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Winell K, Arffman M, Salomaa V. Decreasing national trends in diabetic complications hide regional differences: a prospective population-based study using health care registers in Finland. SCAND CARDIOVASC J 2023; 57:2247190. [PMID: 37614115 DOI: 10.1080/14017431.2023.2247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/12/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Objectives. To examine whether possibilities to improve care among patients with diabetes are reflected in the numbers of cardiovascular complications at national and regional level in Finland. Methods. The study population included all patients with diabetes in Finland since 1964. The incidences of first acute coronary syndrome, ischemic stroke and lower limb amputation were examined for the period from 2010 to 2017. The age- and sex-standardised incidence rates were calculated for the first events. Adjusted Poisson regression mixed models were used to calculate average annual trends and assess regional variation of incidences during the periods 2010 to 2013 and 2014 to 2017 in the university hospital districts (UHDs) and hospital districts (HDs). Results. The nationwide incidence of first acute coronary syndrome decreased among patients with diabetes by 2.7% (95% confidence interval 2.3%; 3.0%), ischemic stroke by 2.0% (1.5%; 2.4%) and major lower limb amputation by 4.6% (3.1%; 5.9%) annually. The sexes differed only in the decrease in acute coronary events. The annual decrease among males was 2.1% (1.6%; 2.6%) and among females was 3.4% (2.8%; 4.0%) (p = .001). Marked variation was observed among UHDs and HDs in the incidences of cardiovascular events and lower limb amputations in patients with diabetes. The variation in annual trends of diabetic complications was most pronounced in acute coronary syndrome among UHDs with an estimated variance of 0.0006 (p = .034). Conclusions. The decrease in the incidence of first cardiovascular events among patients with diabetes continued from 2010 to 2017 in Finland. However, the declining national incidence rates hide regional differences which should be a target for improvement.
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Affiliation(s)
- Klas Winell
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
- Conmedic, Espoo, Finland
| | - Martti Arffman
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- THL - Finnish Institute of Health and Welfare, Helsinki, Finland
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2
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Choi HJ, LeBlanc M, Moger TA, Valberg M, Page CM, Aamodt G, Næss Ø. Geographical variation in cardiovascular disease mortality in Norway: The role of life course socioeconomic position and parental health. Health Place 2023; 83:103095. [PMID: 37659155 DOI: 10.1016/j.healthplace.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 09/04/2023]
Abstract
Despite substantial geographical variation in cardiovascular (CVD) mortality within countries, little is known about whether this variation can be explained by individuals' life course socioeconomic position (SEP) or differences in family history of premature CVD deaths. Cox proportional hazards models were used to investigate the association between the county of residence at ages 50-59 and CVD death in Norwegians born between 1940 and 1959 and survived to at least age 60, using national data. Individual life course SEP and family history of premature CVD death reduced the geographical variation in CVD mortality across Norwegian counties, but some significant differences remained. Furthermore, CVD risk varied by residents' migration histories between two counties with distinct CVD and socioeconomic profiles.
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Affiliation(s)
- Hye Jung Choi
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Mathematics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Science, Ås, Norway
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway
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Sipilä JOT. Adult-Onset Neuroepidemiology in Finland: Lessons to Learn and Work to Do. J Clin Med 2023; 12:3972. [PMID: 37373667 DOI: 10.3390/jcm12123972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Finland is a relatively small genetic isolate with a genetically non-homogenous population. Available Finnish data on neuroepidemiology of adult-onset disorders are limited, and this paper describes the conclusions that can be drawn and their implications. Apparently, Finnish people have a (relatively) high risk of developing Unverricht-Lundborg disease (EPM1), Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Spinal muscular atrophy, Jokela type (SMAJ) and adult-onset dystonia. On the other hand, some disorders, such as Friedreich's ataxia (FRDA) and Wilson's disease (WD), are almost absent or completely absent in the population. Valid and timely data concerning even many common disorders, such as stroke, migraine, neuropathy, Alzheimer's disease and Parkinson's disease, are unavailable, and there are virtually no data on many less-common neurological disorders, such as neurosarcoidosis or autoimmune encephalitides. There also appear to be marked regional differences in the incidence and prevalence of many diseases, suggesting that non-granular nationwide data may be misleading in many cases. Concentrated efforts to advance neuroepidemiological research in the country would be of clinical, administrative and scientific benefit, but currently, all progress is blocked by administrative and financial obstacles.
