scholarly journals British surname origins, population structure and health outcomes – an observational study of English hospital records

2021 ◽  
Author(s):  
Jakob Petersen ◽  
Jens Kandt ◽  
Paul Longley
Keyword(s):  
Population Structure ◽  
Health Outcomes ◽  
Hospital Admissions ◽  
Reference Group ◽  
Gastrointestinal Disorders ◽  
Area Deprivation ◽  
Data Mining Approach ◽  
Jaw Fractures ◽  
Upper Gastrointestinal ◽  
Age And Sex

Abstract BackgroundPopulation and social structure act as important confounders on pathways linking genotypes to health outcomes. This study examines whether the historical, geographical origins of British surnames – as markers of population structure - are associated with differential health outcomes today. MethodsWe coded the hospital admissions of more than 30 million patients in England between 1999 and 2013 to their surname origin and divided their diagnoses into 125 major disease categories. A base population dataset was constructed with patients’ first admission of any kind. Age- and sex-standardised odds ratios were calculated with logistic regression using patients with ubiquitous English surnames such as “Smith” as reference. Using a data mining approach, we scanned the results for “signals”, where a branch of related surname origins all had significantly higher or lower risk than the reference group. We subsequently studied the age- and sex-standardised incidence for each signal across the density of the surname origin (quintiles) as well as quintiles of area deprivation. ResultsWe identified a signal with Scottish surnames (alcohol-related disorders) and three with different branches of English surnames (disorders of teeth and jaw, fractures, upper gastrointestinal disorders). For the three English surname groups, the risk was only different to patients with other surnames in the quintile with the highest density of that group. Differential risk remained when studied across quintiles of area deprivation. ConclusionsThe study shows that surname origins are associated with diverse health outcomes and may thus act as combined markers of population structure over and above area deprivation.

The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015

Endoscopy ◽  
2021 ◽  
Author(s):  
James Rees ◽  
Felicity Evison ◽  
Jemma Mytton ◽  
Prashant Patel ◽  
Nigel Trudgill
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Key Management ◽  
Hospital Admissions ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Emergency Admissions ◽  
Co Morbidity ◽  
Standardized Mortality Rate ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported. Methods This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality. Results 242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 – 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; P < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 – 0.80; P < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 – 0.87; P < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 – 3.04; P < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 – 6.94; P < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 – 2.18; P < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 – 1.23; P < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 – 1353.8] per 100 000 men in 2003). Conclusions Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.

scholarly journals Pulmonary embolism during the COVID-19 pandemic

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
BV Silva ◽  
T Rodrigues ◽  
N Cunha ◽  
J Brito ◽  
P Alves Da Silva ◽  
...  
Keyword(s):  
Physical Activity ◽  
Pulmonary Embolism ◽  
Hospital Admissions ◽  
Reference Group ◽  
Group Versus ◽  
Pulmonary Angiography ◽  
Reference Period ◽  
Funding Sources ◽  
Clinical Probability

Abstract Funding Acknowledgements Type of funding sources: None. Background During the COVID-19 pandemic many countries have imposed lockdown restrictions to movement. Since the 18th of March in Portugal, thousands of people have been confined to their homes. While hospital admissions for COVID-19 patients increased exponentially, admissions for non-COVID-19 patients decreased dramatically. However, it remains unclear whether lockdown-related immobility can contribute to the increased incidence of pulmonary embolism. Purpose To compare the incidence of pulmonary embolism (PE) during the lockdown period (Abril 1 to May 31, 2020) compared to the reference period in 2019. Methods Retrospective study of consecutive outpatients who presented to the emergency department and underwent computed tomography pulmonary angiography (CTPA) due to suspicion of PE. Results Compared to the same period of 2019, the lockdown period was associated with a significant increase in PE diagnosis (29 versus 18 patients). PE patients during lockdown were older (median age 71 years; interquartile range [IQR][60-85] versus 59 years [44-76]; p = 0.046) and have lower prevalence of active cancer (14% versus 33% in the reference period). Women represent 55% (n = 16) of patients in lockdown group (versus 50% in 2019 group). Clinical probability (GENEVA score) was similar in both groups (median score 2.72 in lockdown group and 2.50 in reference group, p = 0.452). None of the patients with PE was diagnosed with COVID-19. Conclusion We have observed a marked increase (62%) in PE diagnosis during lockdown period compared to the reference period, which can be explained by the reduction in physical activity due to teleworking and closure of gyms and sports activities. These data reinforce the importance of promoting physical activity programs at home. The role of pharmacological or mechanical thromboprophylaxis in this scenario remains unclear.

scholarly journals Cross-border mobility in European countries: associations between cross-border worker status and health outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucas Nonnenmacher ◽  
Michèle Baumann ◽  
Etienne le Bihan ◽  
Philippe Askenazy ◽  
Louis Chauvel
Keyword(s):  
European Union ◽  
Health Outcomes ◽  
Chronic Diseases ◽  
Reference Group ◽  
Labour Force ◽  
High Risk Population ◽  
The European Union ◽  
Health Index ◽  
Cross Sectional Survey ◽  
Cross Border

