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Rebić N, De Vera MA, Gupta A, Amiri N. Perinatal Use and Discontinuation of Disease-Modifying Antirheumatic Drugs: Outcomes of Patients Seen at a Pregnancy and Rheumatic Diseases Clinic. J Clin Rheumatol 2024; 30:188-192. [PMID: 38753224 DOI: 10.1097/rhu.0000000000002090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Managing rheumatic disease activity using pregnancy-compatible medications is essential for reducing adverse maternal and fetal outcomes. We characterized medication use and discontinuation before, during, and after pregnancy, among female patients with rheumatic diseases attending a targeted pregnancy and rheumatic diseases clinic. METHODS We conducted a cross-sectional medical record review of female patients with rheumatic diseases at a Canadian clinic between January 2017 and July 2020. Patients were categorized by pregnancy stage at their latest clinic visit: (1) preconception; (2) pregnant; (3) postpartum. We assessed use of conventional, biologic, and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), prednisone, and nonsteroidal anti-inflammatory drugs across 6 perinatal windows: 24 and 12 months preconception, each pregnancy trimester, and 3 months postpartum. We reported adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for medication discontinuation in the first trimester and subsequent disease flare. RESULTS Of 230 included patients, 85 (37.0%), 12 (5.2%), and 133 (57.8%) were preconception, pregnant, and postpartum, respectively. Approximately half experienced at least 1 disease flare during each pregnancy stage (56.4% preconception, 58.1% during pregnancy, and 53.7% postpartum). Most used at least 1 DMARD throughout the perinatal period (82.6% preconception, 55.6% during pregnancy, and 45.1% postpartum). Overall, 25.5% discontinued at least 1 DMARD in the first trimester. DMARD discontinuation was associated with disease flare during pregnancy (aOR, 1.49; 95% CI, 0.55-4.03; p = 0.87) and postpartum (aOR, 3.09; 95% CI, 0.83-11.47; p = 0.09). CONCLUSIONS Patients receiving care at a pregnancy and rheumatic disease clinic show perinatal medication use patterns consistent with recent recommendations and clinical guidelines.
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Huang Y, Bruera S, Agarwal SK, Suarez-Almazor ME, Bazzazzadehgan S, Ramachandran S, Bhattacharya K, Bentley JP, Yang Y. Opioid Treatment for Adults With and Without Systemic Autoimmune/Inflammatory Rheumatic Diseases: Analysis of 2006-2019 United States National Data. Arthritis Care Res (Hoboken) 2024. [PMID: 38766880 DOI: 10.1002/acr.25378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/29/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This study compared opioid prescribing among ambulatory visits with systemic autoimmune/inflammatory rheumatic diseases (SARDs) or without and assessed factors associated with opioid prescribing in SARDs. METHODS This cross-sectional study used the National Ambulatory Medical Care Survey between 2006 and 2019. Adult (≥18 years) visits with a primary diagnosis of SARDs, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus were included in the study. Opioid prescribing was compared between those with vs without SARDs using multivariable logistic regression accounting for the complex survey design and adjusting for predisposing, enabling, and need factors within Andersen's Behavioral Model of Health Services Use. Another multivariable logistic regression examined the predictors associated with opioid prescribing in SARDs. RESULTS Annually, an average of 5.20 million (95% confidence interval [CI] 3.58-6.82) visits were made for SARDs, whereas 780.14 million (95% CI 747.56-812.72) visits were made for non-SARDs. The SARDs group was more likely to be prescribed opioids (22.53%) than the non-SARDs group (9.83%) (adjusted odds ratio [aOR] 2.65; 95% CI 1.68-4.18). Among the SARDs visits, patient age from 50 to 64 (aOR 1.95; 95% CI 1.05-3.65 relative to ages 18-49) and prescribing of glucocorticoids (aOR 1.75; 95% CI 1.20-2.54) were associated with an increased odd of opioid prescribing, whereas private insurance relative to Medicare (aOR 0.50; 95% CI 0.31-0.82) was associated with a decreased odds of opioid prescribing. CONCLUSION Opioid prescribing in SARDs was higher compared to non-SARDs. Concerted efforts are needed to determine the appropriateness of opioid prescribing in SARDs.
