepsis in PD were upwards across the last decades.

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Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests

BMJ ◽

10.1136/bmj.k4666 ◽

2018 ◽

pp. k4666 ◽

Cited By ~ 33

Author(s):

Jack W O’Sullivan ◽

Sarah Stevens ◽

F D Richard Hobbs ◽

Chris Salisbury ◽

Paul Little ◽

...

Keyword(s):

Primary Care ◽

Temporal Trends ◽

Age Groups ◽

Fold Increase ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Test Use ◽

Over Time ◽

Age And Sex ◽

Total Test

Abstract Objectives To assess the temporal change in test use in UK primary care and to identify tests with the greatest increase in use. Design Retrospective cohort study. Setting UK primary care. Participants All patients registered to UK General Practices in the Clinical Practice Research Datalink, 2000/1 to 2015/16. Main outcome measures Temporal trends in test use, and crude and age and sex standardised rates of total test use and of 44 specific tests. Results 262 974 099 tests were analysed over 71 436 331 person years. Age and sex adjusted use increased by 8.5% annually (95% confidence interval 7.6% to 9.4%); from 14 869 tests per 10 000 person years in 2000/1 to 49 267 in 2015/16, a 3.3-fold increase. Patients in 2015/16 had on average five tests per year, compared with 1.5 in 2000/1. Test use also increased statistically significantly across all age groups, in both sexes, across all test types (laboratory, imaging, and miscellaneous), and 40 of the 44 tests that were studied specifically. Conclusion Total test use has increased markedly over time, in both sexes, and across all age groups, test types (laboratory, imaging, and miscellaneous) and for 40 of 44 tests specifically studied. Of the patients who underwent at least one test annually, the proportion who had more than one test increased significantly over time.

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P-L04 Temporal changes in prevalence and associated risk factors for gallbladder dysplasia and adenocarcinoma in patients undergoing cholecystectomy. A UK hospital-based observational study

British Journal of Surgery ◽

10.1093/bjs/znab430.097 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Stephen Lam ◽

Wing Chou ◽

Giles Toogood ◽

Simon Wemyss-Holden ◽

Alexia Tsigka ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Disease Risk ◽

Precancerous Lesions ◽

Temporal Trends ◽

Temporal Changes ◽

Multivariate Logistic Regression Model ◽

Low Grade ◽

Associated Risk Factors ◽

Over Time

Abstract Background A metaplasia-dysplasia–carcinoma sequence is the most plausible carcinogenic pathway for gallbladder cancer. Although the incidence of gallbladder carcinoma is increasing, little is known about its precancerous lesions. The aim of this study was to determine temporal changes in the prevalence of low-grade dysplasia (LGD), high-grade dysplasia (HGD) and gallbladder adenocarcinoma and associated risk factors. Methods We retrospectively identified consecutive patients who underwent cholecystectomy between January 2011 and March 2020. Patients were grouped according to histology: no dysplasia; LGD; HGD; and adenocarcinoma. Fitted linear models estimated temporal trends in prevalence and mean age for all histological outcomes. Logistic regression estimated associated risk factors. Results A total of 5 835 patients were included in the analysis. The prevalence of LGD was 1.47%, HGD 0.17% and adenocarcinoma 0.19%. Prevalence for all diseases increased over time, and mean age at diagnoses decreased over time. In a multivariate logistic regression model, with no dysplasia as the reference group, female sex increased the odds of LGD (OR 4.57, 95% CI 3.07-10.10, p = <0.0001). BMI was not associated with disease risk. Conclusions Our data suggests the prevalence of precancerous gallbladder lesions are increasing in younger patients. Although a risk factor for cholelithiasis, BMI was not associated with disease progression. If occurring in a dysplasia-carcinoma sequence, mean age of diagnoses suggests a progression period of 20 years. Further research is required to explain both the significant sex disparity and potential environmental risk factors for gallbladder dysplasia.

