scholarly journals Patient Characteristics Associated with Different Types of Prison TB: An Epidemiological Analysis of 921 TB Cases Diagnosed at an Ethiopian Prison

2021 ◽  
Author(s):  
Asmah Amirkhani ◽  
Maheen Humayun ◽  
Wen Ye ◽  
Yoseph Worku ◽  
Zhenhua Yang
Keyword(s):  
General Population ◽  
Patient Characteristics ◽  
World Health ◽  
Control Treatment ◽  
Pulmonary Tb ◽  
Hiv Coinfection ◽  
Increased Risk ◽  
Different Types ◽  
Extra Pulmonary ◽  
Over Time

Abstract Background: Despite incarcerated population being at an increased risk of tuberculosis (TB) and serving as a potential source of TB transmission for the general population, prison TB remains understudied. Given its adverse impact on progress towards TB elimination, World Health Organization (WHO) has identified prison TB research as a top priority to guide TB treatment/control interventions. Methods: We retrospectively analyzed 921 notified TB cases that were diagnosed at Kality Federal Prison, Ethiopia during 2009-2017. To assess trends of microbiologically confirmed pulmonary TB (PTB), extra-pulmonary TB (EPTB), and TB-HIV co-infection, an ecological analysis of aggregated cases was used to report trends over time. Additionally, we used multivariable log binomial regression to identify patient characteristics associated with microbiologically confirmed PTB, extra-pulmonary TB (EPTB), and TB-HIV co-infection. Results: Microbiologically confirmed PTB proportion increased over time. Young age was identified as an important risk factor for EPTB (aPR=1.74, 95%CI: 0.97, 3.13) while HIV coinfection was negatively associated with EPTB (aPR=0.73, 95%CI: 0.55, 0.97). While previous TB history was associated with a lower likelihood of EPTB (aPR=0.42, 95%CI:0.25, 0.70), it was associated with an increased risk of TB-HIV coinfection (aPR=1.37, 95%CI:1.10, 1.71). Clinically diagnosed PTB patients were more likely to have TB-HIV coinfection compared to microbiologically confirmed PTB patients (aPR= 1.32, 95%CI: 1.02, 1.72).Conclusions: Increasing proportion of microbiologically confirmed PTB may suggest delayed access to treatment, severe disease and increased risk of intramural transmission. Associations with clinical/demographic factors varied for different types of TB and were not always consistent with what has been previously reported for the general population, necessitating the need to refocus prison TB control/treatment strategies based on context specific epidemiological factors.

scholarly journals Role of the Media in Health-Related Awareness Campaigns on Perceptions of COVID-19: A Pre-Post Study in the General Population of Pakistan

2020 ◽  
Author(s):  
Atta Ur Rehman ◽  
Rubeena Zakar ◽  
Muhammaz Zakria Zakar ◽  
Ume Hani ◽  
Florian Fischer
Keyword(s):  
Public Health ◽  
General Population ◽  
World Health ◽  
Health Awareness ◽  
Awareness Campaigns ◽  
First Case ◽  
The Media ◽  
Knowledge Gains ◽  
Over Time

Abstract Background: In January 2020, the World Health Organization declared the COVID-19 outbreak a global public health emergency. Medical preparedness and community education are the most valuable preventive tools for combatting this pandemic. The objective of this study was to assess the role of media public health awareness campaigns on the knowledge of the general population about COVID-19 in Rawalpindi, Pakistan.Methods: A quantitative study using a pre-post design among 384 respondents was conducted. To recruit study participants, a systematic random sampling technique was used. A structured questionnaire was administered to the participants twice: The first response (t1) from participants was filled in during the first week in February 2020 before any confirmed cases were reported in the country, and the second response (t2) was completed one month after the first case detection in Pakistan (March 2020). Media health awareness campaigns were launched just after the detection of the first case in Pakistan. Data was analysed by computing descriptive statistics and paired t-tests to measure the level of association between variables.Results: Exposure to the media and knowledge relating to COVID-19, particularly its symptoms and frequent handwashing as a preventive measure, increased over time. Whereas only a quarter of respondents judged the isolation of suspected cases in quarantine to be important to prevent the spread of infection in society at t1, more than half did so at t2. The same increase was visible in relation to the statement that a lockdown helps to follow social distancing. Socio-demographic characteristics were not significantly associated with knowledge (gains). However, more frequent use of electronic media is associated with greater knowledge gains from t1 to t2.Conclusions: The findings of this study provide evidence that awareness and knowledge related to COVID-19 symptoms and preventive measures increased significantly over time. The increased frequency of following the media indicates that health awareness campaigns are important for enhancing the knowledge of the general public regarding COVID-19.