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Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, 80210 Joensuu, Finland
- Clinical Neurosciences, Faculty of Medicine, University of Turku, 20014 Turku, Finland
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Komulainen T, Koivisto A, Jäkälä P. Incidence of first-ever transient ischemic attack in Eastern Finland. Acta Neurol Scand 2022; 146:615-622. [PMID: 36029100 PMCID: PMC9805147 DOI: 10.1111/ane.13689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The incidence of stroke has been declining in Finland, as well as in Europe. However, it is unclear whether the incidence of transient ischemic attack (TIA) is also decreasing. In fact, the TIA incidence in the Finnish population has never been reported. Therefore, here we investigated the incidence of TIA in the Eastern Finnish population in 2017. MATERIALS AND METHODS All patients with suspected TIA, from a defined catchment area, were referred to a neurological emergency unit at Kuopio University Hospital (KUH) in the Northern Savonia region of Eastern Finland, which had a population of 246,653 in 2017. The original study population comprised TIA patients diagnosed based on the WHO TIA criteria in 2017. Incidence rates were calculated by dividing the number of TIA cases by the number of people in different age groups. RESULTS Among 432 patients with a suspected TIA referred to the neurological emergency unit at Kuopio University Hospital in 2017, 293 were living in Northern Savonia and were ultimately diagnosed with TIA after neurological examinations. The number of first-ever TIAs was 211. The crude incidence of all TIA was 122/100,000 inhabitants, and of first-ever TIA was 86/100,000. The age-standardized incidence (European population 2010) of the first-ever TIA was calculated to be 64/100,000. The mean age of first-ever TIA patients was 70 years: 72 years for women versus 68 years for men. CONCLUSIONS We found a high incidence of TIA in Eastern Finland.
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Affiliation(s)
- Tiina Komulainen
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Anne Koivisto
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland,Geriatrics, Internal Medicine and RehabilitationHelsinki University HospitalHelsinkiFinland,Department of NeurosciencesUniversity of HelsinkiHelsinkiFinland
| | - Pekka Jäkälä
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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Bihrmann K, Gislason G, Larsen ML, Ersbøll AK. Joint mapping of cardiovascular diseases: comparing the geographic patterns in incident acute myocardial infarction, stroke and atrial fibrillation, a Danish register-based cohort study 2014-15. Int J Health Geogr 2021; 20:41. [PMID: 34461900 PMCID: PMC8404297 DOI: 10.1186/s12942-021-00294-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disease mapping aims at identifying geographic patterns in disease. This may provide a better understanding of disease aetiology and risk factors as well as enable targeted prevention and allocation of resources. Joint mapping of multiple diseases may lead to improved insights since e.g. similarities and differences between geographic patterns may reflect shared and disease-specific determinants of disease. The objective of this study was to compare the geographic patterns in incident acute myocardial infarction (AMI), stroke and atrial fibrillation (AF) using the unique, population-based Danish register data. METHODS Incident AMI, stroke and AF was modelled by a multivariate Poisson model including a disease-specific random effect of municipality modelled by a multivariate conditionally autoregressive (MCAR) structure. Analyses were adjusted for age, sex and income. RESULTS The study included 3.5 million adults contributing 6.8 million person-years. In total, 18,349 incident cases of AMI, 28,006 incident cases of stroke, and 39,040 incident cases of AF occurred. Estimated municipality-specific standardized incidence rates ranged from 0.76 to 1.35 for AMI, from 0.79 to 1.38 for stroke, and from 0.85 to 1.24 for AF. In all diseases, geographic variation with clusters of high or low risk of disease after adjustment was seen. The geographic patterns displayed overall similarities between the diseases, with stroke and AF having the strongest resemblances. The most notable difference was observed in Copenhagen (high risk of stroke and AF, low risk of AMI). AF showed the least geographic variation. CONCLUSION Using multiple-disease mapping, this study adds to the results of previous studies by enabling joint evaluation and comparison of the geographic patterns in AMI, stroke and AF. The simultaneous mapping of diseases displayed similarities and differences in occurrence that are non-assessable in traditional single-disease mapping studies. In addition to reflecting the fact that AF is a strong risk factor for stroke, the results suggested that AMI, stroke and AF share some, but not all environmental risk factors after accounting for age, sex and income (indicator of lifestyle and health behaviour).