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Affiliation(s)
- Yinan Huang
- The University of Mississippi School of Pharmacy, University, Mississippi
| | | | | | | | | | | | | | - John P Bentley
- The University of Mississippi School of Pharmacy, University, Mississippi
| | - Yi Yang
- The University of Mississippi School of Pharmacy, University, Mississippi
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Attia DHS, Mohamed ER, Ismaeel AY, Suliman YA, Moneim NHA, Abdel Noor RA. Insight into the Epidemiology of the Adult-onset Systemic Autoimmune Rheumatic Diseases in Egypt: A Descriptive Study of 8690 Patients. Curr Rheumatol Rev 2024; 20:522-533. [PMID: 38314595 DOI: 10.2174/0115733971277833231226071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/05/2023] [Accepted: 12/07/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND/OBJECTIVE Although systemic autoimmune rheumatic diseases (SARDs) seem to be ubiquitous, Africa and the Middle East seem to be a remarkable exception with scarcity of data compared with the developed countries. Furthermore, most of the studies addressed a particular disease. This work aimed to shed light on the relative frequency and epidemiology of the different adult-onset SARDs in Egypt. METHODS This is a retrospective hospital-based study including six university hospitals providing free health care services: Cairo, Alexandria, Tanta, Suez Canal, Beni-Suef and Assiut University Hospitals. All available files for patients attending the outpatient clinics or admitted to the inpatient departments between January 2000 and December 2021 were retrospectively reviewed. Data about the patient's diagnosis, gender, age at disease onset, year of disease onset and residence were collected. RESULTS The study included 8690 patients. Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Behçet's disease (BD) and spondyloarthropathies (SPA) represented the main SARDs in Egypt. They mainly affect young patients below the age of 40 years. RA and SLE mainly affect females; males are mainly affected by axial SPA and BD. There is an increasing incidence of SARDs during the study period. CONCLUSION The study revealed the high burden of SARDs in Egypt, helping better allocation of economic resources for the management of diseases of the highest prevalence and those affecting the young reproductive age groups. Increased public and medical staff awareness about SARDs is recommended to help early referral of patients to rheumatologists and, hence, better estimation of their epidemiology.
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Affiliation(s)
- Doaa H S Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman R Mohamed
- Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Y Ismaeel
- Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Yossra A Suliman
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nermeen H A Moneim
- Physical Medicine, Rheumatology & Rehabilitation Department, Faculty of Medicine, Suez Canal University, Suez, Egypt
| | - Rasha A Abdel Noor
- Internal Medicine and Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. Do Patterns of Early Disease Severity Predict Grade 12 Academic Achievement in Youths With Childhood-Onset Chronic Rheumatic Diseases? J Rheumatol 2023; 50:1165-1172. [PMID: 36725055 DOI: 10.3899/jrheum.220656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the association of early disease severity with grade 12 standards test performance in individuals with childhood-onset chronic rheumatic diseases (ChildCRDs), including juvenile arthritis and systemic autoimmune rheumatic diseases. METHODS We used linked provincial administrative data to identify patients with ChildCRDs born between 1979 and 1998 in Manitoba, Canada. Primary outcomes were Language and Arts Achievement Index (LAI) scores and Math Achievement Index (MAI) scores from grade 12 standards test results as well as enrollment data. The secondary outcome was enrollment in grade 12 by 17 years of age. Latent class trajectory analysis identified disease severity groups using physician visits following diagnosis. Multivariable linear regression tested the association of disease severity groups with LAI and MAI scores, and logistic regression tested the association of disease severity with age-appropriate enrollment, after adjusting for sociodemographic factors and psychiatric morbidities. RESULTS The study cohort included 541 patients, 70.1% of whom were female. A 3-class trajectory model provided the best fit; it classified 9.7% of patients as having severe disease, 54.5% as having moderate disease, and 35.8% as having mild disease. After covariate adjustment, severe disease was associated with poorer LAI and MAI scores but not with age-appropriate enrollment. CONCLUSION Among patients with ChildCRDs, those with severe disease performed more poorly on grade 12 standards tests, independent of sociodemographic and psychiatric risk factors. Clinicians should work with educators and policy makers to advocate for supports to improve educational outcomes of patients with ChildCRDs.
