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Nielsen LH, Bøtker HE, Sørensen HT, Schmidt M, Pedersen L, Sand NP, Jensen JM, Steffensen FH, Tilsted HH, Bøttcher M, Diederichsen A, Lambrechtsen J, Kristensen LD, Øvrehus KA, Mickley H, Munkholm H, Gøtzsche O, Husain M, Knudsen LL, Nørgaard BL. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: a Danish multicentre cohort study. Eur Heart J 2018; 38:413-421. [PMID: 27941018 DOI: 10.1093/eurheartj/ehw548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 10/23/2016] [Indexed: 01/01/2023] Open
Abstract
Aims To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. Methods and results This cohort study included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death. The Kaplan-Meier estimator was used to compute 91 day to 3.5 year risk according to the CAD severity. Comparisons between patients with and without CAD were based on Cox-regression adjusted for age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac medications, and post-CCTA treatment within 90 days. The composite endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5% for patients without CAD, 6.8% for obstructive CAD, and 15% for three-vessel/left main disease. Compared with patients without CAD, higher relative risk of the composite endpoint was observed for non-obstructive CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63], obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD (HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41; 95% CI :2.90-6.69). The results were consistent in strata of age, sex, and comorbidity. Conclusion Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden.
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Affiliation(s)
- Lene H Nielsen
- Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Peter Sand
- Department of Cardiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming H Steffensen
- Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | | | - Morten Bøttcher
- Department of Cardiology, Regional Hospital Herning, Herning, Denmark
| | | | | | - Lone D Kristensen
- Department of Cardiology, Regional Hospital Silkeborg, Silkeborg, Denmark
| | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Denmark
| | - Henrik Munkholm
- Department of Cardiology, Lillebaelt Hospital-Vejle, Kabbeltoft 25, DK-7100 Vejle, Denmark
| | - Ole Gøtzsche
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Majed Husain
- Department of Cardiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Lars L Knudsen
- Department of Cardiology, Regional Hospital Herning, Herning, Denmark
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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202
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Cronin-Fenton D, Lash TL, Ahern TP, Damkier P, Christiansen P, Ejlertsen B, Sørensen HT. Concurrent new drug prescriptions and prognosis of early breast cancer: studies using the Danish Breast Cancer Group clinical database. Acta Oncol 2018; 57:120-128. [PMID: 29202630 DOI: 10.1080/0284186x.2017.1407040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Myriad reports suggest that frequently used prescription drugs alter the viability of breast cancer cells in pre-clinical studies. Routine use of these drugs, therefore, may impact breast cancer prognosis, and could have important implications for public health. METHODS The Danish Breast Cancer Group (DBCG) clinical database provides high-quality prospectively collected data on breast cancer diagnosis, treatment, and routine follow-up for breast cancer recurrence. Individual-level linkage of DBCG data to other population-based and medical registries in Denmark, including the Danish National Prescription Registry, has facilitated large population-based pharmacoepidemiology studies. A unique advantage of using DBCG data for such studies is the ability to investigate the association of drugs with breast cancer recurrence rather than breast cancer mortality - which may be misclassified - or all-cause mortality. Here we summarize findings from pharmacoepidemiological studies, based on DBCG data, on the association between routinely used prescription drugs and risk of breast cancer recurrence. RESULTS Our findings suggest that concurrent use of glucocorticoids, ACE inhibitors, aspirin, NSAIDs, selective COX-2 inhibitors, digoxin, and opioids has little impact on breast cancer recurrence. Similarly, patients who use SSRIs concurrently with tamoxifen treatment are not at increased risk of recurrence. In contrast, post-diagnostic use of simvastatin, a lipophilic statin, correlates with a decreased risk of breast cancer recurrence, providing a rationale for a prospective randomized clinical trial investigating simvastatin as an adjuvant therapy for breast cancer. CONCLUSION As a whole, findings of pharmacoepidemiological studies based on DBCG data provide reassurance to physicians and healthcare personnel who provide supportive care during and after cancer (including prescriptions for comedications) and to breast cancer survivors for whom the risk of breast cancer recurrence is a major concern.
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Affiliation(s)
| | - Timothy L. Lash
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas P. Ahern
- Departments of Surgery and Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peer Christiansen
- Breast Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Health Research & Policy (Epidemiology), Stanford University, Stanford, CA, USA
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203
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Gedebjerg A, Almdal TP, Berencsi K, Rungby J, Nielsen JS, Witte DR, Friborg S, Brandslund I, Vaag A, Beck-Nielsen H, Sørensen HT, Thomsen RW. Prevalence of micro- and macrovascular diabetes complications at time of type 2 diabetes diagnosis and associated clinical characteristics: A cross-sectional baseline study of 6958 patients in the Danish DD2 cohort. J Diabetes Complications 2018; 32:34-40. [PMID: 29107454 DOI: 10.1016/j.jdiacomp.2017.09.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/17/2022]
Abstract
AIMS To examine the prevalence of micro- and macrovascular complications and their associated clinical characteristics at time of type 2 diabetes (T2D) diagnosis. METHODS We examined the prevalence of complications and associated clinical characteristics among 6958 newly diagnosed T2D patients enrolled in the prospective Danish Center for Strategic Research in T2D cohort during 2010-2016. We calculated age- and gender-adjusted prevalence ratios (aPRs) of complications using log-binomial and Poisson regression. RESULTS In total, 35% (n=2456) T2D patients had diabetic complications around diagnosis; 12% (n=828) had microvascular complications, 17% (n=1186) macrovascular complications, and 6% (n=442) had both. HbA1c levels of ≥7% were associated with microvascular complications [HbA1c 7%-8%; aPR: 1.35, 95% confidence interval (CI): 1.12-1.62] but not macrovascular complications [aPR: 0.91, 95% CI: 0.76-1.08]. High C-peptide≥800pmol/L was associated with macrovascular [aPR 1.34, 95% CI: 1.00-1.80] but not microvascular [aPR 0.97, 95% CI: 0.71-1.33] complications. Macrovascular complications were associated with male sex, age>50years, obesity, hypertriglyceridemia, low HDL cholesterol, smoking, elevated CRP levels, and anti-hypertensive therapy. Microvascular complications were associated with high blood pressure, hypertriglyceridemia, and absence of lipid-lowering therapy. CONCLUSIONS One-third of patients with T2D had diabetes complications around time of diagnosis. Our findings suggest different pathophysiological mechanisms behind micro- and macrovascular complications.
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Affiliation(s)
- Anne Gedebjerg
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Danish Diabetes Academy, Odense University Hospital, Odense, Denmark.
| | - Thomas Peter Almdal
- Department of Endocrinology PE, Rigshospitalet, University of Copenhagen, Denmark
| | - Klara Berencsi
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Department of Endocrinology IC, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jens Steen Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Daniel R Witte
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Søren Friborg
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Ivan Brandslund
- Department of Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | | | - Henning Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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204
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Amiche MA, Abtahi S, Driessen JHM, Vestergaard P, de Vries F, Cadarette SM, Burden AM. Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study. Arch Osteoporos 2018; 13:30. [PMID: 29552730 PMCID: PMC5857556 DOI: 10.1007/s11657-018-0424-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/03/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examined the effect of cumulative exposure to high doses of oral glucocorticoids on fracture risk. Compared to short-course users (daily dose ≥ 15 mg + cumulative < 1 g), heavy users (daily dose ≥ 15 mg + cumulative dose ≥ 1 g) had the highest risk of fracture. These patients should be monitored for fracture management strategies. PURPOSE The effect of cumulative exposure to high daily doses of oral glucocorticoids on fracture risk remains debated. We therefore aimed to examine the hip fracture risk associated with short courses and heavy use of high-dosed oral glucocorticoids. METHODS We conducted a population-based case-control study using the Danish National Health Service data, 1996-2011. Cases were those aged ≥ 18 years who sustained a hip (primary outcome) fracture (n = 81,342). Vertebral and forearm fractures were considered in secondary analyses. Controls (matched 1:1) were those without a fracture. Average daily dose (DD) and total cumulative dose (CD) were calculated among current oral glucocorticoid users. Among patients with a high daily dose (DD ≥ 15 mg), we identified short-course users as those with a CD < 1 g and heavy users as those with a CD ≥ 1 g. We estimated adjusted odds ratio (adj.OR) of fracture with current glucocorticoid use compared to never-use, using conditional logistic regression. RESULTS A high DD (≥ 15 mg) and high CD (≥ 1 g) were independently associated with an increased hip fracture risk (adj.OR 2.5; 95% CI 2.2-2.9; adj.OR 1.6; 95% CI 1.5-1.8, respectively). However, the risk was substantially increased among heavy users (DD ≥ 15 mg and CD ≥ 1 g: adj.OR 2.9; 95% CI 2.5-3.4) as compared to short-course users (DD ≥ 15 mg and CD < 1 g: adj.OR 1.4; 95% CI 1.1-1.9). Associations were stronger for vertebral fractures, yet little association was identified for forearm fractures. CONCLUSION Among patients receiving a high DD (≥ 15 mg), heavy users (≥ 1 g CD) showed the most substantial increase in hip fracture risk. Among those receiving high DD, a threshold of 1 g CD may identify heavy users that are candidates for focused fracture management services.
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Affiliation(s)
- M. Amine Amiche
- 0000 0001 2157 2938grid.17063.33Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Shahab Abtahi
- 0000 0004 0480 1382grid.412966.eDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Johanna H. M. Driessen
- 0000 0004 0480 1382grid.412966.eDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands ,0000000120346234grid.5477.1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands ,0000 0001 0481 6099grid.5012.6NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Peter Vestergaard
- 0000 0001 0742 471Xgrid.5117.2Department of Clinical Medicine, Aalborg University, Aalborg, Denmark ,0000 0004 0646 7349grid.27530.33Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Frank de Vries
- 0000 0004 0480 1382grid.412966.eDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands ,0000000120346234grid.5477.1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Suzanne M. Cadarette
- 0000 0001 2157 2938grid.17063.33Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Andrea M. Burden
- 0000 0004 0480 1382grid.412966.eDepartment of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands ,0000000120346234grid.5477.1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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205
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Lund JL, Horváth-Puhó E, Komjáthiné Szépligeti S, Sørensen HT, Pedersen L, Ehrenstein V, Stürmer T. Conditioning on future exposure to define study cohorts can induce bias: the case of low-dose acetylsalicylic acid and risk of major bleeding. Clin Epidemiol 2017; 9:611-626. [PMID: 29200891 PMCID: PMC5703173 DOI: 10.2147/clep.s147175] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background A principle of cohort studies is that cohort membership is defined by current rather than future exposure information. Pharmacoepidemiologic studies using existing databases are vulnerable to violation of this principle. We evaluated the impact of using data on future redemption of prescriptions to determine cohort membership, motivated by a published example seeking to emulate a “per-protocol” association between continuous versus never use of low-dose acetylsalicylic acid (ASA) and major bleeding (e.g., cerebral hemorrhage or gastrointestinal bleeding). Materials and methods Danish medical registry data from 2004 to 2011 were used to construct two analytic cohorts. In Cohort 1, we used information about future redemption of low-dose ASA prescriptions to identify cohorts of continuous and never-ASA users. In Cohort 2, we identified ASA initiators and non-initiators using only contemporaneous data and censored follow-up for changes in use over time. We implemented propensity score-matched Poisson regression to evaluate associations between ASA use and major bleeding and estimated adjusted incidence rate differences (IRDs) per 1,000 person-years and ratios (IRRs) overall and stratified by time since initiation. Results Among >6 million eligible Danish adults, we identified 403,693 low-dose ASA initiators (Cohort 2), of whom 189,150 were defined as continuous users (Cohort 1). Overall, IRDs and IRRs were similar across cohorts. However, the IRD for major bleeding in the first 90 days was substantially larger in Cohort 1 (IRD=25 per 1,000 person-years) compared with Cohort 2 (IRD=10 per 1,000 person-years). Conclusion Using future medication redemption data to define baseline cohorts violates basic epidemiologic principles. Compared with an approach using only contemporaneous data to define cohorts, the approach based on future redemption data generated a substantially higher short-term association between low-dose ASA use and major bleeding on the absolute, but not the relative, scale possibly due to selection and immortal time biases.
