Regional differences in cardiac mortality rates in Russia: the role of statistical features

Aim. To analyze the contribution of cardiac causes to all-cause mortality, to characterize the differences in standardized mortality rates (SMRs) in Russian regions, as well as to identify promising directions for improving establishment of cardiovascular death and its coding.Material and methods. We used the Federal State Statistics Service (Rosstat) data on the mortality rate and the average annual population in one-year age groups for 2019. To calculate the SMR, the European Standard Population was used. For each cardiac death, the SMR from 23 causes was calculated, which were combined into 4 groups, and for each of these groups, the regional mean and standard deviation of SMR in Russian regions were estimated.Results. In 2019, the cardiac SMR in Russian regions was 301,02±77,67, which corresponded to 30,5±5,8% of all death causes. At the same time, the coefficient of variation of regional cardiac SMR was 25,8%. In general, in 60,9±13,8% of cases, the cause of cardiac death was chronic diseases, mainly related to atherosclerosis. The proportion of deaths from acute types of coronary artery disease was 17,3±9,7%, deaths not associated with atherosclerosis (heart defects, myocardial diseases, etc.) — 17,5±8,2%, deaths associated with hypertension — 4,2±5,2%. The coefficient of variation of regional SMR was 34,66, 64,47, 50,99 and 122,7, respectively.Conclusion. Significant regional differences in SMR from certain cardiac causes and groups of causes, as well as their contribution to mortality pattern, were revealed. It is necessary to continue the research on the methodology of statistical recording of certain cardiovascular diseases.

Cardiovascular diseases mortality and alcohol control policy in Lithuania: exploring a possible link

Background Lithuania possesses one of the highest alcohol per capita consumption and has previously implemented alcohol control policies to reduce the alcohol-attributable burden. The aim of this study was to investigate Lithuanian cardiovascular disease (CVD) mortality rate trends between 2001 and 2018 and to explore a possible link between CVD mortality rate and alcohol control policy implementation. Methods Lithuanian population mortality and alcohol consumption data for 2001–2018 were obtained from Statistics Lithuania and The State Register of Death Cases and Their Causes, Institute of Hygiene. Sex-specific CVD mortality rates were directly standardized to the European standard population by five-year age groups and categorized according to the ICD-10 codes for all CVDs (I00-I99), ischemic heart disease (IHD) (I20-I25), cerebrovascular diseases (I60-I69) and alcoholic cardiomyopathy (ACM) (I42.6). Joinpoint regression analyses were performed to identify points of inflection to explore their alignment with five selected alcohol policy enactments. Results Overall, the 2001–2018 yearly mortality rates for all CVDs significantly decreased on average by − 1.6% (95% CI -2.0, − 1.2%) among men and − 2.1% (95% CI -2.5, − 1.8%) among women. Yearly changes in all CVDs, IHD, cerebrovascular diseases and ACM mortality rates were insignificant prior to their respective critical year points in 2006, 2005, 2008 and 2007, but significantly decreased afterwards by an average of − 2.4% (95% CI -2.7, − 2.0%), − 1.6% (95% CI -2.1, − 1.1%), − 1.2% (95 CI -1.7, − 0.6%) and − 4.5% (95% CI -7.3, − 1.6%) among men, and by − 2.7% (95% CI -3.0, − 2.3%), − 2.0% (95% CI -2.6, − 1.4%), − 1.8% (95% CI 2.4, − 1.3%) and − 6.6% (95% CI -10.7, − 2.2%) among women, respectively. The changes in the mortality rate trends for all CVDs, IHD, cerebrovascular diseases and especially ACM coincided with alcohol policies enacted on the January 1, 2008, January 1, 2009, April 1, 2014 and March 1, 2017. Conclusions Yearly mortality rates for all CVDs, IHD, cerebrovascular diseases and ACM have declined in Lithuania between 2001 and 2018, and declining trends were more prominent in women than in men. Among the ICD-10 CVD categories investigated, the points of inflection identified for the ACM mortality rate trend coincided best with the selected alcohol policy enactment dates.

