scholarly journals Scottish Index of Multiple Deprivation (SIMD) Indicators as Predictors of Mortality Among Patients Hospitalised with COVID-19 Disease in the Lothian Region, Scotland During the First Wave: A Cohort Study

2021 ◽  
Author(s):  
Marcello S Scopazzini ◽  
Roo Nicola Rose Cave ◽  
Callum P Mutch ◽  
Daniella A Ross ◽  
Anda Bularga ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Multiple Deprivation ◽  
Multiple Risk Factors ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Uk ◽  
Index Of Multiple Deprivation ◽  
Age And Sex

Abstract Background: Sars-CoV-2, the causative agent of COVID-19, has led to more than 100,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which indicators of Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. Methods: This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and more specifically 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Univariable and multivariable logistic regression analyses adjusted for age and sex were used to determine measures of association between exposures of interest and the primary outcome. Results: After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p=0.053 and OR 2.17, CI 1.22-3.86, p=0.009, respectively), but this association was not significant in our multivariable model adjusted for co-morbidities and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p=0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p=0.002)). Conclusions: In contrast to other studies, deprivation quintile distribution was not predictive of mortality in our cohort. This possibly reflects the greater affluence and ethnic homogeneity of the Lothian Region compared to the rest of Scotland. We identified an increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, specific indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.

scholarly journals Impact of ToxigenicClostridium difficileColonization on the Risk of SubsequentC. difficileInfection in Intensive Care Unit Patients

2015 ◽  
Vol 36 (11) ◽  
pp. 1324-1329 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Karen C. Carroll ◽  
Pranita D. Tamma ◽  
Madeleine L. Sudekum ◽  
Reno Frei ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Relative Risk ◽  
Independent Risk Factor ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Johns Hopkins Hospital ◽  
Increased Risk ◽  
Colonization Rates

BACKGROUNDClostridium difficileinfection (CDI) in hospitalized patients is generally attributed to the current stay, but recent studies reveal highC. difficilecolonization rates on admission.OBJECTIVETo determine the rate of colonization with toxigenicC. difficileamong intensive care unit patients upon admission as well as acquired during hospitalization, and the risk of subsequent CDI.METHODSProspective cohort study from April 15 through July 8, 2013. Adults admitted to an intensive care unit within 48 hours of admission to the Johns Hopkins Hospital, Baltimore, Maryland, were screened for colonization with toxigenicC. difficile. The primary outcome was risk of developing CDI.RESULTSAmong 542 patients, 17 (3.1%) were colonized with toxigenicC. difficileon admission and an additional 3 patients were found to be colonized during hospitalization. Both colonization with toxigenicC. difficileon admission and colonization during hospitalization were associated with an increased risk for development of CDI (relative risk, 10.29 [95% CI, 2.24–47.40],P=.003; and 15.66 [4.01–61.08],P<.001, respectively). Using multivariable analysis, colonization on admission and colonization during hospitalization were independent predictors of CDI (relative risk, 8.62 [95% CI, 1.48–50.25],P=.017; and 10.93 [1.49–80.20],P=.019, respectively), while adjusting for potential confounders.CONCLUSIONSIn intensive care unit patients, colonization with toxigenicC. difficileis an independent risk factor for development of subsequent CDI. Further studies are needed to identify populations with higher toxigenicC. difficilecolonization rates possibly benefiting from screening or avoidance of agents known to promote CDI.Infect. Control Hosp. Epidemiol.2015;36(11):1324–1329