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Affiliation(s)
- Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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206
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Olesen KKW, Madsen M, Lip GYH, Egholm G, Thim T, Jensen LO, Raungaard B, Nielsen JC, Bøtker HE, Sørensen HT, Maeng M. Coronary artery disease and risk of adverse cardiac events and stroke. Eur J Clin Invest 2017; 47:819-828. [PMID: 28804899 DOI: 10.1111/eci.12804] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction are at increased risk of ischaemic stroke. Previous myocardial infarction is an important part of risk assessment for ischaemic stroke. However, there is a lack of information regarding the association between the severity and extent of coronary artery disease and long-term risk of ischaemic stroke. MATERIALS AND METHODS A cohort study of coronary angiographies performed in western Denmark from 1 January 2003 to 31 December 2012. Patients were stratified according to the number of vessels affected by obstructive coronary artery disease (lumen narrowing ≥50%) at the time of angiography: zero-, one-, two- or three-vessel disease and diffuse vessel disease. We followed patients for a maximum of 7 years. Endpoints were all-cause death, cardiac death, myocardial infarction and ischaemic stroke. Cumulative risks and crude and adjusted rate ratios were estimated. RESULTS The study population included 78 195 patients. Of these, 32 061 (41·0%) had zero-vessel disease, 6205 (7·9%) had diffuse vessel disease, 20 202 (25·8%) had one-vessel disease, 10 675 (13·7%) had two-vessel disease, and 9038 (11·6%) had three-vessel disease. Median follow-up was 3·6 years (interquartile range 1·7-6·0 years). Increasing severity of obstructive coronary artery disease was associated with an increasing risk of all-cause death, cardiac death, myocardial infarction (MI) and ischaemic stroke during follow-up. CONCLUSIONS The presence and extent of coronary artery disease was associated with an incremental risk of not only death, cardiac death, myocardial infarction, but also ischaemic stroke over a 7-year period.
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Affiliation(s)
- Kevin Kris Warnakula Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Gro Egholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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207
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Randomized clinical trial: the impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy. Eur J Gastroenterol Hepatol 2017; 29:1118-1125. [PMID: 28678044 DOI: 10.1097/meg.0000000000000934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB).The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. PATIENTS AND METHODS In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. RESULTS The incidence of UGIB was 0.8 versus 1.3% in screened patients and controls, respectively (P=0.381).Significantly fewer screened patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5%) (P=0.422). CONCLUSION Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.
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208
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Nørgård BM, Magnussen B, Larsen MD, Friedman S. Reassuring results on birth outcomes in children fathered by men treated with azathioprine/6-mercaptopurine within 3 months before conception: a nationwide cohort study. Gut 2017; 66:1761-1766. [PMID: 27456154 DOI: 10.1136/gutjnl-2016-312123] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/09/2016] [Accepted: 07/02/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Information on the safety of paternal use of azathioprine (AZA) and 6-mercaptopurine (6-MP) prior to conception is limited. Based on nationwide data from the Danish health registries, we examined the association between paternal use of AZA/6-MP within 3 months before conception and adverse birth outcomes. DESIGN This nationwide cohort study is based on data from all singletons born in Denmark from 1 January 1997 through 2013. Children fathered by men who used AZA/6-MP within 3 months before conception constituted the exposed cohort (N=699), and children fathered by men who did not use AZA/6-MP 3 months prior to conception constituted the unexposed cohort (N=1 012 624). The outcomes were congenital abnormalities (CAs), preterm birth and small for gestational age (SGA). We adjusted for multiple covariates and performed a restricted analysis of men with IBD. RESULTS There were no significantly increased risks of CAs, preterm birth or SGA in exposed versus unexposed cohorts of children. The adjusted ORs were 0.82 (95% CI 0.53 to 1.28) for CAs, 1.17 (95% CI 0.72 to 1.92) for preterm birth and 1.38 (95% CI 0.76 to 2.51) for SGA. Restricting our analysis to fathers with IBD showed similar results with no significantly increased risk of adverse birth outcomes. CONCLUSIONS This nationwide study is the largest to date, examining the effect of preconceptual paternal use of AZA/6-MP on birth outcomes in live born singletons. The results of no significantly increased risks of adverse birth outcomes are reassuring and support the continuation of paternal AZA/6-MP treatment during conception.
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Affiliation(s)
- B M Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - B Magnussen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - M D Larsen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark
| | - S Friedman
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Odense, Denmark.,Center for Crohn's and Colitis, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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209
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Kinlaw AC, Stürmer T, Lund JL, Pedersen L, Kappelman MD, Daniels JL, Frøslev T, Mack CD, Sørensen HT. Trends in Antibiotic Use by Birth Season and Birth Year. Pediatrics 2017; 140:e20170441. [PMID: 28808074 PMCID: PMC5574728 DOI: 10.1542/peds.2017-0441] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined 2 birth cohort effects on antibiotic prescribing during the first year of life (henceforth, infancy) in Denmark: (1) the birth season effect on timing and overall occurrence of antibiotic prescribing, and (2) the birth year effect amid emerging nationwide pneumococcal vaccination programs and changing prescribing guidelines. METHODS We linked data for all live births in Denmark from 2004 to 2012 (N = 561 729) across the National Health Service Prescription Database, Medical Birth Registry, and Civil Registration System. Across birth season and birth year cohorts, we estimated 1-year risk, rate, and burden of redeemed antibiotic prescriptions during infancy. We used interrupted time series methods to assess prescribing trends across birth year cohorts. Graphical displays of all birth cohort effect data are included. RESULTS The 1-year risk of having at least 1 redeemed antibiotic prescription during infancy was 39.5% (99% confidence interval [CI]: 39.3% to 39.6%). The hazard of a first prescription increased with age throughout infancy and varied by season; subsequently, Kaplan-Meier-derived risk functions varied by birth season cohort. After rollout of a first vaccination program and new antibiotic prescribing guidelines, 1-year risk decreased by 4.4% over 14 months (99% CI: 3.4% to 5.5%); it decreased again after rollout of a second vaccination program by 6.9% over 3 years (99% CI: 4.4% to 9.3%). CONCLUSIONS In Denmark, birth season and birth year cohort effects influenced timing and risk of antibiotic prescribing during infancy. Future studies of antibiotic stewardship, effectiveness, and safety in children should consider these cohort effects, which may render some children inherently more susceptible than others to downstream antibiotic effects.
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Affiliation(s)
- Alan C Kinlaw
- Cecil G. Sheps Center for Health Services Research,
- Departments of Epidemiology and
| | - Til Stürmer
- Cecil G. Sheps Center for Health Services Research
- Departments of Epidemiology and
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Michael D Kappelman
- Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Christina D Mack
- Departments of Epidemiology and
- QuintilesIMS, Durham, North Carolina; and
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
- Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California
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210
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Olesen KKW, Madsen M, Egholm G, Thim T, Jensen LO, Raungaard B, Bøtker HE, Sørensen HT, Maeng M. Patients With Diabetes Without Significant Angiographic Coronary Artery Disease Have the Same Risk of Myocardial Infarction as Patients Without Diabetes in a Real-World Population Receiving Appropriate Prophylactic Treatment. Diabetes Care 2017; 40:1103-1110. [PMID: 28596210 DOI: 10.2337/dc16-2388] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The risk of myocardial infarction (MI) in patients with diabetes is greater than for patients without diabetes. Consequently, prophylactic treatment is recommended for patients with diabetes and risk factors for ischemic heart disease. We aimed to estimate the risk of adverse cardiac events in patients with and without diabetes with and without coronary artery disease (CAD) after coronary angiography (CAG). RESEARCH DESIGN AND METHODS A population-based cohort of patients registered in the Western Denmark Heart Registry who underwent CAG between 1 January 2003 and 31 December 2012 was stratified according to the presence or absence of obstructive CAD and diabetes. End points were death, cardiac death, and MI. Unadjusted and adjusted rate ratios (RRs) were calculated by using patients without diabetes and without CAD as the reference group. RESULTS We included 93,866 patients of whom 12,544 (13.4%) had diabetes at the time of CAG. Median follow-up was 4.1 years. Patients with and without diabetes without obstructive CAD had the same adjusted risk of death (RR 1.03 [95% CI 0.92-1.15]), cardiac death (RR 1.21 [95% CI 0.90-1.64]), and MI (RR 0.88 [95% CI 0.65-1.17]). Patients with diabetes without CAD were more often treated with statins (75.3% vs. 46.0%) and aspirin (65.7% vs. 52.7%) than patients without diabetes and CAD. CONCLUSIONS In a real-world population, patients with diabetes with high rates of statin and aspirin treatment had the same risk of cardiovascular events as patients without diabetes in the absence of angiographically significant CAD.
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Affiliation(s)
- Kevin K W Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gro Egholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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211
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Ehrenstein V, Andersen SL, Qazi I, Sankar N, Pedersen AB, Sikorski R, Acquavella JF. Tenosynovial Giant Cell Tumor: Incidence, Prevalence, Patient Characteristics, and Recurrence. A Registry-based Cohort Study in Denmark. J Rheumatol 2017; 44:1476-1483. [PMID: 28765257 DOI: 10.3899/jrheum.160816] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Tenosynovial giant cell tumor (TGCT) is a rare benign proliferative and inflammatory disease arising from synovia of joints, bursae, or tendon sheaths. We aimed to estimate incidence rate and prevalence of TGCT in Denmark, to describe patient characteristics and treatment modalities among patients with TGCT, and to estimate risk of TGCT recurrence. METHODS Using registry data on pathology examinations and inpatient and outpatient hospital diagnoses, we identified adult patients with diagnoses of diffuse TGCT (D-TGCT) or localized TGCT (L-TGCT) between 1997 and 2012, followed through 2012. We described patients' characteristics, treatment modalities, and recurrence. RESULTS We identified 2087 patients with L-TGCT and 574 patients with D-TGCT. Their incidence rates per million person-years were 30.3 (95% CI 29.1-31.7) and 8.4 (95% CI 7.7-9.1), respectively. At the end of 2012, prevalence per 100,000 persons was 44.3 (95% CI 42.4-46.3) for L-TGCT and 11.5 (95% CI 10.6-12.6) for D-TGCT. Women made up 61% of the patients with L-TGCT and 51% of the patients with D-TGCT. Median age at diagnosis was 47 years. Ten-year risk of recurrence was 9.8% (95% CI 8.4-11.3%) after L-TGCT and 19.1% (95% CI 15.7-22.7%) after D-TGCT. CONCLUSION This study contributes evidence about epidemiology of TGCT based on routinely collected population-based data gathered in a setting of universal equal access to healthcare and complete followup.
