Comorbidities in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis versus the General Population

Objective.To evaluate the consultation rates of selected comorbidities in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV) compared with the general population in southern Sweden.Methods.We used data from a population-based cohort of patients with AAV diagnosed between 1998 and 2010 in Southern Sweden (701,000 inhabitants). For each patient we identified 4 reference subjects randomly sampled from the general population and matched for year of birth, sex, area of residence, and index year. Using the population-based Skåne Healthcare Register, we identified relevant diagnostic codes, registered between 1998 and 2011, for selected comorbidities assigned after the date of diagnosis of AAV or the index date for the reference subjects. We calculated rate ratios for comorbidities (AAV:reference subjects).Results.There were 186 patients with AAV (95 women, mean age 64.5 yrs) and 744 reference persons included in the analysis. The highest rate ratios (AAV:reference) were obtained for osteoporosis (4.6, 95% CI 3.0–7.0), followed by venous thromboembolism (4.0, 95% CI 1.9–8.3), thyroid diseases (2.1, 95% CI 1.3–3.3), and diabetes mellitus (2.0, 95% CI 1.3–2.9). For ischemic heart disease, the rate ratio of 1.5 (95% CI 1.0–2.3) did not reach statistical significance. No statistically significant differences were found for cerebrovascular accidents.Conclusion.AAV is associated with increased consultation rates of several comorbidities including osteoporosis and thromboembolic and endocrine disorders. Comorbid conditions should be taken into consideration when planning and providing care for patients with AAV.

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Incidence of atrial fibrillation in different major cancer subtypes: a Nationwide population-based 12 year follow up study

BMC Cancer ◽

10.1186/s12885-019-6314-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Christina Boegh Jakobsen ◽

Morten Lamberts ◽

Nicholas Carlson ◽

Morten Lock-Hansen ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

The Elderly ◽

Population Based ◽

Incidence Rates ◽

Cancer Subtypes ◽

History Of ◽

The Difference ◽

Rate Ratios ◽

New Onset

Abstract Background The prevalence of both atrial fibrillation (AF) and malignancies are increasing in the elderly, but incidences of new onset AF in different cancer subtypes are not well described.The objectives of this study were therefore to determine the incidence of AF in different cancer subtypes and to examine the association of cancer and future AF. Methods Using national databases, the Danish general population was followed from 2000 until 2012. Every individual aged > 18 years and with no history of cancer or AF prior to study start was included. Incidence rates of new onset AF were identified and incidence rate ratios (IRRs) of AF in cancer patients were calculated in an adjusted Poisson regression model. Results A total of 4,324,545 individuals were included in the study. Cancer was diagnosed in 316,040 patients. The median age of the cancer population was 67.0 year and 51.5% were females. Incidences of AF were increased in all subtypes of cancer. For overall cancer, the incidence was 17.4 per 1000 person years (PY) vs 3.7 per 1000 PY in the general population and the difference increased with age. The covariate adjusted IRR for AF in overall cancer was 1.46 (95% confidence interval (CI) 1.44–1.48). The strength of the association declined with time from cancer diagnosis (IRR0-90days = 3.41 (3.29–3.54), (IRR-180 days-1 year = 1.57 (CI 1.50–1.64) and (IRR2–5 years = 1.12 (CI 1.09–1.15). Conclusions In this nationwide cohort study we observed that all major cancer subtypes were associated with an increased incidence of AF. Further, cancer and AF might be independently associated.

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Intrauterine Growth and Cerebral Palsy in Twins: A European Multicenter Study

Twin Research and Human Genetics ◽

10.1375/twin.9.3.460 ◽

2006 ◽

Vol 9 (3) ◽

pp. 460-466 ◽

Cited By ~ 14

Author(s):

Svetlana V. Glinianaia ◽

Stephen Jarvis ◽

Monica Topp ◽

Pascale Guillem ◽

Mary J. Platt ◽

...

Keyword(s):