Marked and widening socioeconomic inequalities in type 2 diabetes prevalence in Scotland

BackgroundThis study investigated the association between socioeconomic status and type 2 diabetes (T2D) prevalence in Scotland in 2021 and tested the null hypothesis that inequalities had not changed since they were last described for 2001–2007.MethodsData from a national population-based diabetes database for 35-to-84-year-olds in Scotland for 2021 and mid-year population estimates for 2019 stratified by sex and fifths of the Scottish Index of Multiple Deprivation were used to calculate age-specific prevalence of T2D. Age-standardised prevalence was estimated using the European Standard Population with relative risks (RRs) compared between the most (Q1) and least (Q5) deprived fifths for each sex, and compared against similar estimates from 2001 to 2007.ResultsComplete data were available for 255 764 people (98.9%) with T2D. Age-standardised prevalence was lowest for women in Q5 (3.4%) and highest for men in Q1 (11.6%). RRs have increased from 2.00 (95% CI 1.52 to 2.62) in 2001–2007 to 2.48 (95% CI 2.43 to 2.53) in 2021 for women and from 1.58 (95% CI 1.20 to 2.07) in 2007 to 1.89 (95% CI 1.86 to 1.92) in 2021 for men.ConclusionsSocioeconomic inequalities in T2D prevalence have widened between 2001–2007 and 2021. Further research is required to investigate potential medium-term effects of the COVID-19 pandemic.

P14.45 The incidence of major subtypes of primary brain tumours in adults in England 1995–2017

BACKGROUND Primary brain tumours are a complex heterogenous group of benign and malignant tumours. Reports on their occurrence in the English population by sex, age, and morphological subtype and on their incidence are currently not available. Using data from the National Cancer Registration and Analysis Service (NCRAS), the incidence of adult primary brain tumour by major subtypes in England will be described. METHODS Data on all adult English patients diagnosed with primary brain tumour between 1995 and 2017, excluding spinal, endocrinal and other CNS tumours, were extracted from NCRAS. Incidence rates were standardised to the 2013 European Standard Population. Results are presented by sex, age, and morphological subtype. RESULTS Between 1995 and 2017, a total of 133,669 cases of adult primary brain tumour were registered in England. Glioblastoma was the most frequent tumour subtype (31.8%), followed by meningioma (27.3%). The age-standardised incidence for glioblastoma increased from 3.27 per 100,000 population per year in 1995 to 7.34 in men in 2013 and from 2.00 to 4.45 in women. Meningioma incidence also increased from 1.89 to 3.41 per 100,000 in men and from 3.40 to 7.46 in women. The incidence of other astrocytic and unclassified brain tumours declined between 1995 and 2007 and remained stable thereafter. CONCLUSION Part of the increase in the incidence of major subtypes of brain tumours in England could be explained by advances in clinical practice including the adoption of new diagnostic tools, classifications and molecular testing, and improved cancer registration practices.

Incidence of surgery for chronic subdural hematoma in Finland during 1997–2014: a nationwide study

OBJECTIVE The number of surgeries performed for chronic subdural hematoma (CSDH) has increased. However, these changes have been poorly reported. The authors aimed to assess the national incidence of surgeries for CSDH in Finland during an 18-year time period from 1997 to 2014. They hypothesized that the incidence of CSDH surgeries has continued to increase, particularly among the elderly. METHODS A nationwide register-based follow-up study was performed using the Finnish Care Register for Health Care. All adult patients undergoing primary CSDH surgeries during 1997–2014 were included. The study population was followed up from the time of CSDH surgery until death or the end of follow-up on December 31, 2017. The incidences of CSDH surgery per 100,000 person-years were calculated separately in each age group and sex. Age standardization was performed for those 20 years of age and older with weights from the 2013 European Standard Population. Negative binomial regression models were used to assess changes in incidence rate ratios (IRRs) during the study period. RESULTS In total, 9280 patients were identified. The age-standardized incidence of CSDH surgery increased from 12.2 to 16.5 per 100,000 person-years during 1997–2014. The age- and sex-adjusted incidence of CSDH surgery increased by 30% (IRR 1.30, 95% CI 1.20–1.41). The age- and sex-adjusted incidence increased more in the older age groups, with an IRR of 1.24 for those aged 60–69 years, 1.32 for those 70–79 years, 1.46 for those 80–89 years, and 1.85 for those aged 90 years or older. The adjusted incidence did not increase for those aged 18–59 years. The sex difference (2:1 men/women) was consistent throughout the study period, with a higher incidence among men. One year after the primary surgery, 19% of the population had a resurgery, and the 1-year case fatality rate was 15%. The median age of patients increased from 73 to 76 years. CONCLUSIONS During the past 2 decades, the age- and sex-adjusted incidence of CSDH surgery has increased in Finland, with major increases for those aged 60 years or older. This increase is likely to continue in parallel with the aging population and increased life expectancies.