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Affiliation(s)
- Vera Ehrenstein
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA. .,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital.
| | - Søren L Andersen
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Ibrahim Qazi
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Neil Sankar
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Alma B Pedersen
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Robert Sikorski
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - John F Acquavella
- From the Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Five Prime Therapeutics Inc., South San Francisco, California, USA.,V. Ehrenstein, MPH, DSc, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; S.L. Andersen, PhD, Biostatistician, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; I. Qazi, PharmD, Senior Clinical Scientist, Five Prime Therapeutics Inc.; N. Sankar, MD, MPH, Medical Director, Clinical Consultant, Five Prime Therapeutics Inc.; A.B. Pedersen, MD, PhD, DMSc, Clinical Associate Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital; R. Sikorski, MD, PhD, Chief Medical Officer, Five Prime Therapeutics Inc.; J.F. Acquavella, PhD, Professor, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
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Jørgensen C, Pitter F, Kehlet H. Safety aspects of preoperative high-dose glucocorticoid in primary total knee replacement. Br J Anaesth 2017; 119:267-275. [DOI: 10.1093/bja/aex190] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 12/16/2022] Open
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213
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Sundbøll J, Hováth-Puhó E, Adelborg K, Ording A, Schmidt M, Bøtker HE, Sørensen HT. Risk of arterial and venous thromboembolism in patients with atrial fibrillation or flutter: A nationwide population-based cohort study. Int J Cardiol 2017; 241:182-187. [DOI: 10.1016/j.ijcard.2017.04.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/03/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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214
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Pitter FT, Jørgensen CC, Lindberg-Larsen M, Kehlet H. Postoperative Morbidity and Discharge Destinations After Fast-Track Hip and Knee Arthroplasty in Patients Older Than 85 Years. Anesth Analg 2017; 122:1807-15. [PMID: 27195631 DOI: 10.1213/ane.0000000000001190] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elderly patients are at risk of increased length of hospital stay (LOS), postoperative complications, readmission, and discharge to destinations other than home after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recent studies have found that enhanced recovery protocols or fast-track surgery can be safe for elderly patients undergoing these procedures and may result in reduced LOS. However, detailed studies on preoperative comorbidity and differentiation between medical and surgical postoperative morbidity in elderly patients are scarce. The aim of this study was to provide detailed information on postoperative morbidity resulting in LOS >4 days or readmissions <90 days after fast-track THA and TKA in patients ≥85 years. METHODS This is a descriptive, observational study in consecutive unselected patients ≥85 years undergoing fast-track THA/TKA. The primary outcome was the causes of postoperative morbidity leading to an LOS of >4 days. Secondary outcomes were 90-day surgically related readmissions, discharge destination, 90-day mortality, and role of disposing factors for LOS >4 days and 90-day readmissions. Data on preoperative characteristics were prospectively gathered using patient-reported questionnaires. Data on all admissions were collected using the Danish National Health Registry, ensuring complete follow-up. Any cases of LOS >4 days or readmissions were investigated through review of discharge forms or medical records. Backward stepwise logistic regression was used for analysis of association between disposing factors and LOS >4 days and 90-day readmission. RESULTS Of 13,775 procedures, 549 were performed in 522 patients ≥85 years. Median age was 87 years (interquartile range, 85-88) and median LOS of 3 days (interquartile range, 2-5). In 27.3% procedures, LOS was >4 days, with 82.7% due to medical causes, most often related to anemia requiring blood transfusion and mobilization issues. Use of walking aids was associated with LOS >4 days (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.26-3.15; P = 0.003), whereas preoperative anemia showed borderline significance (OR, 1.52; 95% CI, 0.99-2.32; P = 0.057). Thirty-eight patients (6.9%) were not discharged directly home, of which 68.4% had LOS >4 days. Readmission rates were 14.2% and 17.9% within 30 and 90 days, respectively, and 75.5% of readmissions within 90 days were medical, mainly due to falls and suspected but disproved venous thromboembolic events. Preoperative anemia was associated with increased (OR, 1.81; 95% CI, 1.13-2.91; P = 0.014) and living alone with decreased (OR, 0.50; 95% CI, 0.31-0.80; P = 0.004) risk of 90-day readmissions. Ninety-day mortality was 2.0%, with 1.0% occurring during primary admission. CONCLUSIONS Fast-track THA and TKA with an LOS of median 3 days and discharge to home are feasible in most patients ≥85 years. However, further attention to pre- and postoperative anemia and the pathogenesis of medical complications is needed to improve postoperative outcomes and reduce readmissions.
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Affiliation(s)
- Frederik T Pitter
- From the *Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; †The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark; and ‡Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
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215
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Kjærgaard KA, Christiansen MK, Schmidt M, Olsen MS, Jensen HK. Long-Term Cardiovascular Risk in Heterozygous Familial Hypercholesterolemia Relatives Identified by Cascade Screening. J Am Heart Assoc 2017; 6:JAHA.116.005435. [PMID: 28652386 PMCID: PMC5669167 DOI: 10.1161/jaha.116.005435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Heterozygous familial hypercholesterolemia increases the risk of adverse cardiovascular events. Whether affected relatives of probands are at increased risk remains unknown. We aimed to evaluate the long‐term cardiovascular risk in heterozygous familial hypercholesterolemia relatives with a low‐density lipoprotein receptor (LDLR) mutation who were all recommended statin therapy. Methods and Results Participants were identified by cascade screening at Aarhus University Hospital during 1992–1994. A comparison cohort from the Danish general population was matched 10:1 to relatives by birth year and sex. Using medical registries, participants were followed until the event of interest, migration, death, or end of follow‐up on December 31, 2014. The primary end point was all‐cause mortality and major adverse cardiovascular events comprising myocardial infarction, ischemic stroke, transient ischemic attack, peripheral artery disease, and coronary revascularization. We included 220 relatives. Median age was 37 years (interquartile range: 27–52 years) of which 118 (54%) had an LDLR mutation. By 2004, when prescription data became available, 89% of mutation‐carrying participants were taking statins during their follow‐up period. Despite frequent use of lipid‐lowering medication, the adjusted hazard ratio of the primary end point was 1.65 (95% confidence interval, 1.17–2.33) in mutation‐carrying relatives compared with the general population cohort. The risk in non–mutation‐carrying relatives was not different from that of the general population cohort (adjusted hazard ratio: 0.85; 95% confidence interval, 0.56–1.29). Comparing mutation‐carrying relatives with non–mutation‐carrying relatives, the adjusted hazard ratio was 1.94 (95% confidence interval, 1.14–3.31). Results were driven by nonfatal events. Conclusion Heterozygous familial hypercholesterolemia relatives with an LDLR mutation had an increased long‐term risk of adverse cardiovascular events.
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Affiliation(s)
- Kasper Aalbæk Kjærgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Smærup Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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216
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Nielsen SW, Ljungdalh PM, Nielsen J, Nørgård BM, Qvist N. Maternal use of selective serotonin reuptake inhibitors during pregnancy is associated with Hirschsprung's disease in newborns - a nationwide cohort study. Orphanet J Rare Dis 2017. [PMID: 28633635 PMCID: PMC5477755 DOI: 10.1186/s13023-017-0667-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hirschsprung's disease is a rare condition caused by congenital malformation of the gastrointestinal tract affecting 1:5000 children. Not much is known about risk factors for development of Hirschsprung's disease. Two clinical cases of hirschsprung's disease led to an investigation of the association between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and development of Hirschsprung's Disease in the newborn child. The study examined a nationwide, unselected cohort of children born in Denmark from 1 January 1996 until 12 March 2016 (n = 1,256,317). We applied multivariate models to register-based data to estimate the odds ratio of Hirschsprung's disease, adjusting for possible confounders. The studied exposure period for SSRIs were 30 days prior to conception to the end of the first trimester. RESULTS In the main exposed cohort the prevalence of Hirschsprung's disease was 16/19.807 (0.08%) compared to 584/1.236.510 (0.05%) in the unexposed cohort. In women who redeemed a minimum of one prescription of selective serotonin reuptake inhibitors, the adjusted odds ratio for development of Hirschsprung's disease was 1.76 (95%CI: 1.07-2.92). In women who redeemed a minimum of two prescriptions, the adjusted odds ratio for Hirschsprung's disease was 2.34 (95% CI: 1.21-4.55). CONCLUSIONS Our data suggest that early maternal use of selective serotonin reuptake inhibitors is significantly associated with the development of Hirschsprung's disease in the newborn child. Treatment of depression during pregnancy always has to be weighed against the risks posed by untreated maternal depression. Our results have to be confirmed in other studies.
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Affiliation(s)
- Sebastian Werngreen Nielsen
- Department of Surgical Gastroenterology A, Odense University Hospital, and Research Unit of Surgery, Institute of Clinical Research, University of Southern Denmark, 5000, Odense C, DK, Denmark. .,, Engelshøjgade 26 1TH, 6400, Sønderborg, Denmark.
| | - Perniller Møller Ljungdalh
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, 5000, Odense C, DK, Denmark
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, 5000, Odense C, DK, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, 5000, Odense C, DK, Denmark
| | - Niels Qvist
- Department of Surgical Gastroenterology A, Odense University Hospital, and Research Unit of Surgery, Institute of Clinical Research, University of Southern Denmark, 5000, Odense C, DK, Denmark
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217
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Hyldgaard C, Hilberg O, Pedersen AB, Ulrichsen SP, Løkke A, Bendstrup E, Ellingsen T. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis 2017; 76:1700-1706. [DOI: 10.1136/annrheumdis-2017-211138] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/04/2017] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
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218
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Agergaard K, Mau-Sørensen M, Stage TB, Jørgensen TL, Hassel RE, Steffensen KD, Pedersen JW, Milo MLH, Poulsen SH, Pottegård A, Hallas J, Brøsen K, Bergmann TK. Clopidogrel-Paclitaxel Drug-Drug Interaction: A Pharmacoepidemiologic Study. Clin Pharmacol Ther 2017; 102:547-553. [DOI: 10.1002/cpt.674] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- K Agergaard
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - M Mau-Sørensen
- Department of Oncology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - TB Stage
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
- Department of Bioengineering and Therapeutics Sciences; University of California San Francisco; San Francisco California USA
| | - TL Jørgensen
- Department of Oncology; Odense University Hospital; Odense Denmark
- AgeCare, Academy of Geriatric Cancer Research; Odense University Hospital; Odense Denmark
| | - RE Hassel
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - KD Steffensen
- Department of Oncology; Lillebaelt Hospital; Vejle Denmark
| | - JW Pedersen
- Department of Oncology; Herlev Hospital, Copenhagen University Hospital; Herlev Denmark
| | - MLH Milo
- Department of Oncology; Aalborg University Hospital; Aalborg Denmark
| | - SH Poulsen
- Department of Oncology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - A Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - J Hallas
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
| | - K Brøsen
- Clinical Pharmacology and Pharmacy; Department of Public Health, University of Southern Denmark; Odense Denmark
- OPEN; Odense Patient Data Explorative Network, Odense University Hospital; Odense Denmark
| | - TK Bergmann
- Department of Clinical Biochemistry and Pharmacology; Odense University Hospital; Odense Denmark
- Hospital Pharmacy; Hospital of South West Denmark; Esbjerg Denmark
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219
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Adelborg K, Szépligeti S, Sundbøll J, Horváth-Puhó E, Henderson VW, Ording A, Pedersen L, Sørensen HT. Risk of Stroke in Patients With Heart Failure. Stroke 2017; 48:1161-1168. [DOI: 10.1161/strokeaha.116.016022] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The long-term risk of specific stroke subtypes among heart failure patients is largely unknown. We examined short-term and long-term risk of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in heart failure patients and in a general population comparison cohort.