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Affiliation(s)
- Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.,Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
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Ketsela A, Gebreyesus SH, Deressa W. Spatial distribution of under immunization among children 12-23 months old in Butajira HDSS, southern Ethiopia. BMC Pediatr 2021; 21:226. [PMID: 33971837 PMCID: PMC8108332 DOI: 10.1186/s12887-021-02690-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Immunization is essential to prevent between 2 and 3 million deaths globally each year and it is widely accepted that it is one of the most cost-effective health interventions. Despite all its advantages, immunization in Ethiopia is still far from the target set by the United Nations Sustainable Development Goals to achieve universal immunization by all countries in 2030. The 2016 Ethiopian Demographic and Health Survey (EDHS) reported an overall full immunization rate of only 38.3%. The objective of this study was to evaluate the spatial distribution of under immunization in 12 to 23 months old children and further identify the determinants of under immunization clustering in the Butajira Health and Demographic Surveillance Site (HDSS). Methods We conducted a community based sectional survey from March to April, 2016 in Butajira HDSS. We collected data on immunization status from a total of 482 children between the age of 12 to 23 months. We randomly selected household and interviewed mothers and /or observed vaccination cards when available to collect data on child’s immunization status. We also collected the geographic location of all villages within the ten Kebeles using a Handheld Global Positioning System (GPS) (Garmin GPSMAP®). We analyzed the spatial distribution of under immunization and clustering using the SatScan® software which employs a purely spatial Bernoulli’s model. We also ran a logistic regression model to help evaluate the causes of clustering. Results We found that only 22.4% [95% CI: 18.9, 26.4%] of children were fully immunized. This study identified one significant cluster of under immunization among children 12–23 months of age within the Butajira HDSS (relative risk (RR) = 1.24,P < 0·01). We found that children residing in this cluster had more than 1.24 times risk of under immunization compared with children residing outside of the identified cluster. We found significant differences with regard to Maternal Tetanus Toxoid immunization status and place of delivery between cases found within a spatial cluster and cases found outside the cluster. For example, the odds of home delivery is more than two times [AOR 2.21: 95%CI; 1.06, 4.63] among children within an identified spatial cluster than the odds among children found outside the identified cluster. Conclusions Under immunization of 12–23 months old children and under immunization with specific vaccines such as Polio, BCG, DPT (1–3) and Measles clustered geographically. Spatial studies could be effective in identifying geographic areas of under immunization for targeted intervention like in this study to gear health education to the specific locality. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02690-4.
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Affiliation(s)
- Admassu Ketsela
- Menelik II Medical & Health Sciences College, Kotebe Metropolitan University, Addis Ababa, Ethiopia.