Cerebral Palsy ◽

Statistical Significance ◽

A Priori ◽

Population Based ◽

Aggregated Data ◽

Growth Standards ◽

Intrauterine Growth ◽

Increased Risk ◽

Multi Center Study ◽

Rate Ratios

AbstractPopulation-based studies in twins have been of insufficient size to explore the relationship between risk of cerebral palsy and intrauterine growth. Earlier studies in singletons have suggested an optimum size at birth for minimum cerebral palsy risk between the 75th and 90th percentiles of weight for gestational age. We aggregated data from nine European cerebral palsy registers for 1976 to 1990. Using sex-specific fetal growth standards for twins, a z score of weight-for-gestation was derived for each of the 373 twin cases. The rates of cerebral palsy in each z-score band were compared to the rate in the a priori reference band of 0.67 to less than 1.28 (equivalent to the 75th to less than 90th percentiles). In twins born at 32 weeks' gestation or more (92% of all twins), cerebral palsy rates were higher for both light and heavy-forgestation babies compared to an optimum (i.e., minimum risk) in the reference band. However, the rate ratio for heavy babies (90th percentile or greater) did not reach conventional (95% confidence intervals [CI]) statistical significance (rate ratios = 1.76; 90% CI 1.02–3.03). For twins born at less than 32 weeks, the significantly higher risk for cerebral palsy was observed consistently in all z-score bands less than average compared to the reference band. This multi-center study demonstrates that for twins born at 32 weeks' gestation or more, an increased risk of cerebral palsy is associated with deviations from optimal intrauterine growth at about 1 standard deviation above mean weight, as was earlier reported for singletons. For twins born at less than 32 weeks' gestation, this pattern is only demonstrable for babies weighing below the optimum weight-for-gestation.

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Cardiovascular drug use and mortality in patients with schizophrenia or bipolar disorder: a Danish population-based study

Psychological Medicine ◽

10.1017/s003329171300216x ◽

2013 ◽

Vol 44 (8) ◽

pp. 1625-1637 ◽

Cited By ~ 38

Author(s):

T. M. Laursen ◽

P. B. Mortensen ◽

J. H. MacCabe ◽

D. Cohen ◽

C. Gasse

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Drug Use ◽

General Population ◽

Cerebrovascular Disease ◽

Severity Of Illness ◽

Population Based ◽

Danish Population ◽

Co Morbidity ◽

Rate Ratios

BackgroundCardiovascular (CV) co-morbidity is one of the major modifiable risk factors driving the excess mortality in individuals with schizophrenia or bipolar disorder. Population-based studies in this area are sparse.MethodWe used Danish population registers to calculate incidence rate ratios (IRRs) for CV drug use, and mortality rate ratios comparing subjects with schizophrenia or bipolar disorder with subjects with no prior psychiatric hospitalization.ResultsIRRs for CV prescriptions were significantly decreased in patients with schizophrenia or bipolar disorder compared with the general population. Among persons without previous myocardial infarction (MI) or cerebrovascular disease, persons with schizophrenia or bipolar disorder had an up to 6- and 15-fold increased mortality from all causes or unnatural causes, respectively, compared with the general population, being most pronounced among those without CV treatment (16-fold increase). Among those with previous MI or cerebrovascular disease, excess all-cause and unnatural death was lower (up to 3-fold and 7-fold increased, respectively), but was similar in CV-treated and -untreated persons.ConclusionsThe present study shows an apparent under-prescription of most CV drugs among patients with schizophrenia or bipolar disorder compared with the general population in Denmark. The excess of mortality by unnatural deaths in the untreated group suggests that the association between CV treatment and mortality may be confounded by severity of illness. However, our results also suggest that treatment of CV risk factors is neglected in these patients.

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Validity of Diagnostic Codes and Prevalence of Physician-Diagnosed Psoriasis and Psoriatic Arthritis in Southern Sweden – A Population-Based Register Study

PLoS ONE ◽

10.1371/journal.pone.0098024 ◽

2014 ◽

Vol 9 (5) ◽

pp. e98024 ◽

Cited By ~ 57

Author(s):

Sofia Löfvendahl ◽

Elke Theander ◽

Åke Svensson ◽

Katarina Steen Carlsson ◽

Martin Englund ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Population Based ◽

Southern Sweden ◽

Diagnostic Codes

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Ten-year risk of cerebrovascular accidents in incident rheumatoid arthritis: a population-based study of trends over time

Rheumatology ◽

10.1093/rheumatology/keaa579 ◽

2020 ◽

Author(s):

Kiana Yazdani ◽

Hui Xie ◽

J Antonio Avina-Zubieta ◽

Yufei Zheng ◽

Michal Abrahamowicz ◽

...

Keyword(s):

General Population ◽

Cox Model ◽

Population Based ◽

Case Definition ◽

P Value ◽

Linear Quadratic ◽

Cox Models ◽

Cerebrovascular Accidents ◽

Interaction Term ◽

Over Time

Abstract Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. Methods We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. Results Overall, 23 545 RA and 47 090 general population experienced 658 and 1220 incident CVAs, respectively. A spline Cox model with a knot at year of onset 1999 was selected. A significant decline in risk of CVA was observed in individuals with RA onset after 1999 [0.90 (0.86, 0.95); P = 0.0001]. The change in CVA risk over time differed significantly in RA with onset from 1999 onwards compared with the general population (P-value of interaction term = 0.03), but not before 1999 (P = 0.06). Conclusion Our findings suggest that people with RA onset from 1999 onwards, had a significantly greater decline in 10-year risk of CVA compared with the general population.