Methods—
In this nationwide cohort study (1980−2012), we used Danish population-based medical registries to identify and follow (1) all patients hospitalized for the first time with heart failure and (2) a birth year–, sex-, and calendar year–matched general population comparison cohort. Age-, sex-, and comorbidity-adjusted stroke rate ratios were computed based on Cox regression analysis.
Results—
We included 289 353 patients with heart failure and 1 446 765 individuals from the general population in the analysis. One- and 5-year risks among heart failure patients were 1.4% and 3.9% for ischemic stroke, 0.2% and 0.5% for ICH, and 0.03% and 0.07% for SAH. The 30-day adjusted stroke rate ratio was increased markedly for ischemic stroke (5.08; 95% confidence interval, 4.58–5.63] and was also elevated for ICH (2.13; 95% confidence interval, 1.53–2.97) and SAH (3.52; 95% confidence interval, 1.54–8.08). Between 31 days and 30 years, risk of all stroke subtypes remained positively associated with heart failure (1.5- to 2.1-fold for ischemic stroke, 1.4- to 1.8-fold for ICH, and 1.1- to 1.7-fold for SAH) in comparison with the general population cohort.
Conclusions—
Heart failure was associated with increased short-term and long-term risk of all stroke subtypes, suggesting that heart failure is a potent and persistent risk factor for ischemic stroke, ICH, and SAH.
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Affiliation(s)
- Kasper Adelborg
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Szimonetta Szépligeti
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Jens Sundbøll
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Erzsébet Horváth-Puhó
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Victor W. Henderson
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Anne Ording
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Lars Pedersen
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
| | - Henrik Toft Sørensen
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (K.A., S.S., J.S., E.H.-P., V.W.H., A.O., L.P., H.T.S.); and Department of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Department of Neurology and Neurological Sciences (V.W.H.), Stanford University, CA
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Broersen LHA, Horváth-Puhó E, Pereira AM, Erichsen R, Dekkers OM, Sørensen HT. Corticosteroid use and mortality risk in patients with perforated colonic diverticular disease: a population-based cohort study. BMJ Open Gastroenterol 2017; 4:e000136. [PMID: 28461904 PMCID: PMC5387955 DOI: 10.1136/bmjgast-2017-000136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 01/05/2023] Open
Abstract
Background Corticosteroids are a potential risk factor for mortality in patients with perforated diverticular disease, due to blinding of disease severity, hampered wound healing or adrenal insufficiency. We examined mortality in corticosteroid users and non-users among patients with perforated diverticular disease. Methods A cohort study based on medical databases including all patients ≥18 years in Denmark (source population 5 289 261 inhabitants) admitted to a hospital with incident perforated diverticular disease between 2005 and 2013. 7-day, 1-month, 3-month and 1-year mortality risks in corticosteroid users and non-users were calculated using the Kaplan–Meier method, and compared with Cox proportional hazard regression adjusted for age, sex and comorbidities. Results The study included 4640 patients with perforated diverticular disease. Of these, 3743 (80.7%) had not used corticosteroids in the year before admission and 725 (15.6%) had been exposed to systemic corticosteroid treatment. The remaining 172 patients had been exposed to either inhaled or intestinal acting corticosteroid therapy. Mortality risk in non-users was 4.4% after 7 days and 15.6% after 1 year. This risk was doubled for corticosteroid users who filled their last prescription during the 90 days before admission, with mortality risks ranging from 14.2% after 7 days to 47.6% after 1 year. 1-year mortality risk was even higher for corticosteroid users with a first filled prescription ≤90 days before admission: 52.5%. Conclusions Corticosteroid use was associated with clearly increased mortality risk after perforated diverticular disease. Thus, use of corticosteroids should be regarded as an important clinical prognostic factor for mortality in patients with this condition.
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Affiliation(s)
- L H A Broersen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - A M Pereira
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - R Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - O M Dekkers
- Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Jørgensen CC, Kehlet H. Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand 2017; 61:436-444. [PMID: 28150297 DOI: 10.1111/aas.12860] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. METHODS Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. RESULTS Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0-30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. CONCLUSION Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.
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Affiliation(s)
- C. C. Jørgensen
- Section for Surgical Pathophysiology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
- The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement; Copenhagen Denmark
| | - H. Kehlet
- Section for Surgical Pathophysiology; Rigshospitalet; Copenhagen University; Copenhagen Denmark
- The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement; Copenhagen Denmark
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Simonsen DF, Farkas DK, Horsburgh CR, Thomsen RW, Sørensen HT. Increased risk of active tuberculosis after cancer diagnosis. J Infect 2017; 74:590-598. [PMID: 28366685 DOI: 10.1016/j.jinf.2017.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/27/2017] [Accepted: 03/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer may increase risk of active tuberculosis but evidence is sparse. We therefore examined tuberculosis risk in patients with incident cancer using Danish nationwide medical databases. METHODS We conducted a matched follow-up study comparing risk of active tuberculosis in cancer-exposed individuals to that in a general population comparison cohort, matched on gender, age, and country of origin, in different follow-up intervals using Cox regression. FINDINGS We identified 290,944 patients with incident cancer and 871,147 matched comparison cohort members during 1 January, 2004-30 November, 2013. After adjusting for comorbidities, the overall adjusted hazard ratio (aHR) for tuberculosis among cancer patients was 2.48 (95% confidence interval [CI]: 1.99-3.10). The highest tuberculosis risks were observed following cancers of the aerodigestive tract (aHR = 8.12; 95% CI: 4.33-15.22), tobacco-related cancers (aHR = 5.01; 95% CI: 3.37-7.44), and hematological cancers (aHR = 4.88; 95% CI: 2.27-10.48). Tuberculosis risk was highly elevated within the first year after cancer diagnosis (aHR = 4.14; 95% CI: 2.88-5.96), with a 6.78-fold increased aHR for cancer patients receiving cytostatics or radiotherapy. Beyond five years of observation, the overall aHR for tuberculosis remained at 2.66 (95% CI: 1.22-5.81). INTERPRETATION Cancer is a clinical predictor for increased risk of active tuberculosis, probably related to decreased infection barriers, immunosuppression, and shared risk factors.
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Affiliation(s)
- Dennis F Simonsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Charles R Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Hallas J, Hellfritzsch M, Rix M, Olesen M, Reilev M, Pottegård A. Odense Pharmacoepidemiological Database: A Review of Use and Content. Basic Clin Pharmacol Toxicol 2017; 120:419-425. [PMID: 28164442 DOI: 10.1111/bcpt.12764] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/27/2017] [Indexed: 11/27/2022]
Abstract
The Odense University Pharmacoepidemiological Database (OPED) is a prescription database established in 1990 by the University of Southern Denmark, covering reimbursed prescriptions from the county of Funen in Denmark and the region of Southern Denmark (1.2 million inhabitants). It is still active and thereby has more than 25 years of continuous coverage. In this MiniReview, we review its history, content, quality, coverage, governance and some of its uses. OPED's data include the Danish Civil Registration Number (CPR), which enables unambiguous linkage with virtually all other health-related registers in Denmark. Among its research uses, we review record linkage studies of drug effects, advanced drug utilization studies, some examples of method development and use of OPED as sampling frame to recruit patients for field studies or clinical trials. With the advent of other, more comprehensive sources of prescription data in Denmark, OPED may still play a role as in certain data-intensive regional studies.
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Affiliation(s)
- Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Morten Rix
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Morten Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Pedersen AB, Gammelager H, Kahlert J, Sørensen HT, Christiansen CF. Impact of body mass index on risk of acute kidney injury and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 2017; 28:1087-1097. [PMID: 27866215 DOI: 10.1007/s00198-016-3836-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Abstract
UNLABELLED The literature is limited regarding risk factors for acute kidney injury (AKI) and mortality in hip fracture patients, although AKI is common in these patients. While obese patients were at increased risk of AKI, underweight patients with and without AKI had elevated mortality for up to 1 year after hip fracture surgery, compared with normal-weight patients. INTRODUCTION This study aimed to examine risk of postoperative AKI and subsequent mortality, by body mass index (BMI) level, in hip fracture surgery patients aged 65 and over. METHODS A regional cohort study using medical databases was used. We included all patients who underwent surgery to repair a hip fracture during the years 2005-2011 (n = 13,529) at hospitals in Northern Denmark. We calculated cumulative risk of AKI by BMI level during 5 days postsurgery and subsequent short-term (6-30 days postsurgery) and long-term (31-365 days post-surgery) mortality. We calculated crude and adjusted hazard ratios (aHRs) for AKI and death with 95% confidence intervals (CIs), comparing underweight, overweight, and obese patients with normal-weight patients. RESULTS Risks of AKI within five postoperative days were 11.9, 10.1, 12.5, and 17.9% for normal-weight, underweight, overweight, and obese patients, respectively. Among those who developed AKI, short-term mortality was 14.1% for normal-weight patients compared to 23.1% for underweight (aHR 1.7 (95% CI 1.2-2.4)), 10.7% for overweight (aHR 0.9 (95% CI 0.6-1.1)), and 15.2% for obese (aHR 0.9 (95% CI 0.6-1.4)) patients. Long-term mortality was 24.5% for normal-weight, 43.8% for underweight (aHR 1.6 (95% CI 1.0-2.6)), 20.5% for overweight (aHR 0.8 (95% CI 0.6-1.2)), and 21.4% for obese (aHR 1.1 (95% CI 0.7-1.8) AKI patients. Similar associations between BMI and mortality were observed among patients without postoperative AKI, although the absolute mortality risk estimates by BMI were considerably lower in patients without than in those with AKI. CONCLUSIONS Obese patients were at increased risk of AKI compared with normal-weight patients. Among patients with and without postoperative AKI, overweight and obesity were not associated with mortality. Compared to normal-weight patients, underweight patients had elevated mortality for up to 1 year after hip fracture surgery irrespective of the presence of AKI. The absolute mortality risks were higher in all BMI groups with the presence of AKI.