scholarly journals P401 Risk of severe COVID-19 outcomes associated with inflammatory bowel disease medications: Reassuring insights from the United Kingdom PREPARE-IBD multicentre cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S409-S410
Author(s):  
C A Lamb ◽  
S Sebastian ◽  
A J Kent ◽  
J P Segal ◽  
H A Gonzalez ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
United Kingdom ◽  
Bowel Disease ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
British Society ◽  
The United Kingdom ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background During the early COVID-19 pandemic, the British Society of Gastroenterology (BSG) developed a risk stratification grid to inform the United Kingdom (UK) government regarding strict social isolation, termed “shielding”. This advised inflammatory bowel disease (IBD) patients thought to be most clinically vulnerable to SARS-CoV-2 infection or severe COVID-19 outcomes, to stay at home and minimize face to face contact, even with household members. Those considered at highest risk included recent commencement of combination biologic and immunomodulator therapy, prednisolone ≥20mg/day, presence of comorbidities, age ≥70 years or clinically active disease in those receiving immunosuppression. Mesalazine was not considered to increase risk. An acknowledged limitation was an absence of COVID-19 risk data. This study sought to identify patient or IBD medication-related factors associated with severe outcomes from COVID-19. Methods PREPARE-IBD was a multi-centre observational United Kingdom (UK) cohort study including adult IBD patients (≥18 years) diagnosed with COVID-19 by PCR between 1st March 2020 and 31st August 2020. The primary outcome was severe COVID-19 defined as requirement for intensive care admission, invasive ventilation or death. We tested associations of severe outcomes with medications and other covariates using multiple logistic regression. Results 211 patients were included from 60 UK centres. 56 of 211 patients (26.5%) met the primary outcome. Severe COVID-19 was more common in ulcerative colitis relative to Crohn’s disease patients (33.9% [37/109] vs. 18.6% [16/86], p=0.018). Shortness of breath, nausea and vomiting were more common with severe COVID-19 (p&lt;0.001 and p=0.023 respectively). Multivariable analysis identified co-morbidities and age as associated with severe COVID-19 outcomes; odds ratio (OR [95% CI]) 1.68 (1.23-2.35) for each co-morbidity, and an OR 1.03 (1.00-1.05) with each successive year of age. Neither clinically active IBD (OR 0.58 [0.26-1.26]), non-white ethnicity (OR 1.98 [0.92-4.28]), nor prednisolone use (OR 2.42 [0.47-11.26]) were associated with increased risk. On multivariable analysis, mesalazine was associated with severe COVID-19 outcomes (OR 2.03 [1.01-4.12]). Univariable analysis identified biologics and thiopurines as protective (OR 0.38 [0.15-0.87] and 0.32 [0.092-0.86] respectively). On multivariable analysis no association of severe COVID-19 outcomes with thiopurine or biologic exposure was seen. Conclusion Our data provide reassurance for the continued evidence-based use of corticosteroids, immunomodulators and biologic therapies in IBD during the ongoing COVID-19 pandemic, and is consistent with an as yet unexplained association between mesalazine use and severe COVID-19 outcomes.

scholarly journals P094 Incidence of clinically diagnosed Paget’s disease of bone: evidence of a continuing decline

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Michael J Cook ◽  
Stephen R Pye ◽  
William G Dixon ◽  
Terence W O'Neill
Keyword(s):  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
Crude Incidence ◽  
Multiple Deprivation ◽  
The Uk ◽  
Incident Cases ◽  
Index Of Multiple Deprivation ◽  
Age And Sex