Longitudinal changes in anthropometric measures and new-onset atrial fibrillation among men and women from general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Lu ◽  
S Geurts ◽  
M.J Tilly ◽  
M.A Ikram ◽  
B Arshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
General Population ◽  
Community Dwelling ◽  
Anthropometric Measures ◽  
Men And Women ◽  
Longitudinal Changes ◽  
Increased Risk ◽  
Over Time ◽  
New Onset

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia of clinical significance. Recent evidence suggests differences in epidemiology and risk factors of AF between women and men. Obesity and body size are established risk factors for AF. However, anthropometric measures tend to change over time. Few studies have investigated the impact of longitudinal changes in anthropometric measures on incident AF among men and women. Purpose To assess the association between longitudinal changes in different anthropometric measures and new-onset AF among community-dwelling men and women. Methods Among 12,848 participants free of AF at baseline were included in this large prospective population-based cohort study, each anthropometric measure was measured at least once and up to five times. Anthropometric measures included weight, height, waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). Anthropometric measures were standardized for direct comparisons. Joint models were used to assess the association of each anthropometric factor and their longitudinal changes with incident AF. Models were adjusted for age and traditional cardiovascular risk factors. Results A total of 5,266 men and 7,218 women (mean age 63.87 years for men and 64.94 years for women) were followed up for a median of 10.5 years. AF occurred in 630 (12.0%) men and 692 (8.7%) women. Longitudinal increases in weight, height, WC, HC and BMI increased the risk for new-onset AF in a linear manner. The age-adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.38 (1.26–1.51) for weight, 1.41 (1.26–1.59) for height, 1.26 (1.13–1.41) for WC, 1.36 (1.19–1.55) for HC and 1.22 (1.11–1.35) for BMI among men. Among women, the age-adjusted HRs (95% CI) were 1.41 (1.30–1.52) for weight, 1.21 (1.07–1.38) for height, 1.39 (1.27–1.52) for WC, 1.29 (1.19–1.40) for HC and 1.28 (1.19–1.37) for BMI. Further, longitudinal increase in WHR was significantly associated with increased risk of AF in women [HR (95% CI): 1.42 (1.21–1.66)] but not in men [HR (95% CI): 1.11 (0.96–1.30)]. Conclusions Longitudinal changes in anthropometric measures were associated with the increased risk for new-onset AF among men and women in the general population. An increase in measures of central obesity over time showed a stronger association with incident AF among women, compared to men. Our findings underscore the importance of a sex-specific approach for screening and monitoring of anthropometric measures for AF prevention. Main results among men and women Funding Acknowledgement Type of funding source: None

scholarly journals Prevalence of coexisting autoimmune thyroidal diseases in coeliac disease is decreasing

2020 ◽  
Vol 8 (2) ◽  
pp. 148-156 ◽  
Author(s):  
Patricia Dominguez Castro ◽  
Grace Harkin ◽  
Mary Hussey ◽  
Brian Christopher ◽  
Clifford Kiat ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
General Population ◽  
Autoimmune Diseases ◽  
Coeliac Disease ◽  
Immune Mediated ◽  
Population Type ◽  
Increased Risk ◽  
General Populations ◽  
Over Time

Background Coeliac disease (CD) is associated with an increased risk of other immune-mediated conditions. Aim: To investigate the prevalence of coexistent immune-mediated diseases in CD patients, and changes in the prevalence of autoimmune thyroidal diseases over the last 50 years. Methods Medical record data were collected retrospectively from 749 CD patients in Ireland. Prevalence of autoimmune diseases was compared with previously published results from general populations. Patients were divided into four groups based on the year of diagnosis to analyse changes in the prevalence of autoimmune thyroidal disease over time. Results Median age at the time of CD diagnosis was 56 years (range 18–91 years). A total of 233 (31.1%) patients had a coexistent immune-mediated condition (IMC). Autoimmune thyroidal diseases were seen in 149 (19.9%) patients, hypothyroidism in 110 (14.7%), type 1 diabetes in 27 (3.6%), psoriasis in 20 (2.7%), inflammatory bowel disease in 14 (1.9%) and rheumatoid arthritis in 12 (1.6%). All conditions were more common in CD patients than in the general population. Type 1 diabetes was diagnosed mainly before CD, whereas there was no such trend in other conditions. Autoimmune thyroidal diseases became less common in female CD patients over time. Conclusions Prevalence of autoimmune diseases is increased in adult CD patients compared with the general population. However, concomitant autoimmune thyroidal diseases became less common over time in women.