Stability Over Time Of High Incidence Bladder Cancer In An Industrialized Area In North-Eastern Spain. A Longitudinal Study In A Region Of 400,000 Inhabitants.

Purpose: To study whether the incidence of bladder cancer in an industrialized area in ​​North-Eastern Spain remains as high as in the nineties.Methods: Patients diagnosed with histologically confirmed primary bladder cancer, during 2018-2019, in an area in North-Eastern Spain (430,883 inhabitants) were included. Crude incidence rates were estimated per 100,000 person-year based on the number of individuals getting their first diagnosis. Direct age-standardized incidence rates were calculated applying both the European and the World Standard Populations.Results: 295 patients were included (mean age 72.5±10.3 years; 89.8% men). The crude rate was 62.6 (95%CI:55.0-70.1) for men and 6.8 (95%CI:4.4-9.3) for women. The annual rate adjusted to the European Standard Population was 85.3 (95%CI:75.0-95.5) for men and 7.0 (95%CI:4.5-9.5) for women, and adjusted to the World Standard Population, 31.7 (95%CI:27.9-35.5) and 2.9 (95%CI:1.8-3.9) respectively. Conclusion: The incidence of bladder cancer in this area in ​​North-Eastern Spain is one of the highest in men and one of the lowest in women, both in Europe and Worldwide. The decrease in the industrial activity has not led to a decrease in bladder cancer incidence. The heterogeneity of bladder cancer registries in terms of definition and inclusion criteria makes it difficult to compare results.

P607 The Faroese IBD Study: Update on incidence from 2015–2020 and prevalence from 1960–2020

Background Previous reports have found that the Faroe Islands has the highest reported incidence of inflammatory bowel disease (IBD) in the world.1,2 The purpose of this study was to update our previous work on the IBD incidence from 1960–20142 with data up until 2020 and to describe the prevalence of IBD over 60 years. Methods All cases of Crohn’s disease (CD), ulcerative colitis (UC) and IBD unclassified (IBDU) diagnosed between 1960 to 2020, including all age groups and year of death, were retrieved from the Medical Centre at the National Hospital of the Faroe Islands. Diagnoses were ascertained according to the Copenhagen Diagnostic Criteria. Population data from 1960–2020 were retrieved from Statistics Denmark and Statistics Faroe Islands. Point prevalence rates (per 100,000) were estimated as all IBD patients alive and living in the Faroe Islands by the end of 1960, 1970, 1980, 1990, 2000, 2010 and 2020, divided by the Faroese population (end of year). Results 232 individuals have been diagnosed with IBD during the past 6 years in the Faroe Islands: 29 (12%) with CD, 111 (48%) with UC and 92 (40%) with IBDU, resulting in an increased age-standardised IBD incidence rate (European Standard Population, ESP) from 74 per 100,000 person-years (py) in 2010–14 to 80 in 2015–20. Figure 1 illustrates the updated IBD incidence rate integrated with results from our previous study.2 The point prevalence rate of IBD was 5,8 cases per 100,000 persons in 1960; 46,6 in 1970; 133,9 in 1980; 325,4 in 1990; 610,7 in 2000; 925,1 in 2010 and 1407,9 cases per 100,000 in 2020, corresponding to 1,4% of the Faroese population living with IBD in 2020 compared to 0,6% in 2000. Conclusion The increasing incidence of IBD from 2015–2020 is mainly driven by IBDU, accounting for 40% of all cases and has increased from 21 per 100,000 (ESP) in 2010–14 to 32 in 2015–2020. The age-standardised incidence rate of CD remains unchanged compared to our previous study, at 10 per 100,000 (ESP), while the incidence of UC has decreased from 44 to 39 per 100,000 (ESP). The prevalence of IBD has increased radically in accordance with the increasing incidence. Further investigations into the high proportion of IBDU and causes of the observed IBD pattern is currently ongoing. 1. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2018;390:2769–78.et al. 2. The Faroese IBD Study: Incidence of Inflammatory Bowel Diseases Across 54 Years of Population-based Data. J Crohns Colitis 2016;10:934–42.