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Improvement in 5-year mortality in incident rheumatoid arthritis compared with the general population—closing the mortality gap

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2016-209562 ◽

2016 ◽

Vol 76 (6) ◽

pp. 1057-1063 ◽

Cited By ~ 50

Author(s):

Diane Lacaille ◽

J Antonio Avina-Zubieta ◽

Eric C Sayre ◽

Michal Abrahamowicz

Keyword(s):

Rheumatoid Arthritis ◽

General Population ◽

Population Based ◽

Vital Statistics ◽

Mortality Trends ◽

Physician Visits ◽

Rate Ratios ◽

Population Controls ◽

Over Time

ObjectiveExcess mortality in rheumatoid arthritis (RA) is expected to have improved over time, due to improved treatment. Our objective was to evaluate secular 5-year mortality trends in RA relative to general population controls in incident RA cohorts diagnosed in 1996–2000 vs 2001–2006.MethodsWe conducted a population-based cohort study, using administrative health data, of all incident RA cases in British Columbia who first met RA criteria between January 1996 and December 2006, with general population controls matched 1:1 on gender, birth and index years. Cohorts were divided into earlier (RA onset 1996–2000) and later (2001–2006) cohorts. Physician visits and vital statistics data were obtained until December 2010. Follow-up was censored at 5 years to ensure equal follow-up in both cohorts. Mortality rates, mortality rate ratios and HRs for mortality (RA vs controls) using proportional hazard models adjusting for age, were calculated. Differences in mortality in RA versus controls between earlier and later incident cohorts were tested via interaction between RA status (case/control) and cohort (earlier/later).Results24 914 RA cases and controls experienced 2747 and 2332 deaths, respectively. Mortality risk in RA versus controls differed across incident cohorts for all-cause, cardiovascular diseases (CVD) and cancer mortality (interactions p<0.01). A significant increase in mortality in RA versus controls was observed in earlier, but not later, cohorts (all-cause mortality adjusted HR (95% CI): 1.40 (1.30 to 1.51) and 0.97 (0.89 to 1.05), respectively).ConclusionsIn our population-based incident RA cohort, mortality compared with the general population improved over time. Increased mortality in the first 5 years was observed in people with RA onset before, but not after, 2000.

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Hospital-based Psychiatric Service Utilization and Morbidity in Multiple Sclerosis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100034065 ◽

1998 ◽

Vol 25 (3) ◽

pp. 230-235 ◽

Cited By ~ 31

Author(s):

John D. Fisk ◽

Susan A. Morehouse ◽

Murray G. Brown ◽

Chris Skedgel ◽

T. Jock Murray

Keyword(s):

Multiple Sclerosis ◽

Bipolar Disorder ◽

Nova Scotia ◽

General Population ◽

Service Utilization ◽

Suicide Attempts ◽

Psychiatric Service ◽

Psychiatric Morbidity ◽

Population Based ◽

Diagnostic Codes

ABSTRACT:Background:Despite the common association of psychiatric morbidity and multiple sclerosis (MS), population-based prevalence estimates of these disorders are limited. Such estimates are of particular importance to those conducting trials of interventions for the treatment of MS. This study examined the prevalence of bipolar disorder, depression, and attempted suicide among hospital service utilizers in Nova Scotia and compared these measures for the MS and non-MS population.Methods:Data regarding diagnosis and utilization were extracted from two linked databases which included all hospital separation records for Nova Scotia over a 3 year period (1992/93-1994/95).Results:The prevalence of bipolar disorder in hospitalized MS patients was 1.97% and depression was 4.27%. These rates were significantly higher than the 0.92% and 2.04%, respectively, for the non-MS hospital utilizers. These diagnoses also accounted for more than half of the primary diagnostic codes for psychiatric service separations by MS patients. The proportion of total hospital utilization which was accounted for by psychiatric services did not differ between MS and non-MS utilizers. While suicide attempts were rare, the estimated frequency of suicide attempts in the total MS population was more than three times that of the general population.Conclusions:Bipolar disorder and depression were twice as prevalent in hospitalized MS patients as in the general population of hospital utilizers while the estimated frequency of suicide attempts was at least three times greater. These results illustrate that psychiatric morbidity and service utilization are important considerations in the care of MS patients.

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Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.160249 ◽

2016 ◽

Vol 44 (1) ◽

pp. 84-90 ◽

Cited By ~ 19

Author(s):

Aladdin J. Mohammad ◽

Martin Englund ◽

Carl Turesson ◽

Gunnar Tomasson ◽

Peter A. Merkel

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Statistical Significance ◽

Unmet Need ◽

Reference Population ◽

Population Based ◽

Southern Sweden ◽

Venous Thromboembolic ◽

First Occurrence ◽

Severe Infections

Objective.To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.Methods.The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated.Results.There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33–3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61–3.40), severe infections (1.85, 95% CI 1.57–2.18), thyroid diseases (1.55, 95% CI 1.25–1.91), cerebrovascular accidents (1.40, 95% CI 1.12–1.74), and diabetes mellitus (1.29, 95% CI 1.05–1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00–1.44).Conclusion.Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.