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Tao J, Wang YT, Abudoukelimu M, Yang YN, Li XM, Xie X, Chen BD, Liu F, He CH, Li HY, Ma YT. Association of genetic variations in the Wnt signaling pathway genes with myocardial infarction susceptibility in Chinese Han population. Oncotarget 2018; 7:52740-52750. [PMID: 27391264 PMCID: PMC5288145 DOI: 10.18632/oncotarget.10401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/18/2016] [Indexed: 12/12/2022] Open
Abstract
Numerous studies have implicated the Wnt pathway in the development and progression of myocardial infarction (MI); however, there are very few investigations addressing the effects of polymorphisms in the Wnt pathway genes on MI susceptibility. We investigated the possible correlation between genetic variations in Wnt pathway genes and MI risk. Three polymorphisms (rs7832767 C > T in SFRP1 gene, rs2293303 C > T in CTNNB1 gene, rs16893344 C > T in WISP1 gene) were finally selected and genotyped in 465 MI patients and 485 healthy controls, using the PCR-RFLP method. We found that the SFRP1 rs7832767 variant allele (T) was associated with a significantly increased risk of MI [TT vs. CC: adjusted odds ratio (AOR) = 3.13, 95% CI = 1.78-5.51; CT/TT vs. CC: AOR = 1.53, 95% CI = 1.12-2.08; TT vs. CC/CT: AOR = 2.87, 95% CI = 1.66-4.97)]. The significant association with MI risk was also found for the CTNNB1 rs2293303 (CT vs. CC: AOR = 3.48, 95% CI = 2.28-5.33; TT vs. CC: AOR = 7.37, 95% CI = 2.08-26.16; CT/TT vs. CC: AOR = 3.72, 95% CI = 2.46-5.62; TT vs. CC/CT: AOR = 5.52, 95% CI = 1.58-19.28), and WISP1 rs16893344 polymorphisms (CT vs. CC: AOR = 2.43, 95% CI = 1.70-3.47; TT vs. CC: AOR = 5.17, 95% CI = 1.85-14.41; CT/TT vs. CC: AOR = 2.58, 95% CI = 1.83-3.66; TT vs. CC/CT: AOR = 3.88, 95% CI = 1.41-10.64). The associations remain significant in stratified analysis by demographic and clinical characteristics of participants, with few exceptions. Our study provided the first evidence of the association between polymorphisms in the Wnt pathway genes and MI susceptibility in Chinese Han population. Epidemiological studies with larger samples and functional analyses are warranted to further verify our results.
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Affiliation(s)
- Jing Tao
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yong-Tao Wang
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Mayila Abudoukelimu
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yi-Ning Yang
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiao-Mei Li
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiang Xie
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Bang-Dang Chen
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, Xinjiang, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, Xinjiang, China
| | - Chun-Hui He
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hua-Yin Li
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yi-Tong Ma
- Department of Cardiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Kormi I, Nieminen MT, Havulinna AS, Zeller T, Blankenberg S, Tervahartiala T, Sorsa T, Salomaa V, Pussinen PJ. Matrix metalloproteinase-8 and tissue inhibitor of matrix metalloproteinase-1 predict incident cardiovascular disease events and all-cause mortality in a population-based cohort. Eur J Prev Cardiol 2017; 24:1136-1144. [PMID: 28429955 DOI: 10.1177/2047487317706585] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Extracellular matrix degrading proteases and their regulators play an important role in atherogenesis and subsequent plaque rupture leading to acute cardiovascular manifestations. Design and methods In this prospective cohort study, we investigated the prognostic value of circulating matrix metalloproteinase-8, tissue inhibitor of matrix metalloproteinase-1 concentrations, the ratio of matrix metalloproteinase-8/ tissue inhibitor of matrix metalloproteinase-1 and, for comparison, myeloperoxidase and C-reactive protein concentrations for incident cardiovascular disease endpoints. The population-based FINRISK97 cohort comprised 7928 persons without cardiovascular disease at baseline. The baseline survey included a clinical examination and blood sampling. During a 13-year follow-up the endpoints were ascertained through national healthcare registers. The associations of measured biomarkers with the endpoints, including cardiovascular disease event, coronary artery disease, acute myocardial infarction, stroke and all-cause death, were analysed using Cox regression models. Discrimination and reclassification models were used to evaluate the clinical implications of the biomarkers. Results Serum tissue inhibitor of matrix metalloproteinase-1 and C-reactive protein concentrations were associated significantly with increased risk for all studied endpoints. Additionally, matrix metalloproteinase-8 concentration was associated with the risk for a coronary artery disease event, myocardial infarction and death, and myeloperoxidase concentration with the risk for cardiovascular disease events, stroke and death. The only significant association for the matrix metalloproteinase-8/ tissue inhibitor of matrix metalloproteinase-1 ratio was observed with the risk for myocardial infarction. Adding tissue inhibitor of matrix metalloproteinase-1 to the established risk profile improved risk discrimination of myocardial infarction ( p=0.039) and death (0.001). Both matrix metalloproteinase-8 (5.2%, p < 0.001) and tissue inhibitor of matrix metalloproteinase-1 (12.9%, p < 0.001) provided significant clinical net reclassification improvement for death. Conclusions Serum matrix metalloproteinase-8 and tissue inhibitor of matrix metalloproteinase-1 can be considered as biomarkers of incident cardiovascular disease events and death.