scholarly journals A TREATMENT DILEMMA CONCERNING IMMUNOSUPPRESSANT USE: A CASE REPORT

2017 ◽  
Vol 10 (10) ◽  
pp. 4 ◽  
Author(s):  
Madathil Shinu Mary Iype ◽  
Akhilesh Kunoor ◽  
Anila Kn
Keyword(s):  
Case Report ◽  
Causality Assessment ◽  
Safety Concern ◽  
Infectious Complications ◽  
Typical Case ◽  
Pulmonary Tb ◽  
Tb Treatment ◽  
Increased Risk ◽  
Extra Pulmonary

 Immunosuppressants including corticosteroids (prednisolone >15 mg/day) are responsible for an increased risk of susceptibility to infections (especially pneumonia, tuberculosis [TB] including extra pulmonary TB), an important safety concern when providing immunosuppressive therapy. Anti-TB treatment (ATT) is medicines used to treat tuberculosis, an infectious disease which can affect lungs and other organs. Isoniazid, rifampicin, and pyrazinamide are known to cause ATT induced hepatitis. The prevalence of immunosuppressant induced TB and pyrazinamide induced hepatotoxicity during treatment for active TB ranges to about 0.6%-1% and <1%, respectively. Here, we illustrate a typical case report of a 61-year-old woman who is a known case of interstitial lung disease and developed TB arthritis following therapy with the long-term use of immunosuppressants (prednisolone, azathioprine, leflunomide, and sulfasalazine). ATT regimen was started for TB arthritis which was later modified along with addition of liver protectant due to the development of hepatotoxicity. The causality of both the adverse drug reactions was confirmed to be probable via NARANJO causality assessment scale. This case highlights the incidence of infectious complications like TB which may be expected to be encountered more frequently in the future due to the increasing use of immunosuppressants for the treatment of allergic and inflammatory disorders.

Minor Physical Anomalies and Obstetric Complications in Schizophrenia

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A65-A73 ◽  
Author(s):  
Thomas F. McNeil ◽  
Elizabeth Cantor-Graae
Keyword(s):  
High Risk ◽  
General Population ◽  
Genetic Risk ◽  
Early Life ◽  
Obstetric Complications ◽  
Mental Disturbance ◽  
Increased Risk ◽  
Minor Physical Anomalies ◽  
Over Time ◽  
Predictive Efficiency

Objective To evaluate the possibility of using congenital minor physical anomalies (MPA) and obstetric complications (OC) as individual-orientated, early life markers signalling increased risk for schizophrenia. Method Previous findings using Waldrop and colleagues' MPA scale (and additional items) and systematic study of OC history are summarised concerning schizophrenia patients and individuals at heightened genetic risk for schizophrenia. Results Significantly increased rates of both MPA and OC are consistently found in patients with schizophrenia. Minor physical anomalies are stable characteristics over time and can be studied efficiently from early childhood onward. Minor physical anomalies predict a variety of mental disorders in normal-risk children, but the predictive efficiency of MPA for schizophrenia in genetic high-risk samples and in the general population is unknown. Obstetric complications predict serious mental disturbance and neurodisorder in genetic high-risk cases, as well as doubling or tripling the individual's risk for schizophrenia in the general population. Obstetric complication results are sensitive to methodology and are best investigated using prospectively recorded information and an efficient OC scale for scoring the information. Conclusions Both MPA and OC should be included in batteries of methods for identifying individuals at an increased risk for schizophrenia. However, increased rates of MPA and OC are not pathognomonic for schizophrenia, but rather characterise individuals at risk of a much broader range of mental and physical abnormality, as well as normality. Minor physical anomalies and OC are not in themselves stigmatising, but their possible identification as markers for ‘increased risk for schizophrenia’ should be used judiciously. Further research is recommended regarding the MPA and OC patterns related to schizophrenia.

scholarly journals Trends in the Risk of Second Primary Malignancies (SPMs) Among Survivors of Chronic Lymphocytic Leukemia(CLL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4869-4869
Author(s):  
Vivek Kumar ◽  
Sikander Ailawadhi ◽  
Leyla Bojanini ◽  
Aditya Mehta ◽  
Anshika Singh ◽  
...  
Keyword(s):  
General Population ◽  
Hematological Malignancies ◽  
Lymphocytic Leukemia ◽  
Skin Cancers ◽  
Increased Risk ◽  
Depth Analysis ◽  
Time Periods ◽  
The Impact ◽  
Over Time ◽  
Increase In Risk