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Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - H Gammelager
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - J Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
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Jørgensen CC, Kehlet H. Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties. Acta Orthop 2017; 88:55-61. [PMID: 27759465 PMCID: PMC5251265 DOI: 10.1080/17453674.2016.1245998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background - The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies. Patients and methods - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment. We performed 30-day follow-up on in-hospital complications and re-admissions through the Danish National Patient Registry and patient records. Results - Of 13,375 procedures, 649 (4.7%) were in VKA patients with a mean age of 73 (SD 9) years and a median length of stay of 3 days (IQR: 2-4). Preoperative bridging was used in 430 (67%), while 215 (33%) were paused. Of 4 arterial thromboembolic events (ATEs) (0.6%), 2 were in paused patients and 2 were in bridged patients (p = 0.6). Of 3 venous thromboembolic events (VTEs) (0.5%), 2 were in paused patients and 1 was in a bridged patient (p = 0.3). Of 8 major bleedings (MBs) (1.2%), 1 was in a paused patient and 7 were in bridged patients (p = 0.3), 5 of whom received therapeutic bridging. Similar results were found in a propensity-matched cohort. Interpretation - In contrast to recent studies in mixed surgical procedures, no statistically significant differences in ATE, VTE, or MB were found between preoperative bridging and pausation of VKA patients. However, the higher number of thromboembolic events in paused patients and the higher number of major bleedings in bridged patients warrant more extensive investigation.
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Affiliation(s)
- Christoffer C Jørgensen
- Section for Surgical Pathophysiology and,the Lundbeck Foundation Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.,Correspondence:
| | - Henrik Kehlet
- Section for Surgical Pathophysiology and,the Lundbeck Foundation Center for Fast-track Hip and Knee Replacement, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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Haldrup S, Thomsen RW, Bro F, Skov R, Bjerrum L, Søgaard M. Microbiological point of care testing before antibiotic prescribing in primary care: considerable variations between practices. BMC FAMILY PRACTICE 2017; 18:9. [PMID: 28125965 PMCID: PMC5270219 DOI: 10.1186/s12875-016-0576-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022]
Abstract
Background Point-of-care testing (POCT) in primary care may improve rational antibiotic prescribing. We examined use of POCT in Denmark, including patient- and general practitioner (GP)-related predictors. Methods We linked nationwide health care databases to assess POCT use (C-reactive protein (CRP), group A streptococcal (GAS) antigen swabs, bacteriological cultures, and urine test strips) per 1,000 overall GP consultations, 2004–2013. We computed odds ratios (OR) of POCT in patients prescribed antibiotics according to patient and GP age and sex, GP practice type, location, and workload. Results The overall use of POCT in Denmark increased by 45.8% during 2004–2013, from 147.2 per 1,000 overall consultations to 214.8. CRP tests increased by 132%, bacteriological cultures by 101.7% while GAS swabs decreased by 8.6%. POCT preceded 28% of antibiotic prescriptions in 2004 increasing to 44% in 2013. The use of POCT varied more than 5-fold among individual practices, from 54.9 to 394.7 per 1,000 consultations in 2013. POCT use varied substantially with patient age, and males were less likely to receive POCT than females (adjusted OR = 0.75, 95% CI 0.74-0.75) driven by usage of urine test strips among females (18% vs. 7%). Odds of POCT were higher among female GPs and decreased with higher GP age, with lowest usage among male GPs >60 years. GP urban/rural location and workload had little impact. Conclusion GPs use POCT increasingly with the highest use among young female GPs. In 2013, 44% of all antibiotic prescriptions were preceded by POCT but testing rates vary greatly across individual GPs.
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Affiliation(s)
- Steffen Haldrup
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark. .,Department of General Practice, Institute of Public Health, Aarhus University, Aarhus, Denmark.
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - Flemming Bro
- Department of General Practice, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Robert Skov
- Antimicrobial Resistance Reference Laboratory and Surveillance Unit, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Bjerrum
- Section and Research Unit of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
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Tamang S, Milstein A, Sørensen HT, Pedersen L, Mackey L, Betterton JR, Janson L, Shah N. Predicting patient 'cost blooms' in Denmark: a longitudinal population-based study. BMJ Open 2017; 7:e011580. [PMID: 28077408 PMCID: PMC5253526 DOI: 10.1136/bmjopen-2016-011580] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To compare the ability of standard versus enhanced models to predict future high-cost patients, especially those who move from a lower to the upper decile of per capita healthcare expenditures within 1 year-that is, 'cost bloomers'. DESIGN We developed alternative models to predict being in the upper decile of healthcare expenditures in year 2 of a sample, based on data from year 1. Our 6 alternative models ranged from a standard cost-prediction model with 4 variables (ie, traditional model features), to our largest enhanced model with 1053 non-traditional model features. To quantify any increases in predictive power that enhanced models achieved over standard tools, we compared the prospective predictive performance of each model. PARTICIPANTS AND SETTING We used the population of Western Denmark between 2004 and 2011 (2 146 801 individuals) to predict future high-cost patients and characterise high-cost patient subgroups. Using the most recent 2-year period (2010-2011) for model evaluation, our whole-population model used a cohort of 1 557 950 individuals with a full year of active residency in year 1 (2010). Our cost-bloom model excluded the 155 795 individuals who were already high cost at the population level in year 1, resulting in 1 402 155 individuals for prediction of cost bloomers in year 2 (2011). PRIMARY OUTCOME MEASURES Using unseen data from a future year, we evaluated each model's prospective predictive performance by calculating the ratio of predicted high-cost patient expenditures to the actual high-cost patient expenditures in Year 2-that is, cost capture. RESULTS Our best enhanced model achieved a 21% and 30% improvement in cost capture over a standard diagnosis-based model for predicting population-level high-cost patients and cost bloomers, respectively. CONCLUSIONS In combination with modern statistical learning methods for analysing large data sets, models enhanced with a large and diverse set of features led to better performance-especially for predicting future cost bloomers.
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Affiliation(s)
- Suzanne Tamang
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Arnold Milstein
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Lester Mackey
- Department of Statistics, Stanford University, Stanford, California, USA
| | | | - Lucas Janson
- Department of Statistics, Stanford University, Stanford, California, USA
| | - Nigam Shah
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Dekkers OM, Horváth-Puhó E, Cannegieter SC, Vandenbroucke JP, Sørensen HT, Jørgensen JOL. Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study. Eur J Endocrinol 2017; 176:1-9. [PMID: 27697972 DOI: 10.1530/eje-16-0576] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. DESIGN It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. RESULTS The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40-4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33-1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58-8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30-8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. CONCLUSIONS We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.
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Affiliation(s)
- Olaf M Dekkers
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
- Department of Clinical Endocrinology and Metabolism
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | - Jan P Vandenbroucke
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | | | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus, Aarhus, Denmark
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Bell C, Nielsen MK, Neergaard MA, Guldin MB, Jensen AB. Remaining Lifetime After Recognition of Terminal Illness Depends on Diagnosis: A Nationwide Population-Based Cohort Study. J Pain Symptom Manage 2017; 53:116-123. [PMID: 27720788 DOI: 10.1016/j.jpainsymman.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/19/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Timely recognition of the terminal phase of life will benefit patients and caregivers as it may facilitate advance care planning and support. OBJECTIVES The objective of this study was to investigate the remaining lifetime of patients entering a physician-assessed terminal phase and to analyze variation in remaining lifetime according to diagnosis and sociodemographic factors. METHODS Danish National Health Registers were used to establish a prospective cohort of adult patients formally registered with drug reimbursement due to terminal illness in 2012 and followed until June 2014. RESULTS Of the 11,062 included patients, the median remaining lifetime was 55 days and 37% of the patients died within the first month. The majority suffered from cancer (89%). Patients with a noncancer disease had the shortest remaining lifetime (17 days), considerably shorter than patients with cancer (59 days). Patients with prostate cancer had the longest remaining lifetime (76 days), whereas those with hematologic cancer had the shortest among cancer patients (41 days). Compared with lung cancer patients, the probability of death within 30 days were higher for patients with noncancer disease and lower for those with prostate or colorectal cancer. Male gender and high age were associated with higher risk of dying within 30 days. CONCLUSION This study found a median remaining lifetime of 55 days after recognition of terminal illness. Remaining lifetime differed between cancer and noncancer patients and according to age and gender. Increased attention should be directed toward timely recognition of the transition into the terminal phase, especially for patients with noncancer disease.
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Affiliation(s)
- Cathrine Bell
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Mette K Nielsen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette A Neergaard
- The Palliative Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark; The Palliative Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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Zwisler AD, Rossau HK, Nakano A, Foghmar S, Eichhorst R, Prescott E, Cerqueira C, Soja AMB, Gislason GH, Larsen ML, Andersen UO, Gustafsson I, Thomsen KK, Boye Hansen L, Hammer S, Viggers L, Christensen B, Kvist B, Lindström Egholm C, May O. The Danish Cardiac Rehabilitation Database. Clin Epidemiol 2016; 8:451-456. [PMID: 27822083 PMCID: PMC5094528 DOI: 10.2147/clep.s99502] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim of database The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Study population Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Main variables Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Descriptive data Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. Conclusion The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients.
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Affiliation(s)
- Ann-Dorthe Zwisler
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense
| | - Henriette Knold Rossau
- Danish Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense
| | - Anne Nakano
- Department of Clinical Epidemiology, Aarhus University Hospital; Registry Support Centre (West) - Clinical Quality Improvement & Health Informatics, Aarhus
| | - Sussie Foghmar
- Department of Cardiology, Copenhagen University Hospital, Hvidovre
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen
| | - Charlotte Cerqueira
- Registry Support Centre (East) - Epidemiology and Biostatistics, Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup
| | | | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup; The Danish Heart Foundation, Copenhagen; The National Institute of Public Health, University of Southern Denmark
| | | | | | - Ida Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Hvidovre
| | | | | | - Signe Hammer
- Department of Occupational Therapy and Physiotherapy, Herlev Hospital, Herlev
| | - Lone Viggers
- Department of Nutrition, Regional Hospital West Jutland, Holstebro
| | - Bo Christensen
- Department of General Medicine, School of Public Health, Aarhus University, Aarhus
| | - Birgitte Kvist
- Department of Health Care and Prevention, Municipality of Frederikshavn, Frederikshavn
| | | | - Ole May
- Department of Medicine, Cardiovascular Research Unit, Regional Hospital Herning, Herning, Denmark
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Christensen DH, Rungby J, Thomsen RW. Nationwide trends in glucose-lowering drug use, Denmark, 1999-2014. Clin Epidemiol 2016; 8:381-387. [PMID: 27789974 PMCID: PMC5072551 DOI: 10.2147/clep.s113211] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The objective of this study was to examine nationwide population-based time trends in the utilization of all glucose-lowering drugs in Denmark from 1999 to 2014. METHODS Based on nationwide data from the Register of Medicinal Products Statistics, we retrieved sales statistics on glucose-lowering drugs and reported the total number of users and the prevalence of users per 1,000 inhabitants in 1-year intervals for all glucose-lowering drug classes. RESULTS The annual prevalence of glucose-lowering drug users increased more than twofold from 19 per 1,000 inhabitants in 1999 (n=98,362) to 41 per 1,000 in 2014 (n=233,230). Metformin use increased more than sevenfold during the period and was used by 30 of 1,000 inhabitants in 2014, while the prevalence of insulin use increased 1.8-fold to 13 per 1,000 in 2014. After peaking in 2007, use of sulfonylurea halved to 6 per 1,000 in 2014. Newer drug classes including the glucagon-like peptide 1 receptor agonists, the dipeptidylpeptidase-4 inhibitors, and the sodium-glucose cotransporter 2 inhibitors had reached a considerable position by 2014, with 4 per 1,000, 6 per 1,000, and 0.8 per 1,000 inhabitants, respectively; however, the use of glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in elderly people remained low. Thiazolidinediones decreased to virtually no use (0.03 per 1,000) in 2014. CONCLUSION The use of glucose-lowering drugs has doubled during 1999-2014. The pattern of glucose-lowering drug use has changed substantially reflecting the recommendations of metformin as first-line treatment. The newer glucose-lowering drug classes have been well received.