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Affiliation(s)
- Immi Kormi
- 1 Oral and Maxillofacial Department, Oulu University Hospital, Finland
| | - Mikko T Nieminen
- 2 Oral and Maxillofacial Diseases, Helsinki University Hospital, Finland
| | | | - Tanja Zeller
- 4 Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany.,5 German Center for Cardiovascular Research (DZHK e.V), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Stefan Blankenberg
- 4 Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany.,5 German Center for Cardiovascular Research (DZHK e.V), Partner Site Hamburg/Lübeck/Kiel, Germany
| | | | - Timo Sorsa
- 2 Oral and Maxillofacial Diseases, Helsinki University Hospital, Finland.,6 Division of Periodontology, Karolinska Institutet, Sweden
| | | | - Pirkko J Pussinen
- 2 Oral and Maxillofacial Diseases, Helsinki University Hospital, Finland
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Kjærulff TM, Ersbøll AK, Gislason G, Schipperijn J. Geographical clustering of incident acute myocardial infarction in Denmark: A spatial analysis approach. Spat Spatiotemporal Epidemiol 2016; 19:46-59. [PMID: 27839580 DOI: 10.1016/j.sste.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine the geographical patterns in AMI and characterize individual and neighborhood sociodemographic factors for persons living inside versus outside AMI clusters. METHODS The study population comprised 3,515,670 adults out of whom 74,126 persons experienced an incident AMI (2005-2011). Kernel density estimation and global and local clustering methods were used to examine the geographical patterns in AMI. Median differences and frequency distributions of sociodemographic factors were calculated for persons living inside versus outside AMI clusters. RESULTS Global clustering of AMI occurred in Denmark. Throughout the country, 112 significant clusters with high risk of incident AMI were identified. The relative risk of AMI in significant clusters ranged from 1.45 to 47.43 (median=4.84). Individual and neighborhood socioeconomic position was markedly lower for persons living inside versus outside AMI clusters. CONCLUSIONS AMI is geographically unequally distributed throughout Denmark and determinants of these geographical patterns might include individual- and neighborhood-level sociodemographic factors.
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Affiliation(s)
- Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark.
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, DK-1353 Copenhagen K, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark; Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaardsvej 28, DK-2900 Hellerup, Denmark; The Danish Heart Foundation, Hauser Plads 10, DK-1127 Copenhagen K, Denmark.
| | - Jasper Schipperijn
- Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark .
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Sipilä JOT, Gunn JM, Kauko T, Rautava P, Kytö V. Association of restaurant smoking ban and the incidence of acute myocardial infarction in Finland. BMJ Open 2016; 6:e009320. [PMID: 26826146 PMCID: PMC4735218 DOI: 10.1136/bmjopen-2015-009320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the changes in nationwide acute myocardial infarction (AMI) incidence following the implementation of a law banning smoking indoors in restaurants on 1 June 2007. METHODS Retrospective registry study of all hospitalisations for AMI in Finland. All 34,887 hospitalisations for AMI between 1 June 2005 and 31 May 2009 were identified from the Care Register for Health Care (CRHC) and statistics for tobacco consumption were obtained from the National Institute for Health and Welfare. Comorbidities for individual hospitalisations were searched from the CRHC. RESULTS The incidence rate of AMI was reduced by 6.3% (95% CI 4.1% to 8.6%; p<0.0001) in the latter half of the study period following the smoking ban when adjusted for age, gender and overall population prevalence of smoking. Short-term incidence of AMI (6-month prior vs 6 months after the smoking ban) was also reduced (4.5%, 95% CI 0.2% to 9.0%; p=0.0399) and was largest in the working middle-aged group (40-50 years) but observed also in the oldest age group (>70 years). The incidence rates declined similarly for men and women. CONCLUSIONS Banning indoor tobacco smoking in restaurants was associated with a mild additional reduction in AMI incidence on a nationwide level in Finland.