Abstract Background Mobility of workers living in one country and working in a different country has increased in the European Union. Exposed to commuting factors, cross-border workers (CBWs) constitute a potential high-risk population. But the relationships between health and commuting abroad are under-documented. Our aims were to: (1) measure the prevalence of the perceived health status and the physical health outcomes (activity limitation, chronic diseases, disability and no leisure activities), (2) analyse their associations with commuting status as well as (3) with income and health index among CBWs. Methods Based on the ‘Enquête Emploi’, the French cross-sectional survey segment of the European Labour Force Survey (EU LFS), the population was composed of 2,546,802 workers. Inclusion criteria for the samples were aged between 20 and 60 years and living in the French cross-border departments of Germany, Belgium, Switzerland and Luxembourg. The Health Index is an additional measure obtained with five health variables. A logistic model was used to estimate the odds ratios of each group of CBWs, taking non-cross border workers (NCBWs) as the reference group, controlling by demographic background and labour status variables. Results A sample of 22,828 observations (2456 CBWs vs. 20,372 NCBWs) was retained. The CBW status is negatively associated with chronic diseases and disability. A marginal improvement of the health index is correlated with a wage premium for both NCBWs and CBWs. Commuters to Luxembourg have the best health outcomes, whereas commuters to Germany the worst. Conclusion CBWs are healthier and have more income. Interpretations suggest (1) a healthy cross-border phenomenon steming from a social selection and a positive association between income and the health index is confirmed; (2) the existence of major health disparities among CBWs; and (3) the rejection of the spillover phenomenon assumption for CBWs. The newly founded European Labour Authority (ELA) should take into account health policies as a promising way to support the cross-border mobility within the European Union.

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

scholarly journals Genetic Variants in PTGS1 and NOS3 Genes Increase the Risk of Upper Gastrointestinal Bleeding: A Case–Control Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Marcela Forgerini ◽  
Gustavo Urbano ◽  
Tales Rubens de Nadai ◽  
Sabrina Setembre Batah ◽  
Alexandre Todorovic Fabro ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastrointestinal Bleeding ◽  
Genetic Variants ◽  
Case Control Study ◽  
Upper Gastrointestinal Bleeding ◽  
Case Control ◽  
Gastrointestinal Disorders ◽  
Increased Risk ◽  
Upper Gastrointestinal ◽  
Control Study

Objective: To assess the association between PTGS1 and NOS3 variant alleles and the risk to develop upper gastrointestinal bleeding (UGIB) secondary to complicated peptic disease.Methods: A case–control study was conducted in a Brazilian complex hospital from July 2016 to March 2020. Case: Patients with UGIB diagnosis. Control: Patients admitted for surgery not related to gastrointestinal disorders. Variables: UGIB (outcome), genetic variants in PTGS1 and NOS3 genes (independent), and sex, age, schooling, ethnicity, previous history of gastrointestinal disorders, Helicobacter pylori serology, comorbidity, drug therapy, and lifestyle (confounding). The single-nucleotide polymorphisms (SNPs) of the PTSG1 gene (rs1330344, rs3842787, rs10306114, and rs5788) and NOS3 gene (rs2070744 and rs1799983) were determined using the real-time polymerase chain reaction. Helicobacter pylori serology was determined through the chemiluminescence technique. Logistic regression models were built and deviations of allelic frequencies from Hardy–Weinberg equilibrium were verified.Results: 200 cases and 706 controls were recruited. Carriers of the AG genotype of rs10306114 (OR: 2.55, CI 95%: 1.13–5.76) and CA + AA genotypes of rs5788 (OR: 2.53, CI 95%: 1.14–5.59) were associated with an increased risk for the UGIB development. In nonsteroidal anti-inflammatory drugs (NSAIDs) users, the six variants evaluated modified the magnitude of the risk of UGIB, whereas in low-dose aspirin (LDA) users, an increased risk of UGIB was observed for four of them (rs1330344, rs10306114, rs2070744, and rs1799983). Personal ulcer history (p-value: &lt; 0.001); Helicobacter pylori infection (p-value: &lt; 0.011); NSAIDs, LDA, and oral anticoagulant use (p-value: &lt; 0.001); and alcohol intake (p-value: &lt; 0.001) were also identified as independent risk factors for UGIB.Conclusion: This study presents two unprecedented analyses within the scope of the UGIB (rs10306114 and rs2070744), and our findings showing an increased risk of UGIB in the presence of the genetic variants rs10306114 and rs5788, regardless of the drug exposure. Besides, the presence of the evaluated variants might modify the magnitude of the risk of UGIB in LDA/NSAIDs users. Therefore, our data suggest the need for a personalized therapy and drug use monitoring in order to promote patient safety.

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