Trends in Incidence and Mortality of Skin Melanoma in Lithuania 1991–2015

Background. We aimed to investigate age-specific and sex-specific incidence trends of melanoma in Lithuania from 1991 to 2015. Methods. Analysis was based on data from the population-based Lithuanian Cancer Registry database for 1991–2015, and 6024 cases of skin melanoma were identified. Age-adjusted rates (ASRs) by sex and age group were calculated. Adjustment for ASRs was done using the old European standard population, where a total of three age groups were considered: 0–39, 40–59 and 60+. Additionally, the annual percent change (APC) was calculated, and 95% confidence intervals for APC were calculated. Results. Between 1991 and 2015, the overall melanoma rates increased by an annual percent change (APC) of 3.9% in men (95% CI, 3.6–4.1%) and 2.3% in women (95% CI, 2.1–2.5%). The highest incidences of new cutaneous melanoma cases were observed between old adults (60+) of both sexes, while the lowest incidence rates were observed in the young adult group (up to 39 years old), with the lowest APC (1.6% in males and 0.4% in females). The overall number of melanoma deaths during 1991 and 2015 increased from 64 to 103 deaths per year, and the age-standardized rate (ASR) increased 1.3 times (from 1.8 to 2.4). Conclusions. The incidence and mortality of skin melanoma seem to be increased in all age groups. These trends indicate that skin protection behavior is not sufficient in our population and more efforts need to be taken in order to decrease incidence and mortality rates.

Incidence of emergency neurosurgical TBI procedures: A population-based study

Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). For age-adjusted incidence according to the direct method, we used the 2013 European standard population (ESP) and 2000–2025 WHO World standard population distributions. We conducted multivariate logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100 000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100 00 and 3.3/100 000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low GCS) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

Incidence trends of pediatric onset inflammatory bowel disease in the years 2000–2009 in Saxony, Germany–first results of the Saxon Pediatric IBD Registry

Aims In developed countries, the incidence of inflammatory bowel disease (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) is increasing. Therefore, we aimed to investigate the incidence rates and trends over time in the population of children and adolescents in one of the federal states of Germany, in Saxony. Methods Over the 10-year period 2000–2009 all 31 children’s hospitals and pediatric gastroenterologists, respectively in Saxony reported all IBD patients up to 15 years of age to the Saxon Pediatric IBD Registry. The completeness of the registry was estimated as 96.7% by independent surveys in the years 2005–2009. Incidence rates were presented as age-standardized incidence rates (ASR) regarding New European Standard Population 1990 per 100,000 person-years (PY) with 95% confidence intervals [CI]. Joinpoint and linear regression was used for trend analyses. Results 344 patients with confirmed IBD between 2000–2009 were included in the epidemiological evaluation: 212 (61.6%) patients with CD, 122 (35.6%) with UC and 10 (2.9%) with unclassified IBD (IBD-U). The ASR per 100,000 PY over the whole observation period was 7.2 [6.4–7.9] for IBD, 4.4 [3.8–5.0] for CD, 2.6 [2.1–3.0] for UC and 0.2 [0.1–0.3] for IBD-U. For IBD, the ASR per 100,000 PY increased from 4.6 [2.8–6.3] in 2000 to 10.5 [7.5–13.6] in 2009. The incidence trend analysis of ASRs using the joinpoint regression confirmed a significant increase of IBD as well as UC. The mean age at first diagnosis decreased significantly during the observation period from 11.5 (11.0–13.4) in 2000 to 9.6 (5.1–13.5) years in 2009. The median of the diagnostic latency among IBD patients was 3 months. Conclusion The incidence of IBD in children and adolescents in Saxony was slightly higher than the average of other countries in the same time period and followed the trend towards a general increase of IBD. The age at diagnosis was subject to a very unfavorable downward trend.