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Persisting inequalities in birth outcomes related to neighbourhood deprivation

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-213162 ◽

2019 ◽

Vol 74 (3) ◽

pp. 232-239 ◽

Cited By ~ 3

Author(s):

Loes C M Bertens ◽

Lizbeth Burgos Ochoa ◽

Tom Van Ourti ◽

Eric A P Steegers ◽

Jasper V Been

Keyword(s):

The Netherlands ◽

Perinatal Mortality ◽

Birth Outcomes ◽

Premature Birth ◽

Time Trends ◽

Temporal Trends ◽

Neighbourhood Deprivation ◽

Logistic Regression Models ◽

Rate Ratios ◽

Over Time

IntroductionHealth inequalities can be observed in early life as unfavourable birth outcomes. Evidence indicates that neighbourhood socioeconomic circumstances influence health. However, studies looking into temporal trends in inequalities in birth outcomes including neighbourhood socioeconomic conditions are scarce. The aim of this work was to study how inequalities in three different key birth outcomes have changed over time across different strata of neighbourhood deprivation.MethodsNationwide time trends ecological study with area-level deprivation in quintiles as exposure. The study population consisted of registered singleton births in the Netherlands 2003–2017 between 24 and 41 weeks of gestation. Outcomes used were perinatal mortality, premature birth and small for gestational age (SGA). Absolute rates for all birth outcomes were calculated per deprivation quintile. Time trends in birth outcomes were examined using logistic regression models. To investigate relative inequalities, rate ratios for all outcomes were calculated per deprivation quintile.ResultsThe prevalence of all unfavourable birth outcomes decreased over time: from 7.2 to 4.1 per 1000 births for perinatal mortality, from 61.8 to 55.6 for premature birth, and from 121.9 to 109.2 for SGA. Inequalities in all birth outcomes have decreased in absolute terms, and the decline was largest in the most deprived quintile. Time trend analyses confirmed the overall decreasing time trends for all outcomes, which were significantly steeper for the most deprived quintile. In relative terms however, inequalities remained fairly constant.ConclusionIn absolute terms, inequalities in birth outcomes by neighbourhood deprivation in the Netherlands decreased between 2003 and 2017. However, relative inequalities remained persistent.

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Temporal Trends of Infective Endocarditis in Olmsted County, Minnesota between 1970-2018: A Population-Based Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab038 ◽

2021 ◽

Author(s):

Daniel C DeSimone ◽

Brian D Lahr ◽

Nandan S Anavekar ◽

Muhammad R Sohail ◽

Imad M Tleyjeh ◽

...

Keyword(s):

Infective Endocarditis ◽

Temporal Trends ◽

Population Based ◽

Olmsted County ◽

Calendar Time ◽

Coagulase Negative Staphylococci ◽

Significant Difference ◽

Before And After ◽

Prevention Guidelines ◽

Over Time

Abstract Background A population-based study of infective endocarditis (IE) in Olmsted County, Minnesota provides a unique opportunity to define temporal and seasonal variations in IE incidence over an extended time period. Methods Population-based review of all adults (≥18 years) residing in Olmsted County, Minnesota, with definite or possible IE using the Rochester Epidemiology Project from January 1, 1970 through December 31, 2018. Poisson regression was used to characterize the trends in IE incidence; models were fitted with age, sex, calendar time and season, allowing for non-linearity and non-additivity of their effects. Results Overall, 269 cases of IE were identified over a 49-year study period. Median age of IE cases was 67.2 years and 33.8% were females. The overall age- and sex-adjusted incidence of IE was 7.9 cases per 100,000 person-years (95% confidence interval [CI], 7.0 – 8.9), with corresponding rates of 2.4, 2.4, 0.9 and 0.7 per 100,000 person-years for Staphylococcus aureus, viridans group streptococci (VGS), Enterococcus species, and coagulase-negative staphylococci (CoNS) IE, respectively. Temporal trends varied by age, sex and season but on average IE incidence increased over time (P=0.021). Enterococcal IE increased the most (P=0.018), while S. aureus IE appeared to increase but mostly in the winter months (P=0.018). Between 1996 and 2018, the incidence of VGS IE was relatively stable, with no statistically significant difference in the trends before and after the 2007 AHA IE prevention guidelines. Conclusion Overall, IE incidence, and specifically enterococcal IE, increased over time, while S. aureus IE was seasonally dependent. There was no statistically significant difference in VGS IE incidence in the periods before and after publication of the 2007 AHA IE prevention guidelines.