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Affiliation(s)
- Jussi Olli Tapani Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland Department of Neurology, University of Turku, Turku, Finland Neurology Clinic, North Karelia Central Hospital, Joensuu, Finland
| | - Jarmo Mikael Gunn
- Heart Center, Turku University Hospital, Turku, Finland Department of Surgery, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tommi Kauko
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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11
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Ahmadi A, Soori H, Mehrabi Y, Etemad K. Spatial analysis of myocardial infarction in Iran: National report from the Iranian myocardial infarction registry. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:434-9. [PMID: 26487871 PMCID: PMC4590197 DOI: 10.4103/1735-1995.163955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Myocardial infarction (MI) is a leading cause of mortality and morbidity in Iran. No spatial analysis of MI has been conducted to date. The present study was conducted to determine the pattern of MI incidence and to identify the associated factors in Iran by province. Materials and Methods: This study has two parts. One part is prospective and hospital-based, and the other part is an ecological study. In this study, the data of 20,750 new MI cases registered in Iranian Myocardial Infarction Registry in 2012 were used. For spatial analysis in global and local, spatial autocorrelation, Moran's I, Getis-Ord, and logistic regression models were used. Data were analyzed by Stata software and ArcGIS 9.3. Results: Based on autocorrelation coefficient, a specific pattern was observed in the distribution of MI incidence in different provinces (Moran's I: 0.75, P < 0.001). Spatial pattern of incidence was approximately the same in men and women. MI incidence was clustering in six provinces (North Khorasan, Yazd, Kerman, Semnan, Golestan, and Mazandaran). Out of the associated factors with clustered MI in six provinces, temperature, humidity, hypertension, smoking, and body mass index (BMI) could be mentioned. Hypertension, smoking, and BMI contributed to clustering with, respectively, 2.36, 1.31, and 1.31 odds ratio. Conclusion: Addressing the place-based pattern of incidence and clarifying their epidemiologic dimension, including spatial analysis, has not yet been implemented in Iran. Report on MI incidence rate by place and formal borders is useful and is used in the planning and prioritization in different levels of health system.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Public Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Soori
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Liljestrand J, Havulinna A, Paju S, Männistö S, Salomaa V, Pussinen P. Missing Teeth Predict Incident Cardiovascular Events, Diabetes, and Death. J Dent Res 2015; 94:1055-62. [DOI: 10.1177/0022034515586352] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Periodontitis, the main cause of tooth loss in the middle-aged and elderly, associates with the risk of atherosclerotic vascular disease. The objective was to study the capability of the number of missing teeth in predicting incident cardiovascular diseases (CVDs), diabetes, and all-cause death. The National FINRISK 1997 Study is a Finnish population–based survey of 8,446 subjects with 13 y of follow-up. Dental status was recorded at baseline in a clinical examination by a trained nurse, and information on incident CVD events, diabetes, and death was obtained via national registers. The registered CVD events included coronary heart disease events, acute myocardial infarction, and stroke. In Cox regression analyses, having ≥5 teeth missing was associated with 60% to 140% increased hazard for incident coronary heart disease events ( P < 0.020) and acute myocardial infarction ( P < 0.010). Incident CVD ( P < 0.043), diabetes ( P < 0.040), and death of any cause ( P < 0.019) were associated with ≥9 missing teeth. No association with stroke was observed. Adding information on missing teeth to established risk factors improved risk discrimination of death ( P = 0.0128) and provided a statistically significant net reclassification improvement for all studied end points. Even a few missing teeth may indicate an increased risk of CVD, diabetes, or all-cause mortality. When individual risk factors for chronic diseases are assessed, the number of missing teeth could be a useful additional indicator for general medical practitioners.