Abstract Background/Aims  Evidence from the UK suggest that the incidence of Paget's disease of bone declined during the latter half of the last century with a decline also in the incidence of clinically apparent disease. We aimed to characterise the recent incidence of clinically diagnosed Paget’s disease of bone in the UK by age and sex among those aged &gt;18 years and, to determine whether the incidence has changed from 1999-2015. Methods  Incident cases of Paget’s disease during 1999-2015 were identified from the first recorded diagnostic code for Paget’s disease in the UK Clinical Practice Research Datalink (CPRD) database. Crude incidence was calculated for each year from 1999 to 2015 and, to account for changes in the distribution of age and sex over time within the CPRD, direct age- and sex-standardised incidence rates were calculated for each year. This was done by multiplying the crude incidence in each age-sex stratum by the age-sex stratum weight of the 1999 population of those at risk of developing Paget’s disease. We looked also at the incidence of disease by quintile of index of multiple deprivation and geographic region. Using Poisson regression, we looked at the influence of deprivation and geography on occurrence of the disease after adjustment for age and sex. Results  In total 3,592 incident cases of Paget’s disease were identified between 1999 and 2015. Overall the incidence increased with age and at all ages was greater in men than women. In men, and women, respectively, incidence increased from 0.074 and 0.037 per 10,000 per year at the age of 45-49 years to 6.3 and 3.7 per 10,000 per year at age of 85 years and older. When stratified by year, the age- and sex-standardised incidence fell from 0.75/10,000 person years in 1999 to 0.20/10,000 person years in 2015. Crude incidence (1999-2015) was slightly higher in those living in the most deprived areas (0.53/10,000 person years) compared to those in least deprived areas (0.43/10,000 person years). After adjustment for age and sex, compared to those in the highest quintile of index of multiple deprivation, those in the lowest quintile of index of multiple deprivation had over a 30% increased risk of disease. There was evidence also of geographic variation in the occurrence of disease with the highest incidence in the North West of England. Conclusion  The incidence of clinically diagnosed Paget’s disease has continued to decrease since 1999. The reason for the decline remains unknown, though the rapidity of change points to an alteration in one or more environmental determinants. Disclosure  M.J. Cook: None. S.R. Pye: None. W.G. Dixon: None. T.W. O'Neill: None.

scholarly journals Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study

BMJ ◽  
2021 ◽  
pp. n579
Author(s):  
Robert Challen ◽  
Ellen Brooks-Pollock ◽  
Jonathan M Read ◽  
Louise Dyson ◽  
Krasimira Tsaneva-Atanasova ◽  
...  
Keyword(s):  
Cohort Study ◽  
Capacity Planning ◽  
Matched Cohort ◽  
Community Based ◽  
Matched Cohort Study ◽  
Risk Of Mortality ◽  
New Variant ◽  
Proxy Measure ◽  
The Uk ◽  
Index Of Multiple Deprivation

Abstract Objective To establish whether there is any change in mortality from infection with a new variant of SARS-CoV-2, designated a variant of concern (VOC-202012/1) in December 2020, compared with circulating SARS-CoV-2 variants. Design Matched cohort study. Setting Community based (pillar 2) covid-19 testing centres in the UK using the TaqPath assay (a proxy measure of VOC-202012/1 infection). Participants 54 906 matched pairs of participants who tested positive for SARS-CoV-2 in pillar 2 between 1 October 2020 and 29 January 2021, followed-up until 12 February 2021. Participants were matched on age, sex, ethnicity, index of multiple deprivation, lower tier local authority region, and sample date of positive specimens, and differed only by detectability of the spike protein gene using the TaqPath assay. Main outcome measure Death within 28 days of the first positive SARS-CoV-2 test result. Results The mortality hazard ratio associated with infection with VOC-202012/1 compared with infection with previously circulating variants was 1.64 (95% confidence interval 1.32 to 2.04) in patients who tested positive for covid-19 in the community. In this comparatively low risk group, this represents an increase in deaths from 2.5 to 4.1 per 1000 detected cases. Conclusions The probability that the risk of mortality is increased by infection with VOC-202012/01 is high. If this finding is generalisable to other populations, infection with VOC-202012/1 has the potential to cause substantial additional mortality compared with previously circulating variants. Healthcare capacity planning and national and international control policies are all impacted by this finding, with increased mortality lending weight to the argument that further coordinated and stringent measures are justified to reduce deaths from SARS-CoV-2.