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Affiliation(s)
| | - Jørgen Rungby
- Department of Pharmacology, University of Aarhus, Aarhus, Denmark; Department of Endocrinology, Gentofte University Hospital, Copenhagen, Denmark
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Würtz M, Schmidt M, Grove EL, Horváth-Puhó E, Christiansen CF, Sørensen HT. Preadmission use of selective serotonin reuptake inhibitors and short-term mortality in diabetic patients hospitalized due to stroke. J Intern Med 2016; 280:407-18. [PMID: 27138221 DOI: 10.1111/joim.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with diabetes have an increased risk of stroke with a poor prognosis. Moreover, diabetic patients are at increased risk of depression and therefore likely to use selective serotonin reuptake inhibitors (SSRIs). We examined whether preadmission SSRI use was associated with increased mortality in diabetic patients hospitalized due to stroke. METHODS Population-based medical databases were used to identify all first-time stroke-related hospitalizations and subsequent mortality in diabetic patients in Denmark between 2004 and 2012 (n = 12 620). Based on redeemed prescriptions, SSRI use was categorized as current (new or long term), former or nonuse, and absolute 30-day mortality and mortality rate ratios (MRRs) were computed using Cox regression controlling for confounding factors. RESULTS Amongst SSRI nonusers, 30-day stroke mortality was 15.8% (10.4% for ischaemic stroke, 41.8% for intracerebral haemorrhage and 27.3% for subarachnoid haemorrhage). Amongst current SSRI users, 30-day stroke mortality was 23.3% (17.1% for ischaemic stroke, 50.7% for intracerebral haemorrhage and 28.6% for subarachnoid haemorrhage). Current SSRI use was associated with increased 30-day stroke mortality compared with nonuse [adjusted MRR 1.3, 95% confidence interval (CI) 1.1-1.5], with the highest risk observed amongst new users (MRR 1.5, 95% CI 1.2-1.8). Overall stroke mortality was driven by increased mortality due to ischaemic stroke, with adjusted MRRs of 1.3 (95% CI 1.1-1.7) for current users and 1.7 (95% CI 1.2-2.4) for new users. Propensity score-matched results were similar and robust across subgroups. CONCLUSION In patients with diabetes, preadmission SSRI use was associated with increased mortality following ischaemic stroke, compared with nonuse.
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Affiliation(s)
- M Würtz
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark.
| | - M Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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235
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Schmidt M, Ulrichsen SP, Pedersen L, Bøtker HE, Nielsen JC, Sørensen HT. 30-year nationwide trends in incidence of atrial fibrillation in Denmark and associated 5-year risk of heart failure, stroke, and death. Int J Cardiol 2016; 225:30-36. [PMID: 27705839 DOI: 10.1016/j.ijcard.2016.09.071] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Long-term nationwide trends in atrial fibrillation (AF) incidence and 5-year outcomes are rare. METHODS We conducted a population-based cohort study using the Danish National Patient Registry covering all Danish hospitals. We computed standardized incidence rates during 1983-2012. We used Cox regression to estimate hazard ratios (HRs) of heart failure, stroke, and death within 5years, comparing 5-year calendar periods with the earliest period (1983-1987) as reference. RESULTS We identified 312,420 patients with first-time hospital-diagnosed AF. The incidence rate per 100,000person-years increased from 98 in 1983 to 307 in 2012. The mean annual increase during the 30-year study period was 4%, with a 6% increase annually until 2000 and a 1.4% increase annually thereafter. The incidence trends were most pronounced among men and persons above 70years. Among high-risk subgroups, AF incidence was consistently highest in patients with valvular heart disease or heart failure. The rate of heart failure following AF declined by 50% over the entire study period (HR: 0.49, 95% confidence interval (CI): 0.48-0.51) and the mortality rate declined by 40% (HR: 0.62, 95% CI: 0.61-0.63). Within the last two decades, the rate for ischemic stroke declined by 20% (HR 0.81, 95% CI: 0.78-0.84), but increased almost as much for haemorrhagic stroke (HR: 1.14, 95% CI: 1.01-1.29). CONCLUSIONS The long-term risk of heart failure, ischemic stroke, and death following onset of AF has decreased remarkably over the last three decades. Still, the threefold increased incidence of hospital-diagnosed AF during the same period is a major public health concern.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital of Randers, Denmark.
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Health Research & Policy (Epidemiology), Stanford University, Stanford, California, USA
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236
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Pedersen AB, Cronin Fenton D, Nørgaard M, Kristensen NR, Kuno Møller B, Erikstrup C. Body mass index, risk of allogeneic red blood cell transfusion, and mortality in elderly patients undergoing hip fracture surgery. Osteoporos Int 2016; 27:2765-2775. [PMID: 27099965 DOI: 10.1007/s00198-016-3594-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Despite improvements in preoperative and postoperative treatment, hip fracture surgery may lead to blood transfusion. Little is known about the impact of body mass index on transfusion risk and subsequent mortality. Opposite overweight and obese patients, underweight patients had increased risk of transfusion and death within 1 year of surgery. INTRODUCTION Despite improvements in preoperative and postoperative treatment of hip fracture patients, hip fracture surgery may lead to blood loss. We examined the risk of red blood cell transfusion (as an indirect measure of blood loss) and subsequent mortality by body mass index level in patients aged 65 and over undergoing hip fracture surgery. METHODS This is a population-based cohort study using medical databases. We included all patients who underwent surgery for hip fracture during 2005-2013. We calculated the cumulative risk of red blood cell transfusion within 7 days of surgery treating death as a competing risk and, among transfused patients, short- (8-30 days postsurgery) and long-term mortality (31-365 days postsurgery). RESULTS Among 56,420 patients, 47.7 % received at least one red blood cell transfusion within 7 days of surgery. In patients with normal weight, the risk was 48.8 % compared with 57.0 % in underweight patients (adjusted RR = 1.11; CI 1.08-1.15), 42.1 % in overweight patients (adjusted RR = 0.89; CI 0.86-0.91), and 42.2 % in obese patients (adjusted RR = 0.87; CI 0.84-0.91). Among transfused patients, adjusted HRs for short-term mortality were 1.52 (CI 1.34-1.71), 0.70 (CI 0.61-0.80), and 0.58 (CI 0.43-0.77) for underweight, overweight, and obese patients, respectively, compared with normal-weight patients. The corresponding adjusted HRs for long-term mortality were 1.45 (CI 1.33-1.57), 0.80 (CI 0.74-0.86), and 0.58 (CI 0.50-0.69). Similar association between BMI and mortality was observed also among non-transfused patients. CONCLUSIONS Underweight patients had a higher risk of red blood cell transfusion and death in the first year of surgery than normal-weight patients, even when controlling for age and comorbidity. Opposite findings were seen for overweight and obese patients.
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Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark.
| | - D Cronin Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - N R Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus N, Denmark
| | - B Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - C Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Roberto G, Leal I, Sattar N, Loomis AK, Avillach P, Egger P, van Wijngaarden R, Ansell D, Reisberg S, Tammesoo ML, Alavere H, Pasqua A, Pedersen L, Cunningham J, Tramontan L, Mayer MA, Herings R, Coloma P, Lapi F, Sturkenboom M, van der Lei J, Schuemie MJ, Rijnbeek P, Gini R. Identifying Cases of Type 2 Diabetes in Heterogeneous Data Sources: Strategy from the EMIF Project. PLoS One 2016; 11:e0160648. [PMID: 27580049 PMCID: PMC5006970 DOI: 10.1371/journal.pone.0160648] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/23/2016] [Indexed: 11/26/2022] Open
Abstract
Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93–100%), while drug-based components were the main contributors in RLDs (81–100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies.
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Affiliation(s)
- Giuseppe Roberto
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
- * E-mail:
| | - Ingrid Leal
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - A. Katrina Loomis
- Pfizer Worldwide Research and Development, Groton, Connecticut, United States of America
| | - Paul Avillach
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Biomedical Informatics, Harvard Medical School & Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Peter Egger
- GlaxoSmithKline, Worldwide Epidemiology GSK, Stockley Park West, Uxbridge, United Kingdom
| | | | - David Ansell
- The Health Improvement Network, Cegedim Strategic Data Medical Research Ltd, London, United Kingdom
| | - Sulev Reisberg
- Quretec, Software Technology and Applications Competence Center, University of Tartu, Tartu, Estonia
| | - Mari-Liis Tammesoo
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Tartu, Estonia
| | - Helene Alavere
- Estonian Genome Center, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Tartu, Estonia
| | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hosptial, Aarhus, Denmark
| | | | - Lara Tramontan
- Arsenàl.IT Consortium, Veneto's Research Centre for eHealth Innovation, Treviso, Italy
| | - Miguel A. Mayer
- Hospital del Mar Medical Research Institute (IMIM) and Universitat Pompeu Fabra, Barcelona, Spain
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Preciosa Coloma
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francesco Lapi
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Martijn J. Schuemie
- Janssen Research & Development, Epidemiology, Titusville, New Jersey, United States of America
- Observational Health Data Sciences and Informatics, New York, New York, United States of America
| | - Peter Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rosa Gini
- Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy
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Schmidt M, Szépligeti S, Horváth-Puhó E, Pedersen L, Bøtker HE, Sørensen HT. Long-Term Survival Among Patients With Myocardial Infarction Before Age 50 Compared With the General Population: A Danish Nationwide Cohort Study. Circ Cardiovasc Qual Outcomes 2016; 9:523-31. [PMID: 27576336 DOI: 10.1161/circoutcomes.115.002661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/30/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The long-term prognosis for young myocardial infarction (MI) survivors remains poorly understood. METHODS AND RESULTS We conducted a nationwide population-based cohort study using prospectively collected medical data from all hospitals in Denmark during 1980 to 2009. We examined 30-year cause-specific death rates among 21 693 MI patients <50 years versus 216 930 sex- and age-matched people from the general population. We calculated mortality rate ratios (MRRs) based on Cox regression. Between 1980 to 1989 and 2000 to 2009, MI mortality declined from 12.5% to 3.2% within 30 days, 5.1% to 1.6% within 31 to 365 days, and 24.2% to 8.9% within 1 to 10 years. Compared with the general population, the MRR adjusted for sex, age, and cardiovascular and noncardiovascular comorbidity decreased 4.5-fold within 30 days (from 468 to 97), 3-fold within 31 to 365 days (from 11.32 to 3.70), and 2.5-fold within 1 to 10 years (from 4.77 to 1.89). The remaining 1.89-fold increased mortality rate among 1-year survivors in 2000 to 2009 corresponded to 6 additional deaths each year per 1000 patients compared with the general population. Long-term causes of death were primarily because of cardiovascular and chronic pulmonary diseases. The excess 10-year MRR among 1-year survivors was consistent within MI subtypes, did not differ substantially between comorbidity categories, but was higher for women than men (3-fold versus 1.7-fold). CONCLUSIONS The long-term mortality rate after MI before age 50 has decreased remarkably over the last 3 decades, but remains increased relative to the general population, mainly because of deaths from ischemic heart disease and other smoking-related diseases.