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Affiliation(s)
- J.M. Liljestrand
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - A.S. Havulinna
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - S. Paju
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - S. Männistö
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - V. Salomaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - P.J. Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
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Ahmadi A, Khaledifar A, Sajjadi H, Soori H. Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran. Int J Equity Health 2014; 13:116. [PMID: 25428143 PMCID: PMC4251987 DOI: 10.1186/s12939-014-0116-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 11/12/2014] [Indexed: 01/28/2023] Open
Abstract
Introduction Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level. Methods In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models. Results Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education. Conclusion A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Arsalan Khaledifar
- Cardiology Department, School of Medicine, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Homeira Sajjadi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran.
| | - Hamid Soori
- Safety Promotion and Injury Prevention Research center, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, 7th Floor, 2nd SBMU Headquarters Building, Parvaneh St., Velenjak Area, Chamran High Way, Tehran, Iran.
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Paalanen L, Prättälä R, Laatikainen T. Contribution of education level and dairy fat sources to serum cholesterol in Russian and Finnish Karelia: results from four cross-sectional risk factor surveys in 1992-2007. BMC Public Health 2012; 12:910. [PMID: 23101907 PMCID: PMC3519653 DOI: 10.1186/1471-2458-12-910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 10/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food habits vary by socio-economic group and geographic area. Data on socio-economic differences in food habits and in serum total cholesterol concentration from Russia are scarce. Our aim was to examine changes and educational differences in serum total cholesterol and in the consumption of major sources of saturated fat in two geographically neighbouring areas, Russian and Finnish Karelia, and to examine whether the foods associated with serum total cholesterol are different in the two areas. METHODS Data from cross-sectional risk factor surveys from years 1992, 1997, 2002 and 2007 in the district of Pitkäranta, the Republic of Karelia, Russia (n = 2672), and North Karelia, Finland (n = 5437), were used. The analyses included two phases. 1) To examine the differences in cholesterol by education, the means and 95% confidence intervals for education groups were calculated for each study year. 2) Multivariate linear regression analysis was employed to examine the role of butter in cooking, butter on bread, fat-containing milk and cheese in explaining serum total cholesterol. In these analyses, the data for all four study years were combined. RESULTS In Pitkäranta, serum total cholesterol fluctuated during the study period (1992-2007), whereas in North Karelia cholesterol levels declined consistently. No apparent differences in cholesterol levels by education were observed in Pitkäranta. In North Karelia, cholesterol was lower among subjects in the highest education tertile compared to the lowest education tertile in 1992 and 2002. In Pitkäranta, consumption of fat-containing milk was most strongly associated with cholesterol (β=0.19, 95% CI 0.10, 0.28) adjusted for sex, age, education and study year. In North Karelia, using butter in cooking (β=0.09, 95% CI 0.04, 0.15) and using butter on bread (β=0.09, 95% CI 0.02, 0.15) had a significant positive association with cholesterol. CONCLUSIONS In the two geographically neighbouring areas, the key foods influencing serum cholesterol levels varied considerably. Assessment and regular monitoring of food habits are essential to plan nutrition education messages that are individually tailored for the target area and time.
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Affiliation(s)
- Laura Paalanen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, THL, PO Box 30, Helsinki FI-00271, Finland.
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15
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Abstract
Understanding the impact of place on health is a key element of epidemiologic investigation, and numerous tools are being employed for analysis of spatial health-related data. This review documents the huge growth in spatial epidemiology, summarizes the tools that have been employed, and provides in-depth discussion of several methods. Relevant research articles for 2000-2010 from seven epidemiology journals were included if the study utilized a spatial analysis method in primary analysis (n = 207). Results summarized frequency of spatial methods and substantive focus; graphs explored trends over time. The most common spatial methods were distance calculations, spatial aggregation, clustering, spatial smoothing and interpolation, and spatial regression. Proximity measures were predominant and were applied primarily to air quality and climate science and resource access studies. The review concludes by noting emerging areas that are likely to be important to future spatial analysis in public health.