Abstract Background: CLL is the most common leukemia diagnosis in adults and its treatment has undergone significant change from chemotherapy, to immunotherapy and now targeted kinase inhibitors, leading to improved overall survival (OS). With improving survivorship, SPMs can occur but an in-depth analysis of risks and trends of SPMs in CLL survivors is lacking. We performed a population-based analysis to evaluate this. Methods: Patients in the Surveillance, Epidemiology and End Results (SEER) database diagnosed with CLL between 1973-2015 were included. Due to variation in management techniques over time, the cohort was divided in four time periods: 1973-1982, 1983-1992, 1993-2002 and 2003-2015. We evaluated differences in risk for SPMs among CLL survivors compared to risk of individual malignancies expected in the general population during these time periods and studied the effect of demographics and time since CLL diagnosis. Results: Over a nearly 270,000 person-year follow up, 6,467 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95% CI 1.17-1.23), which resulted in a 39 excess cancers per 10,000 population. The CLL survivors had a 20% overall increased risk of developing SPMs (excluding non-squamous skin cancer) compared to the general population. The risks for both solid (SIR 1.15 CI 95% 1.12-1.18) and hematological malignancies (SIR 1.61 95% CI 1.5-1.73) was higher than the expected in the general population. However, the risk for individual cancers was heterogeneous. The tumors associated with the highest risk were Hodgkin lymphoma (almost 8 times higher), Kaposi Sarcoma (4 times), non-epithelial skin cancers (4 times), salivary gland cancer (3 times) and acute lymphocytic leukemia (3 times). In contrast, tumors in the hepatobiliary system, female breast and female genital system were associated with a lower risk than the general population. The highest SIR across the study periods was observed in the younger population (ages 15-49). Although the risk increased in all ethnicities, it was statistically significant only in Caucasians. There was no gender-wise difference in SIR during any of the four time periods. A statistically significant increase in SIR was observed for both men and women from 1973-1982 to 2003-2015. This was mostly due to an increase in risk of hematological malignancies from 1.08 early in the study to 2.56 in the most recent study period. The SIR in solid tumors did not change significantly over time; in absolute terms, however, lung carcinoma contributed the most to the excess risk, followed by non-epithelial skin cancers and non-Hodgkin's lymphoma. The risk of developing a SPM was higher for the CLL survivors during most of the latency periods, but it was statistically significant during the 2-5 months and 12-59 months after diagnosis. A multivariate analysis was conducted to evaluate the impact of period of diagnosis on the development of SPMs among these patients. After adjusting for gender, ethnicity, radiation therapy, chemotherapy, and age at diagnosis of CLL, patients diagnosed with CLL in the most recent time period were at 45% higher risk of developing SPMs as compared to the patient diagnosed during 1973-1982 (Hazard ratio(HR) =1.45 95%CI:1.34-1.6, p<0.001). Moreover increased HRs were also observed for 1983-1992 and 1993-2002 time periods (Fig. 1) Conclusions: With improving therapeutics for cancer treatment, survivorship is improving as well and the risk of SPMs needs to be better understood and addressed. This is truer for CLL, where majority of patients have a favorable survival. The risk of SPMs was 20% higher in CLL survivors than in the general population and was most prominent in the survivors aged 15-49 years at the time of CLL diagnosis. The risk of individual malignancies may be heterogenous but there has been an increase in risk of SPMs over time, mainly due to an increase of secondary hematological malignancies in recent years. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL. Disclosures Ailawadhi: Janssen: Consultancy; Celgene: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Pharmacyclics: Research Funding.

scholarly journals Identification of Tuberculosis Patient Characteristics Using K-Means Clustering

2016 ◽  
Vol 3 (2) ◽  
pp. 129-138
Author(s):  
Betha Nur Sari
Keyword(s):  
Patient Characteristics ◽  
Tuberculosis Patient ◽  
Major Health ◽  
Tuberculosis Patients ◽  
Pulmonary Tb ◽  
Results Of Treatment ◽  
Silhouette Coefficient ◽  
The World ◽  
Extra Pulmonary ◽  
Gene Shaving

In Indonesia, tuberculosis remains one of the major health problems unresolved. Indonesia is second ranked in the world as the country with the most tuberculosis cases. The purpose of this research is to study how K-means clustering applied to the treatment of tuberculosis patients data in order to identify the characteristics of tuberculosis patients. The results of K-means clustering validated by gene shaving and silhoutte coefficient. The experiment results indicate the optimum clusters value obtained from the K-mean clustering that has been validated by gene shaving and silhouette coefficient. K-means clustering divided four groups of tuberculosis patients based on their characteristics. There were divided at a category of disease (pulmonary TB, Extra Pulmonary TB and both), the age of the patient and the results of treatment of tuberculosis.