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Affiliation(s)
- Morten Schmidt
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.).
| | - Szimonetta Szépligeti
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Erzsébet Horváth-Puhó
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Lars Pedersen
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Hans Erik Bøtker
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
| | - Henrik Toft Sørensen
- From the Departments of Clinical Epidemiology (M.S., S.S., E.H.-P., L.P., H.T.S.) and Cardiology (H.E.B.), Aarhus University Hospital, Skejby, Denmark; and Department of Internal Medicine, Regional Hospital of Randers, Denmark (M.S.)
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Mor A, Petersen I, Sørensen HT, Thomsen RW. Metformin and other glucose-lowering drug initiation and rates of community-based antibiotic use and hospital-treated infections in patients with type 2 diabetes: a Danish nationwide population-based cohort study. BMJ Open 2016; 6:e011523. [PMID: 27543589 PMCID: PMC5013429 DOI: 10.1136/bmjopen-2016-011523] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Data on early risk of infection in patients receiving their first treatment for type 2 diabetes are limited. We examined rates of community-based antibiotic use and hospital-treated infection in initiators of metformin and other glucose-lowering drugs (GLDs). DESIGN Population-based cohort study using medical databases. SETTING General practice and hospitals in Denmark. PARTICIPANTS 131 949 patients with type 2 diabetes who initiated pharmacotherapy with a GLD between 2005 and 2012. EXPOSURE Initial GLD used for pharmacotherapy. MAIN OUTCOME MEASURES We computed rates and adjusted HRs of community-based antibiotic use and hospital-treated infection associated with choice of initial GLD with reference to metformin initiation, using an intention-to-treat approach. RESULTS The rate of community-based antibiotic use was 362 per 1000 patient-years at risk (PYAR) and that for hospital-treated infection was 51 per 1000 PYAR. Compared with metformin, the risk of hospital-treated infection was slightly higher in sulfonylurea initiators (HR 1.12, 95% CI 1.08 to 1.16) and substantially higher in insulin initiators (HR 1.63, 95% CI 1.54 to 1.72) initiators after adjustment for comorbid conditions, comedications and other confounding factors. In contrast, virtually no difference was observed for overall community-based antibiotic use (HR 1.02, 95% CI 1.01 to 1.04, for sulfonylurea initiators; and 1.04, 95% CI 1.01 to 1.07, for insulin initiators). CONCLUSIONS Rates of community-based antibiotic treatment and hospitalisation for infection were high in patients receiving their first treatment for type 2 diabetes and differed with the choice of initial GLD used for pharmacotherapy.
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Affiliation(s)
- Anil Mor
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Irene Petersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, Torp-Pedersen C, Gislason G. Trends in One-Year Outcomes of Dialysis-Requiring Acute Kidney Injury in Denmark 2005-2012: A Population-Based Nationwide Study. PLoS One 2016; 11:e0159944. [PMID: 27459297 PMCID: PMC4961397 DOI: 10.1371/journal.pone.0159944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/11/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Dialysis-requiring acute kidney injury (AKI) is associated with substantial mortality and risk of end-stage renal disease (ESRD). Despite considerable growth in incidence of severe AKI, information pertaining to trends in outcomes remains limited. We evaluated time trends in one year risks of ESRD and death in patients with dialysis-requiring AKI over an eight year period in Denmark. METHODS In a retrospective nationwide study based on national registers, all adults requiring acute renal replacement therapy between 2005 and 2012 were identified. Patients with preceding ESRD were excluded. Through individual-level cross-referencing of administrative registries, information pertaining to comorbidity, preceding surgical interventions, and concurrent other organ failure and sepsis was ascertained. Comparisons of period-specific one year odds ratios for ESRD and death were calculated in a multiple logistic regression model. RESULTS A total of 13,819 patients with dialysis-requiring AKI were included in the study. Within one year, 1,017 (7.4%) patients were registered with ESRD, and 7,908 (57.2%) patients died. The one-year rate of ESRD decreased from 9.0% between 2005 and 2006 to 6.1% between 2011 and 2012. Simultaneously, the one-year mortality rate decreased from 58.2% between 2005 and 2006 to 57.5% between 2011 and 2012. Consequently, the adjusted odds ratios for the period 2011-2012 (with the period 2005-2006 as reference) were 0.75 (0.60-0.95, p = 0.015) and 0.87 (95% CI 0.78-0.97, p = 0.010) for ESRD and death, respectively. CONCLUSIONS In a nationwide retrospective study on time trends in one year outcomes following dialysis-requiring AKI, risk of all-cause mortality and ESRD decreased over a period of 8 years.
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Affiliation(s)
- Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- * E-mail:
| | - Kristine Hommel
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Merete Soja
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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Abrahamsen B, Eiken P, Prieto-Alhambra D, Eastell R. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study. BMJ 2016; 353:i3365. [PMID: 27353596 PMCID: PMC4924596 DOI: 10.1136/bmj.i3365] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine the skeletal safety and efficacy of long term (≥10 years) alendronate use in patients with osteoporosis. DESIGN Open register based cohort study containing two nested case control studies. SETTING Nationwide study of population of Denmark. PARTICIPANTS 61 990 men and women aged 50-94 at the start of treatment, who had not previously taken alendronate, 1996-2007. INTERVENTIONS Treatment with alendronate. MAIN OUTCOME MEASURES Incident fracture of the subtrochanteric femur or femoral shaft (ST/FS) or the hip. Non-fracture controls from the cohort were matched to fracture cases by sex, year of birth, and year of initiation of alendronate treatment. Conditional logistic regression models were fitted to calculate odds ratios with and without adjustment for comorbidity and comedications. Sensitivity analyses investigated subsequent treatment with other drugs for osteoporosis. RESULTS 1428 participants sustained a ST/FS (incidence rate 3.4/1000 person years, 95% confidence interval 3.2 to 3.6), and 6784 sustained a hip fracture (16.2/1000 person years, 15.8 to 16.6). The risk of ST/FS was lower with high adherence to treatment with alendronate (medication possession ratio (MPR, a proxy for compliance) >80%) compared with poor adherence (MPR <50%; odds ratio 0.88, 0.77 to 0.99; P=0.05). Multivariable adjustment attenuated this association (adjusted odds ratio 0.88, 0.77 to 1.01; P=0.08). The risk was no higher in long term users (≥10 dose years; 0.70, 0.44 to 1.11; P=0.13) or in current compared with past users (0.91, 0.79 to 1.06; P=0.22). Similarly, MPR >80% was associated with a decreased risk of hip fracture (0.73, 0.68 to 0.78; P<0.001) as was longer term cumulative use for 5-10 dose years (0.74, 0.67 to 0.83; P<0.001) or ≥10 dose years (0.74, 0.56 to 0.97; P=0.03). CONCLUSIONS These findings support an acceptable balance between benefit and risk with treatment with alendronate in terms of fracture outcomes, even for over 10 years of continuous use.
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Affiliation(s)
- Bo Abrahamsen
- Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 3. Sal, DK-5000, Odense, Denmark Department of Medicine, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Hillerød Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark, Pia Eiken Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark, Pia Eiken
| | - Daniel Prieto-Alhambra
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeltal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Oxford OX3 7LD, UK Musculoskeletal Research Unit, IMIM-Parc de Salut Mar and RETICEF, Universitat Autònoma de Barcelona and Instituto Carlos III (FEDER Research Funds), Passeig Marítim 25-29, 08003 Barcelona, Spain,
| | - Richard Eastell
- Academic Unit of Bone Metabolism (AUBM), Northern General Hospital and University of Sheffield, Sheffield S5 7AU, UK
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Mor A, Berencsi K, Nielsen JS, Rungby J, Friborg S, Brandslund I, Christiansen JS, Vaag A, Beck-Nielsen H, Sørensen HT, Thomsen RW. Rates of Community-based Antibiotic Prescriptions and Hospital-treated Infections in Individuals With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study, 2004–2012. Clin Infect Dis 2016; 63:501-11. [PMID: 27353662 DOI: 10.1093/cid/ciw345] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/14/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anil Mor
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Klara Berencsi
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Jens S Nielsen
- Department of Endocrinology, Danish Centre for Strategic Research in Type 2 Diabetes, Diabetes Research Centre, Odense University Hospital
| | - Jørgen Rungby
- Center for Diabetes Research, Gentofte University Hospital, Copenhagen Institute for Biomedicine, Aarhus University
| | - Søren Friborg
- Department of Endocrinology, Danish Centre for Strategic Research in Type 2 Diabetes, Diabetes Research Centre, Odense University Hospital
| | - Ivan Brandslund
- Department of Endocrinology, Danish Centre for Strategic Research in Type 2 Diabetes, Diabetes Research Centre, Odense University Hospital
| | - Jens S Christiansen
- Department of Internal Medicine and Endocrinology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Allan Vaag
- Department of Endocrinology, Diabetes and Metabolism, Rigshospitalet, and Copenhagen University, Denmark
| | - Henning Beck-Nielsen
- Department of Endocrinology, Danish Centre for Strategic Research in Type 2 Diabetes, Diabetes Research Centre, Odense University Hospital
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital
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Pedersen SB, Nielsen JC, Bøtker HE, Goldberger JJ. Beta-Blocker Therapy Early After Myocardial Infarction: A Comparison Between Medication at Hospital Discharge and Subsequent Pharmacy-Dispensed Medication. Drugs Real World Outcomes 2016; 3:279-288. [PMID: 27747827 PMCID: PMC5042935 DOI: 10.1007/s40801-016-0079-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Beta-blocker (BB) therapy after myocardial infarction (MI) reduces all-cause mortality. OBJECTIVE The aim of this study was to investigate BB dosing patterns and compliance following MI. METHODS Using medical patient files and nationwide databases, we identified 100 patients who were discharged following MI in 2012 from Aarhus University Hospital, Denmark, and subsequently redeemed one or more BB prescriptions within 6 months. We obtained information about all BB medication prescribed at discharge and all BB prescriptions redeemed until 31 December 2013. Daily BB doses were computed as percentages of the target doses used in clinical trials documenting the efficacy of BBs after MI. Four dose groups were defined: ≤12.5, >12.5-25, >25-50, and >50 % of target dose. The proportion of patients in each dose group was ascertained at and following discharge, as was the proportion that changed dose group following discharge. RESULTS The median study period was 400 days (interquartile range [IQR] 318-486 days). At discharge, 8 % of daily doses were >50 % of target dose while 80 % were ≤25 % of target dose. At first prescription redemption, 71.7 % of patients moved to a higher dose group (median dose change = 33.4 % [IQR 2.0-115.1]). Still, comparing final daily doses to discharge doses, 40.2 % did not change dose group (median dose change -5.7 % [IQR -18.0 to 4.2]). Only 31.5 % reached a final daily dose >50 % of target dose. CONCLUSIONS Target dose BB treatment was infrequently achieved at discharge following MI. Despite dose up-titration early after discharge, most patients did not receive target dose BB treatment approximately 1 year following MI.