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Probabilistic modelling of effects of antibiotics and calendar time on transmission of healthcare-associated infection

10.1101/2020.04.10.20060384 ◽

2020 ◽

Author(s):

Mirjam Laager ◽

Ben S Cooper ◽

David W Eyre

Keyword(s):

Temporal Trends ◽

Simulated Data ◽

Healthcare Associated Infection ◽

Calendar Time ◽

Transmission Parameters ◽

Number Of Patients ◽

Potential Risk Factors ◽

Healthcare Associated ◽

The Impact ◽

Over Time

AbstractHealthcare-associated infection and antimicrobial resistance are major concerns. However, the extent to which antibiotic exposure affects transmission and detection of infections such as MRSA is unclear. Additionally, temporal trends are typically reported in terms of changes in incidence, rather than analysing underling transmission processes. We present a data-augmented Markov chain Monte Carlo approach for inferring changing transmission parameters over time, screening test sensitivity, and the effect of antibiotics on detection and transmission. We expand a basic model to allow use of typing information when inferring sources of infections. Using simulated data, we show that the algorithms are accurate, well-calibrated and able to identify antibiotic effects in sufficiently large datasets. We apply the models to study MRSA transmission in an intensive care unit in Oxford, UK with 7924 admissions over 10 years. We find that falls in MRSA incidence over time were associated with decreases in both the number of patients admitted to the ICU colonised with MRSA and in transmission rates. In our inference model, the data were not informative about the effect of antibiotics on risk of transmission or acquisition of MRSA, a consequence of the limited number of possible transmission events in the data. Our approach has potential to be applied to a range of healthcare-associated infections and settings and could be applied to study the impact of other potential risk factors for transmission. Evidence generated could be used to direct infection control interventions.

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Temporal Trends in Effect Sizes: Causes, Detection, and Implications

Handbook of Meta-analysis in Ecology and Evolution ◽

10.23943/princeton/9780691137285.003.0015 ◽

2013 ◽

Cited By ~ 3

Author(s):

Julia Koricheva ◽

Michael D. Jennions ◽

Joseph Lau

Keyword(s):

Evolutionary Biology ◽

Meta Analysis ◽

Scientific Evidence ◽

Temporal Trends ◽

Temporal Changes ◽

Effect Sizes ◽

The Social ◽

The Stability ◽

Meta Analyses ◽

Over Time

The general aim of meta-analysis is to combine scientific evidence scattered through a number of individual studies addressing the same topic. Evidence, however, is not static and tends to evolve over time due to changes in research methods, changes in the characteristics of the subjects being studied, for example. A number of recent studies in ecology and evolution have shown that temporal trends in effect sizes are common and often quite dramatic in these fields. Temporal changes in effect sizes could jeopardize the stability of conclusions (i.e., the conclusions of meta-analyses on the same topic conducted in different years might differ). For these reasons, this chapter is devoted to temporal changes in effect sizes. It first summarizes the findings of studies that examined temporal changes in the magnitude and direction of effect sizes in ecology, evolutionary biology, medicine, and the social sciences. It then discusses their possible causes, methods of detection, and implications for the interpretation of the results of the meta-analysis.

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Temporal Changes in the Quality of Acute Stroke Care in Five National Audits across Europe

BioMed Research International ◽

10.1155/2015/432497 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Steffi Hillmann ◽

Silke Wiedmann ◽

Alec Fraser ◽

Juan Baeza ◽

Anthony Rudd ◽

...

Keyword(s):

Quality Indicators ◽

General Trend ◽

Fold Increase ◽

Stroke Care ◽

Temporal Changes ◽

Specific Measure ◽

Acute Stroke Care ◽

Over Time ◽

Care Performance

Background.Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years.Methods.Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time.Results.Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004.Conclusions.A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care.