Does Increased Body Mass Index Predispose Myeloma Patients to Fractures or Shortened Survival?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5051-5051
Author(s):  
Emma C. Scott ◽  
Alan L. Friedman ◽  
Stephen B. Heitner ◽  
Damian Silbermins
Keyword(s):  
Multiple Myeloma ◽  
General Population ◽  
Small Sample ◽  
World Health ◽  
Vertebral Compression Fractures ◽  
Risk Of Death ◽  
Increased Risk ◽  
Fracture Development ◽  
The Mean ◽  
The Impact

Abstract Background: Obese individuals are at increased risk of developing myeloma (Pan et al, Am J of Epidemiol, 2004, Feb) and at increased risk of death, compared to non-obese individuals (Calle et al, N Engl J Med, 2003 April). However, a higher BMI is protective against the development of osteoporosis and fracture in the general population (Siris et al, JAMA, 2001 Dec). Objectives: To assess the effect of obesity on fracture risk and mortality in patients diagnosed with multiple myeloma. Patients and Methods: Retrospective chart review of all patients identified by the Tumor Registry with the diagnosis of multiple myeloma, diagnosed from 1999–2003, at a single center (n= 60). Median age: 66 (range: 39–91). The study group is comprised of the following characteristics: female (58%), African-American (82%), white (15%) and other races (3%). All patients with bone disease were treated with bisphosphonates. Results: According to the World Health Organization criteria for BMI, 32% were grade 1 obese (25–29.9kg/m2), 18% were grade 2 obese (30–34.9kg/m2), 13% were grade 3 or 4 obese (&gt;35kg/m).2 Fracture occurred in 23 patients (38%), either at diagnosis or during follow up. The mean BMI of patients with fracture was 30.7 ± 7.2 kg/m 2. The mean BMI of patients without fracture was 26.5 ± 4.2 kg/m 2.T-test comparison between the 2 groups shows a statistically significant correlation between increased BMI and fracture occurrence (T value = 2.577, p= 0.013). Rank-Spearman correlation was used to assess the significance of age, gender and diabetes as confounding factors; none of these factors were shown contribute to the difference observed. This correlation also shows statistically significant correlation between increased BMI and number of fractures (p= 0.035). Mean BMI of patients with rib fractures was 27.7kg/m2 (N=6), vertebral compression fractures was 31.8 (N=13), pathologic femur fractures was 30.3 (N=5) and all other types was 27.0 (N=4). The BMI is numerically greater in patients with fractures of weight bearing bones, but this difference did not reach statistical significance. Of the 60 patients studied, 27 patients have died. The median survival of patients with a normal BMI (&lt;25 kg/m2) was 50 months, and that of patients with an increased BMI (≥25 kg/m2) was 58 months (p&gt;0.05). Patients with poor performance status experienced shorter survival (p= 0.013). Conclusions: Although a higher BMI is protective against the development of osteoporosis in the general population, our study shows that higher BMI correlates with a greater incidence of osteoporosis and fracture in patients with multiple myeloma. Our results suggest that reduction of BMI should be recommended to reduce the likelihood of fracture and related complications. Prospective studies of larger populations to assess the impact of BMI and weight loss on fracture development are needed. BMI does not appear to impact on the length of survival of these patients. Limitations of this study include its retrospective nature, small sample size, ethnic distribution and location at a single institution.

scholarly journals Clinical characteristics of women with gestational diabetes - comparison of two cohorts enrolled 20 years apart in southern Brazil

2017 ◽  
Vol 135 (4) ◽  
pp. 376-382 ◽  
Author(s):  
Angela Jacob Reichelt ◽  
Letícia Schwerz Weinert ◽  
Livia Silveira Mastella ◽  
Vanessa Gnielka ◽  
Maria Amélia Campos ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Diagnostic Criteria ◽  
International Association ◽  
Neonatal Outcomes ◽  
World Health ◽  
Adjusted Relative Risk ◽  
University Hospitals ◽  
Weight Category ◽  
Increased Risk ◽  
Over Time