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

scholarly journals Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

2021 ◽  
Vol 10 (10) ◽  
pp. 2151
Author(s):  
Rita Pavasini ◽  
Matteo Tebaldi ◽  
Giulia Bugani ◽  
Elisabetta Tonet ◽  
Roberta Campana ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Pooled Analysis ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Short Term Mortality

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

scholarly journals Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Inns ◽  
Kate M. Fleming ◽  
Miren Iturriza-Gomara ◽  
Daniel Hungerford
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Coeliac Disease ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Rotavirus Vaccine ◽  
Rotavirus Vaccination ◽  
Increased Risk ◽  
The Uk

Abstract Background Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. Methods A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. Results There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86–1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68–1.19). Conclusions Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.

scholarly journals Association between Dementia and Clinical Outcome after COVID-19: A Nationwide Cohort Study with Propensity Score Matched Control in South Korea

2021 ◽  
Vol 18 (6) ◽  
pp. 523-529
Author(s):  
Sheng-Min Wang ◽  
See Hyun Park ◽  
Nak-Young Kim ◽  
Dong Woo Kang ◽  
Hae-Ran Na ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Propensity Score ◽  
Odds Ratio ◽  
Matched Control ◽  
Multivariable Analysis ◽  
Ventilatory Support ◽  
Group Pair ◽  
Risk Of Mortality ◽  
High Prevalence

Objective Despite a high prevalence of dementia in older adults hospitalized with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), or so called COVID-19, research investigating association between preexisting diagnoses of dementia and prognosis of COVID-19 is scarce. We aimed to investigate treatment outcome of patients with dementia after COVID-19. Methods We explored a nationwide cohort with a total of 2,800 subjects older than 50 years who were diagnosed with COVID-19 between January and April 2020. Among them, 223 patients had underlying dementia (dementia group). We matched 1:1 for each dementia- non-dementia group pair yielding 223 patients without dementia (no dementia group) using propensity score matching. Results Mortality rate after COVID-19 was higher in dementia group than in no dementia group (33.6% vs. 20.2%, p=0.002). Dementia group had higher proportion of patients requiring invasive ventilatory support than no dementia group (34.1% vs. 22.0%, p=0.006). Multivariable analysis showed that dementia group had a higher risk of mortality than no dementia group (odds ratio=3.05, p<0.001). We also found that patients in dementia group had a higher risk of needing invasive ventilatory support than those in no dementia group. Conclusion Our results suggest that system including strengthen quarantines are required for patients with dementia during the COVID- 19 pandemic.

scholarly journals Mortality, causes of death and influence of medication use in patients with systemic lupus erythematosus vs matched controls

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 207-216
Author(s):  
Irene E M Bultink ◽  
Frank de Vries ◽  
Ronald F van Vollenhoven ◽  
Arief Lalmohamed
Keyword(s):  
Mortality Rate ◽  
Lupus Erythematosus ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
Age And Sex

Abstract Objectives We wanted to estimate the magnitude of the risk from all-cause, cause-specific and sex-specific mortality in patients with SLE and relative risks compared with matched controls and to evaluate the influence of exposure to medication on risk of mortality in SLE. Methods We conducted a population-based cohort study using the Clinical Practice Research Datalink, Hospital Episode Statistics and national death certificates (from 1987 to 2012). Each SLE patient (n = 4343) was matched with up to six controls (n = 21 780) by age and sex. Cox proportional hazards models were used to estimate overall and cause-specific mortality rate ratios. Results Patients with SLE had a 1.8-fold increased mortality rate for all-cause mortality compared with age- and sex-matched subjects [adjusted hazard ratio (HR) = 1.80, 95% CI: 1.57, 2.08]. The HR was highest in patients aged 18–39 years (adjusted HR = 4.87, 95% CI: 1.93, 12.3). Mortality rates were not significantly different between male and female patients. Cumulative glucocorticoid use raised the mortality rate, whereas the HR was reduced by 45% with cumulative low-dose HCQ use. Patients with SLE had increased cause-specific mortality rates for cardiovascular disease, infections, non-infectious respiratory disease and for death attributable to accidents or suicide, whereas the mortality rate for cancer was reduced in comparison to controls. Conclusion British patients with SLE had a 1.8-fold increased mortality rate compared with the general population. Glucocorticoid use and being diagnosed at a younger age were associated with an increased risk of mortality. HCQ use significantly reduced the mortality rate, but this association was found only in the lowest cumulative dosage exposure group.

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