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Affiliation(s)
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jeffrey J Goldberger
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
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Pedersen SB, Hjortshøj SP, Bøtker HE, Farkas DK, Schmidt M, Sørensen HT, Nielsen JC. Venous thromboembolism in patients with implantable cardioverter-defibrillators. Europace 2016; 19:991-1001. [DOI: 10.1093/europace/euw124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/10/2016] [Indexed: 11/13/2022] Open
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Pedersen LH, Petersen OB, Nørgaard M, Ekelund C, Pedersen L, Tabor A, Sørensen HT. Linkage between the Danish National Health Service Prescription Database, the Danish Fetal Medicine Database, and other Danish registries as a tool for the study of drug safety in pregnancy. Clin Epidemiol 2016; 8:91-5. [PMID: 27274312 PMCID: PMC4869617 DOI: 10.2147/clep.s98139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A linked population-based database is being created in Denmark for research on drug safety during pregnancy. It combines information from the Danish National Health Service Prescription Database (with information on all prescriptions reimbursed in Denmark since 2004), the Danish Fetal Medicine Database, the Danish National Registry of Patients, and the Medical Birth Registry. The new linked database will provide validated information on malformations diagnosed both prenatally and postnatally. The cohort from 2008 to 2014 will comprise 589,000 pregnancies with information on 424,000 pregnancies resulting in live-born children, ∼420,000 pregnancies undergoing prenatal ultrasound scans, 65,000 miscarriages, and 92,000 terminations. It will be updated yearly with information on ∼80,000 pregnancies. The cohort will enable identification of drug exposures associated with severe malformations, not only based on malformations diagnosed after birth but also including those having led to termination of pregnancy or miscarriage. Such combined data will provide a unique source of information for research on the safety of medications used during pregnancy.
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Affiliation(s)
- Lars H Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Olav B Petersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ann Tabor
- Department of Fetal Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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246
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Long-term Compliance with Oral 5-aminosalicylic Acid Therapy and Risk of Disease Recurrence in Patients with Ulcerative Colitis: A Population-based Cohort Study. Inflamm Bowel Dis 2016; 22:925-32. [PMID: 26818426 DOI: 10.1097/mib.0000000000000700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Noncompliance to long-term medical therapy is a well-known problem among patients treated for ulcerative colitis, but studies of long-term consequences in unselected patients are lacking. The authors aimed to determine the risk of recurrence according to long-term compliance with oral 5-aminosalicylic acid among unselected patients with ulcerative colitis. METHODS The authors conducted a 7-year follow-up study of a population-based inception cohort of 243 Danish patients with ulcerative colitis diagnosed from 2003 to 2004. Compliance was defined as consumption of ≥80% of prescribed oral 5-aminosalicylic acid. Data were collected from medical records and the Danish National Prescription Database. They performed Cox regression analysis with adjustments for demographic and clinical characteristics to examine risk of recurrence (defined by increased use of oral 5-Aminosalicylic Acid, other additional treatment, or colectomy) in compliant versus noncompliant patients. RESULTS In total, 182 patients (75%) experienced at least 1 recurrence during follow-up. For the first year after diagnosis, risk of recurrence did not differ significantly between compliant and noncompliant patients. For 1 to 3 years (hazard ratio: 0.46, 95% CI, 0.33-0.63) and 3 to 8 years (hazard ratio: 0.42, 95% CI, 0.32-0.55) after diagnosis, risk of recurrence was significantly decreased among noncompliant patients compared with that of compliant patients. CONCLUSIONS This unselected cohort study revealed a reverse association between compliance and recurrence of ulcerative colitis. This is unlikely to be explained by severe confounding because the authors were able to adjust for several demographic and clinical factors. Results may instead reflect that patients during recurrence-free periods through self-management choose not to take their medication.
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247
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Søgaard M, Madsen M, Løkke A, Hilberg O, Sørensen HT, Thomsen RW. Incidence and outcomes of patients hospitalized with COPD exacerbation with and without pneumonia. Int J Chron Obstruct Pulmon Dis 2016; 11:455-65. [PMID: 27042038 PMCID: PMC4780743 DOI: 10.2147/copd.s96179] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Pneumonia may be a major contributor to hospitalizations for chronic obstructive pulmonary disease (COPD) exacerbation and influence their outcomes. Methods We examined hospitalization rates, health resource utilization, 30-day mortality, and risk of subsequent hospitalizations for COPD exacerbations with and without pneumonia in Denmark during 2006–2012. Results We identified 179,759 hospitalizations for COPD exacerbations, including 52,520 first-time hospitalizations (29.2%). Pneumonia was frequent in first-time exacerbations (36.1%), but declined in successive exacerbations to 25.6% by the seventh or greater exacerbation. Pneumonic COPD exacerbations increased 20% from 0.92 per 1,000 population in 2006 to 1.10 per 1,000 population in 2012. Nonpneumonic exacerbations decreased by 6% from 1.74 per 1,000 population to 1.63 per 1,000 population during the same period. A number of markers of health resource utilization were more prevalent in pneumonic exacerbations than in nonpneumonic exacerbations: length of stay (median 7 vs 4 days), intensive care unit admission (7.7% vs 12.5%), and several acute procedures. Thirty-day mortality was 12.1% in first-time pneumonic COPD exacerbations versus 8.3% in first-time nonpneumonic cases (adjusted HR [aHR] 1.20, 95% confidence interval [CI] 1.17–1.24). Pneumonia also predicted increased mortality associated with a second exacerbation (aHR 1.14, 95% CI 1.11–1.18), and up to a seventh or greater exacerbation (aHR 1.10, 95% CI 1.07–1.13). In contrast, the aHR of a subsequent exacerbation was 8%–13% lower for patients with pneumonic exacerbations. Conclusions Pneumonia is frequent among patients hospitalized for COPD exacerbations and is associated with increased health care utilization and higher mortality. Nonpneumonic COPD exacerbations predict increased risk of subsequent exacerbations.
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Affiliation(s)
- Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Anders Løkke
- Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark
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248
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Svensson E, Berencsi K, Sander S, Mor A, Rungby J, Nielsen JS, Friborg S, Brandslund I, Christiansen JS, Vaag A, Beck-Nielsen H, Sørensen HT, Thomsen RW. Association of parental history of type 2 diabetes with age, lifestyle, anthropometric factors, and clinical severity at type 2 diabetes diagnosis: results from the DD2 study. Diabetes Metab Res Rev 2016; 32:308-15. [PMID: 26408959 DOI: 10.1002/dmrr.2721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/12/2015] [Accepted: 08/31/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND We investigated whether parental history of type 2 diabetes mellitus (T2D) is associated with age, lifestyle, anthropometric factors, and clinical severity at the time of T2D diagnosis. METHODS We conducted a cross-sectional study based on the Danish Centre for Strategic Research in Type 2 Diabetes cohort. We examined the prevalence ratios (PR) of demographic, lifestyle, anthropometric, and clinical factors according to parental history, using Poisson regression adjusting for age and gender. RESULTS Of 2825 T2D patients, 34% (n = 964) had a parental history of T2D. Parental history was associated with younger age at diagnosis [adjusted (a)PR 1.66, 95% confidence interval: 1.19, 2.31) for age <40 years; aPR 1.36 (95% confidence interval: 1.24, 1.48) for ages 40-59 years] and with higher baseline fasting plasma glucose [≥7.5 mmol/L, aPR 1.47 (95% confidence interval: 1.20, 1.80)], and also tended to be associated with lower beta cell function. In contrast, patients both with and without a parental history had similar occurrence of central obesity [91% vs. 91%], weight gain ≥30 kg since age 20 [52% vs. 53%], and lack of regular physical activity [60% vs. 58%]. Presence of diabetes complications or comorbidities at T2D diagnosis was not associated with parental history. CONCLUSIONS The lack of an association between parental history and adverse lifestyle factors indicates that T2D patients do not inherit a particular propensity for overeating or inactivity, whereas patients with a parental history may have more severe pancreatic beta cell dysfunction at diagnosis.
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Affiliation(s)
- Elisabeth Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Klara Berencsi
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Simone Sander
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anil Mor
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Rungby
- Department of Pharmacology, University of Aarhus, Aarhus, Denmark
| | - Jens Steen Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Søren Friborg
- Department of Endocrinology M, Odense University Hospital, Odense, Denmark
| | - Ivan Brandslund
- Department of Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | | | - Allan Vaag
- Department of Endocrinology, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Henning Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Søgaard KK, Farkas DK, Pedersen L, Lund JL, Thomsen RW, Sørensen HT. Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers. Cancer Med 2016; 5:1341-51. [PMID: 26923747 PMCID: PMC4924392 DOI: 10.1002/cam4.680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/11/2016] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
Peptic ulcer predicts gastric cancer. It is controversial if peptic ulcers predict other gastrointestinal cancers, potentially related to Helicobacter pylori or shared lifestyle factors. We hypothesized that gastric and duodenal ulcers may have different impact on the risk of gastrointestinal cancers. In a nationwide cohort study using Danish medical databases 1994-2013, we quantified the risk of gastric and other gastrointestinal cancers among patients with duodenal ulcers (dominantly H. pylori-related) and gastric ulcers (dominantly lifestyle-related) compared with the general population. We started follow-up 1-year after ulcer diagnosis to avoid detection bias and calculated absolute risks of cancer and standardized incidence ratios (SIRs). We identified 54,565 patients with gastric ulcers and 38,576 patients with duodenal ulcers. Patient characteristics were similar in the two cohorts. The 1-5-year risk of any gastrointestinal cancer was slightly higher for gastric ulcers patients (2.1%) than for duodenal ulcers patients (2.0%), and SIRs were 1.38 (95% CI: 1.31-1.44) and 1.30 (95% CI: 1.23-1.37), respectively. The SIR of gastric cancer was higher among patients with gastric ulcer than duodenal ulcer (1.92 vs. 1.38), while the SIRs for other gastrointestinal cancers were similar (1.33 vs. 1.29). Compared with gastric ulcer patients, duodenal ulcer patients were at lower risk of smoking- and alcohol-related gastrointestinal cancers. The risk of nongastric gastrointestinal cancers is increased both for patients with gastric ulcers and with duodenal ulcers, but absolute risks are low. H. pylori may be less important for the development of nongastric gastrointestinal cancer than hypothesized.
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Affiliation(s)
- Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jennifer L Lund
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, Torp-Pedersen C, Gislason G. Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors-A Nationwide Study. PLoS One 2016; 11:e0148809. [PMID: 26863015 PMCID: PMC4749171 DOI: 10.1371/journal.pone.0148809] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/22/2016] [Indexed: 01/26/2023] Open
Abstract
Introduction Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study. Materials and Methods All patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated. Results A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137–144) in 2000 to 366 per million (357–375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20–26) and 328 per million (300–355) in 2000, to 213 per million (206–220) and 1124 per million (1076–1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity. Conclusions Although growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.
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Affiliation(s)
- Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- * E-mail:
| | - Kristine Hommel
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Merete Soja
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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