ABSTRACT CONTEXT AND OBJECTIVE: The prevalence and characteristics of gestational diabetes mellitus (GDM) have changed over time, reflecting the nutritional transition and changes in diagnostic criteria. We aimed to evaluate characteristics of women with GDM over a 20-year interval. DESIGN AND SETTING: Comparison of two pregnancy cohorts enrolled in different periods, in university hospitals in Porto Alegre, Brazil: 1991 to 1993 (n = 216); and 2009 to 2013 (n = 375). METHODS: We applied two diagnostic criteria to the cohorts: International Association of Diabetes and Pregnancy Study Groups (IADPSG)/World Health Organization (WHO); and National Institute for Health and Care Excellence (NICE). We compared maternal-fetal characteristics and outcomes between the cohorts and within each cohort. RESULTS: The women in the 2010s cohort were older (31 ± 7 versus 30 ± 6 years), more frequently obese (29.4% versus 15.2%), with more hypertensive disorders (14.1% versus 5.6%) and at increased risk of cesarean section (adjusted relative risk 1.8; 95% confidence interval: 1.4 - 2.3), compared with those in the 1990s cohort. Neonatal outcomes such as birth weight category and hypoglycemia were similar. In the 1990s cohort, women only fulfilling IADPSG/WHO or only fulfilling NICE criteria had similar characteristics and outcomes; in the 2010s cohort, women only diagnosed through IADPSG/WHO were more frequently obese than those diagnosed only through NICE (33 ± 8 kg/m2 versus 28 ± 6 kg/m2; P < 0.001). CONCLUSION: The epidemic of obesity seems to have modified the profile of women with GDM. Despite similar neonatal outcomes, there were differences in the intensity of treatment over time. The IADPSG/WHO criteria seemed to identify a profile more associated with obesity.

O39 VTE risk in the general population: applying context to the impact of JAK inhibition

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Serena Baroncini ◽  
Mark Yates ◽  
Katie Bechman ◽  
Sanjeev Patel ◽  
Andrew Rutherford ◽  
...  
Keyword(s):  
General Population ◽  
Statistical Significance ◽  
Primary Diagnosis ◽  
Linear Pattern ◽  
Background Population ◽  
Increased Risk ◽  
Trends Over Time ◽  
Event Rates ◽  
The Impact ◽  
Over Time

Abstract Background Trial data indicate an increased risk of VTE with JAK inhibition. The EMA and FDA have given regulatory advice for their use as a result. To understand the context of any association, we need to understand VTE risk in the background population. Our objective was to describe the changing epidemiology of VTE risk including a breakdown of DVT and PE in the general population in England, over a 20-year period. Methods We utilised hospital episodes statistics data to study all patients presenting for hospital care in England between 1 January 1998 and 31 December 2017. We identified VTE events using ICD10 codes I26.0, I26.9, I80.1, I80.2 and I80.3. To estimate annualised event rates, we used the number of finished consultant episodes for admitted care where the primary diagnosis was VTE for the numerator; the denominator was the whole population estimate, from the office for National Statistics, for the relevant year for England. Rates were calculated per 100,000 population, and the Cochrane Armitage test was used to evaluate statistical significance of trends over time. Linear regression allowed modelling of estimates over time, with model assumptions tested using residual versus fitted plots. To explore non-linearity, we used a cubic spline model. Results The average VTE rate across the 20 years was 127/100,000. VTE rates have increased over time, climbing from 108/100,000 in 1998, to 151/100,000 in 2017. The relative frequency of DVTs and PEs has changed over this time: in 1998 DVT was more frequent than PE (rates 68/100,000 and 40/100,000 respectively). By 2018 this ratio had reversed (DVT 52/100,000: PE 98/100,000). This change was statistically significant (p &lt; 0.0001). DVT rates declined in a linear manner over time. PE rates increased with a non-linear pattern, with a sharp rise apparent between 2008 and 2010. Conclusion The inversion in the frequency of DVTs and PEs is consistent with previous findings using European data. One possible explanation is changing diagnostics (CTPA replacing V/Q), capturing previously subclinical PE events. Limitations include our ecologic design as well as lack of linkage to mortality records. The presumed VTE risk associated with JAK inhibition is small. It is plausible that future shifts in population wide patterns of VTE could obscure or amplify any effect attributable to JAK inhibitors. As longer-term observational data become available, it is crucial they are interpreted in the context of background population trends. Disclosures S. Baroncini: None. M. Yates: None. K. Bechman: None. S. Patel: None. A. Rutherford: None. A. Kleymann: None. J. Galloway: None.

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