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COVID-19 patients and cancer in northern Italy

10.1101/2020.11.18.20233833 ◽

2020 ◽

Author(s):

Lucia Mangone ◽

Francesco Gioia ◽

Pamela Mancuso ◽

Isabella Bisceglia ◽

Marta Ottone ◽

...

Keyword(s):

General Population ◽

Cancer Survivors ◽

Cumulative Incidence ◽

Population Based ◽

Risk Of Death ◽

Incidence And Mortality ◽

Recent Diagnosis ◽

Rate Ratios ◽

The Impact ◽

Worse Prognosis

AbstractThe aim of this population-based work was to evaluate the impact of having had cancer on COVID-19 risk and prognosis during the first wave of the pandemic (27 February – 13 May 2020) in Reggio Emilia Province. Prevalent cancer cases diagnosed between 1996 and 2020 were linked with the provincial COVID-19 surveillance system. We compared cancer survivors’ cumulative incidence of being tested, testing positive for SARS-CoV-2, and dying of COVID-19 with that of the general population; among COVID-19 patients, we compared cancer survivors’ risk of dying with that of other patients.During the study period 15,391 people (1,525 cancer survivors - CS) underwent RT-PCR for SARS-CoV-2, of whom 4,541 (449 CS) tested positive; 549 (114 CS) died of COVID-19. The probability of undergoing testing was 29.5% in the general population as well in CS, while the cumulative incidence of being tested, testing positive, and COVID-19 death were lower in CS: age- and sex-adjusted Incidence Rate Ratios were 0.69 [95%CI 0.65-0.73], 0.55 [95%CI 0.50-0.61], and 0.52 [95%CI 0.42-0.64], respectively. Cancer survivors had worse prognosis when diagnosed with COVID-19, particularly those below the age of 70 (odds ratio (OR) of death 4.91 [95%CI 2.38-10.09]), while the OR decreased after age 80 (1.20 [95%CI 0.87-1.65]). The OR was higher for patients with a recent diagnosis (<2 years OR=2.99 [95%CI 1.52-5.89]) or metastases (OR=2.14 [95%CI 0.89-5.16]).Cancer patients may have adopted behaviors that protected them from infection, but they were still at higher risk of death once infected.Novelty and impactCancer survivors during the first wave of the pandemic showed lower COVID-19 cumulative incidence and mortality. When infected, they had worse prognosis, particularly in people younger than age 70, with a recent diagnosis, or with metastases.

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Nutritional, Metabolic and Endocrine Disorders in Patients with Bipolar Disorder: A Systematic Review

European Psychiatry ◽

10.1016/s0924-9338(09)70824-7 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

E. Vieta ◽

J. Mostaza ◽

J. Bobes ◽

J. Saiz-Ruiz ◽

F. Rico-Villademoros ◽

...

Keyword(s):

Bipolar Disorder ◽

General Population ◽

Retrospective Cohort ◽

Reference Lists ◽

Population Based ◽

Endocrine Disorders ◽

Cross Sectional ◽

Medline Search ◽

Study Designs ◽

Manual Review

Objective:To evaluate the frequency of nutritional, metabolic and endocrine disorders in patients with bipolar disorder (BD).Methods:A Medline search (up to January 2008) in and manual review of reference lists of relevant primary articles and review articles. All studies in Spanish or English, all study designs, BD diagnosis by any criteria, with a sample size of ≥ 30 patients, and which reported any measure of frequency measure or association.Results:Thirty studies were identified: 18 (60%) cross-sectional and 12 (40%) retrospective cohort; 2 (6.7%) population- based; and 2 (6.7%) random sampling. The frequency of obesity in patients with BD was higher than that of the general population (n=4, 19-53% vs 9-14%), of other medical populations (n=1, 4.6% vs 1.1%) and of patients with schizophrenia (n=1, 11.6% vs 9.9%). The frequency of diabetes in patients with BD was higher than (n=5, 6-26% vs 2-16%) or similar to (n=2, 3.5-4.3% vs 3.4-4.8%) that of the general population; higher than that of other medical samples (n=2, 1.8-4.4% vs 0.6-2.2%) and similar to that in of patients with schizophrenia (n=1, 17.7% vs 17.6%). The frequency of dyslipidaemia was higher than that found in a medical sample (n=1, 0.9% vs 0.3%) and in patients with schizophrenia (n=1, 27% vs 23%). The frequency of hypothyroidism was higher than that of a medical sample (n=1, 10% vs 3%).Conclusion:BD appears to be associated with obesity. It may also be associated with dyslipidaemia and hypothyroidism. Data on the association between BD and diabetes are inconclusive.

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