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Affiliation(s)
- Amy H. Auchincloss
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania 19102;
| | - Samson Y. Gebreab
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48109; ,
| | - Christina Mair
- Prevention Research Center, University of California, Berkeley, California 94704;
| | - Ana V. Diez Roux
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48109; ,
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16
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Turin TC, Specogna AV, Rumana N. Geotopographic and environmental characteristics of communities and the seasonality of stroke occurrences. J Stroke Cerebrovasc Dis 2011; 22:279-80. [PMID: 22112932 DOI: 10.1016/j.jstrokecerebrovasdis.2011.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 08/28/2011] [Indexed: 11/19/2022] Open
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17
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Kim LG, Carson C, Lawlor DA, Ebrahim S. Geographical variation in cardiovascular incidence: results from the British Women's Heart and Health Study. BMC Public Health 2010; 10:696. [PMID: 21078139 PMCID: PMC2996371 DOI: 10.1186/1471-2458-10-696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022] Open
Abstract
Background Prevalence of cardiovascular disease (CVD) in women shows regional variations not explained by common risk factors. Analysis of CVD incidence will provide insight into whether there is further divergence between regions with increasing age. Methods Seven-year follow-up data on 2685 women aged 59-80 (mean 69) at baseline from 23 towns in the UK were available from the British Women's Heart and Health Study. Time to fatal or non-fatal CVD was analyzed using Cox regression with adjustment for risk factors, using multiple imputation for missing values. Results Compared to South England, CVD incidence is similar in North England (HR 1.05 (95% CI 0.84, 1.31)) and Scotland (0.93 (0.68, 1.27)), but lower in Midlands/Wales (0.85 (0.64, 1.12)). Event severity influenced regional variation, with South England showing lower fatal incident CVD than other regions, but higher non-fatal incident CVD. Kaplan-Meier plots suggested that regional divergence in CVD occurred before baseline (before mean baseline age of 69). Conclusions In women, regional differences in CVD early in adult life do not further diverge in later life. This may be due to regional differences in early detection, survivorship of women entering the study, or event severity. Targeting health care resources for CVD by geographic variation may not be appropriate for older age-groups.
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Affiliation(s)
- Lois G Kim
- Department of Medical Statistics Unit, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
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Incidence of facial pain in the general population. Pain 2009; 147:122-7. [PMID: 19783099 DOI: 10.1016/j.pain.2009.08.023] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 08/17/2009] [Accepted: 08/25/2009] [Indexed: 02/06/2023]
Abstract
Facial pain has a considerable impact on quality of life. Accurate incidence estimates in the general population are scant. The aim was therefore to estimate the incidence rate (IR) of trigeminal neuralgia (TGN), postherpetic neuralgia (PHN), cluster headache (CH), occipital neuralgia (ON), local neuralgia (LoN), atypical facial pain (AFP), glossopharyngeal neuralgia (GPN) and paroxysmal hemicrania (PH) in the Netherlands. In the population-based Integrated Primary Care Information (IPCI) medical record database potential facial pain cases were identified from codes and narratives. Two medical doctors reviewed medical records, questionnaires from general practitioners and specialist letters using criteria of the International Association for the Study of Pain. A pain specialist arbitrated if necessary and a random sample of all cases was evaluated by a neurologist. The date of onset was defined as date of first specific symptoms. The IR was calculated per 100,000PY. Three hundred and sixty-two incident cases were ascertained. The overall IR [95% confidence interval] was 38.7 [34.9-42.9]. It was more common among women compared to men. Trigeminal neuralgia and cluster headache were the most common forms among the studied diseases. Paroxysmal hemicrania and glossopharyngeal neuralgia were among the rarer syndromes. The IR increased with age for all diseases except CH and ON, peaking in the 4th and 7th decade, respectively. Postherpetic neuralgia, CH and LoN were more common in men than women. From this we can conclude that facial pain is relatively rare, although more common than estimated previously based on hospital data.
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Stamey JD, Bekele BN, Powers S. Bayesian Modeling of Follow-up Studies with Missing Data. Ann Epidemiol 2009; 19:416-22. [DOI: 10.1016/j.annepidem.2009.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 01/05/2009] [Accepted: 01/09/2009] [Indexed: 11/26/2022]
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