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A246 THE GLOBAL INCIDENCE OF ACUTE PANCREATITIS IS INCREASING OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.244 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 304-306

Author(s):

J Iannuzzi ◽

J H Leong ◽

J Quan ◽

J A King ◽

J W Windsor ◽

...

Keyword(s):

Acute Pancreatitis ◽

Data Extraction ◽

Meta Analysis ◽

Temporal Trends ◽

Western World ◽

Common Disease ◽

Biliary Disease ◽

Comprehensive Overview ◽

Annual Percent Change ◽

Over Time

Abstract Background Acute pancreatitis is a common disease with significant associated morbidity and mortality. Historically, acute pancreatitis has been considered a disease with multiple etiologies and risk factors but is driven by alcohol and biliary disease. Multiple studies have shown that the incidence of acute pancreatitis is increasing globally among both adults and children. Aims The purpose of this study was to assess temporal trends in incidence of acute pancreatitis globally. Methods We performed a systematic literature search to identify population-based studies reporting the annual incidence of acute pancreatitis. Abstracts were independently assessed in duplicate to identify applicable papers for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). The AAPCs were pooled in a meta-analysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map to illustrate global differences. Results Forty-five studies reported the temporal incidence of acute pancreatitis (static map provided, online interactive map: https://kaplan-acute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC = 2.89%; 95% CI: 2.26, 3.52; n=41). Increasing incidence was observed in North America (AAPC = 2.71%; 95% CI: 1.93, 3.50; n=10) and Europe (AAPC = 2.79%; 95% CI: 1.95, 3.63; n=24). The incidence of acute pancreatitis was stable in Asia (AAPC = −0.28%; 95% CI: −5.03, 4.47; n=2). Conclusions This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last five decades and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa and Latin America. Funding Agencies None

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Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003–2015

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02124-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Helen Sjöland ◽

Jonas Silverdal ◽

Entela Bollano ◽

Aldina Pivodic ◽

Ulf Dahlström ◽

...

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Temporal Trends ◽

Physical Symptoms ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Continuous Change ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

Over Time

Abstract Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003–2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003–2007 (Period 1, n = 2029), 2008–2011 (Period 2, n = 3363), 2012–2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype.

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FGF23, a novel muscle biomarker detected in the early stages of ALS

Scientific Reports ◽

10.1038/s41598-021-91496-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ying Si ◽

Mohamed Kazamel ◽

Michael Benatar ◽

Joanne Wuu ◽

Yuri Kwon ◽

...

Keyword(s):

Biomarker Discovery ◽

Clinical Symptoms ◽

Early Stage ◽

Fold Increase ◽

Progressive Increase ◽

Molecular Signature ◽

Muscle Membrane ◽

Sequencing Project ◽

Progressive Muscle Weakness ◽

End Stage

AbstractAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive muscle weakness. Skeletal muscle is a prime source for biomarker discovery since it is one of the earliest sites to manifest disease pathology. From a prior RNA sequencing project, we identified FGF23 as a potential muscle biomarker in ALS. Here, we validate this finding with a large collection of ALS muscle samples and found a 13-fold increase over normal controls. FGF23 was also increased in the SOD1G93A mouse, beginning at a very early stage and well before the onset of clinical symptoms. FGF23 levels progressively increased through end-stage in the mouse. Immunohistochemistry of ALS muscle showed prominent FGF23 immunoreactivity in the endomysial connective tissue and along the muscle membrane and was significantly higher around grouped atrophic fibers compared to non-atrophic fibers. ELISA of plasma samples from the SOD1G93A mouse showed an increase in FGF23 at end-stage whereas no increase was detected in a large cohort of ALS patients. In conclusion, FGF23 is a novel muscle biomarker in ALS and joins a molecular signature that emerges in very early preclinical stages. The early appearance of FGF23 and its progressive increase with disease progression offers a new direction for exploring the molecular basis and response to the underlying pathology of ALS.

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