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Affiliation(s)
- Lily S H Lim
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba;
| | - Okechukwu Ekuma
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Ruth A Marrie
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Marni Brownell
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Christine A Peschken
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Carol A Hitchon
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Kerstin Gerhold
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba
| | - Lisa M Lix
- L.M. Lix, PhD, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Zhao N, Smargiassi A, Chen H, Widdifield J, Bernatsky S. Systemic autoimmune rheumatic diseases and multiple industrial air pollutant emissions: A large general population Canadian cohort analysis. ENVIRONMENT INTERNATIONAL 2023; 174:107920. [PMID: 37068387 DOI: 10.1016/j.envint.2023.107920] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Past investigations of air pollution and systemic autoimmune rheumatic diseases (SARDs) typically focused on individual (not mixed) and overall environmental emissions. We assessed mixtures of industrial emissions of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) and SARDs onset in Ontario, Canada. METHODS We assembled an open cohort of over 12 million adults (without SARD diagnoses at cohort entry) based on provincial health data for 2007-2020 and followed them until SARD onset, death, emigration, or end of study (December 2020). SARDs were identified using physician billing and hospitalization diagnostic codes for systemic lupus, scleroderma, myositis, undifferentiated connective tissue disease, and Sjogren's. Rheumatoid arthritis and vasculitis were not included. Average PM2.5, NO2, and SO2 industrial emissions from 2002 to one year before SARDs onset or end of study were assigned using residential postal codes. A quantile g-computation model for time to SARD onset was developed for the industrial emission mixture, adjusting for sex, age, income, rurality index, chronic obstructive pulmonary disease (as a proxy for smoking), background (environmental overall) PM2.5, and calendar year. We conducted stratified analyses across age, sex, and rurality. RESULTS We identified 43,931 new SARD diagnoses across 143,799,564 person-years. The adjusted hazard ratio for SARD onset for an increase in all emissions by one decile was 1.018 (95% confidence interval 1.013-1.022). Similar positive associations between SARDs and the mixed emissions were observed in most stratified analyses. Industrial PM2.5 contributed most to SARD risk. CONCLUSIONS Industrial air pollution emissions were associated with SARDs risk.
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Affiliation(s)
- Naizhuo Zhao
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Audrey Smargiassi
- Département de Santé Environnementale et Santé au Travail, School of Public Health, Université de Montréal, Montréal, QC, Canada; Institut National de Santé Publique du Québec, Montréal, QC, Canada; Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; ICES, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jessica Widdifield
- ICES, Toronto, ON, Canada; Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sasha Bernatsky
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada.
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Improving access to care for rheumatology services in Canada. Clin Rheumatol 2023; 42:1205-1211. [PMID: 36746833 PMCID: PMC9901822 DOI: 10.1007/s10067-023-06532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Rheumatic diseases are becoming increasingly prevalent in Canada, and its associated strain on the healthcare system is expected to increase over the next decades. Furthermore, there is an increasing body of evidence to suggest that access to rheumatology care is currently not meeting established quality of care benchmarks. To frame issues affecting access to care for rheumatology services in Canada, a proposed chronological framework from a rheumatology patient's perspective is proposed. Illustrating principles from a health policy lens including drawing from the stages heuristic framework and multiple streams theory, issues surrounding access to rheumatology assessment, to rheumatological investigations and lastly to appropriate treatment are explored. In particular, the current supply and demand mismatch within the rheumatology workforce presents challenges for patients in accessing rheumatic diseases providers. Potential policy solutions including increasing the pool of rheumatic diseases care providers, enhancing the clinical capacity with extended role providers and increasing uptake of virtual care are discussed. To ameliorate access to rheumatology investigations, the concept of provider education surrounding the appropriateness of investigations and merit-based funding are explored. Lastly, access to rheumatological treatment is framed using biologic therapies as an example, highlighting the policy challenges in biosimilar uptake and associated ethical and political considerations. By using a health policy lens to explore deficiencies within Canada's current system, the overarching goal of this analysis is to set the stage for reasoned and timely solutions in the future.
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Zhao N, Smargiassi A, Jean S, Gamache P, Laouan-Sidi EA, Chen H, Goldberg MS, Bernatsky S. Long-term exposure to fine particulate matter and ozone and the onset of systemic autoimmune rheumatic diseases: an open cohort study in Quebec, Canada. Arthritis Res Ther 2022; 24:151. [PMID: 35739578 PMCID: PMC9219240 DOI: 10.1186/s13075-022-02843-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To estimate associations between fine particulate matter (PM2.5) and ozone and the onset of systemic autoimmune rheumatic diseases (SARDs). METHODS An open cohort of over 6 million adults was constructed from provincial physician billing and hospitalization records between 2000 and 2013. We defined incident SARD cases (SLE, Sjogren's syndrome, scleroderma, polymyositis, dermatomyositis, polyarteritis nodosa and related conditions, polymyalgia rheumatic, other necrotizing vasculopathies, and undifferentiated connective tissue disease) based on at least two relevant billing diagnostic codes (within 2 years, with at least 1 billing from a rheumatologist), or at least one relevant hospitalization diagnostic code. Estimated PM2.5 and ozone concentrations (derived from remote sensing and/or chemical transport models) were assigned to subjects based on residential postal codes, updated throughout follow-up. Cox proportional hazards models with annual exposure levels were used to calculate hazard ratios (HRs) for SARDs incidence, adjusting for sex, age, urban-versus-rural residence, and socioeconomic status. RESULTS The adjusted HR for SARDS related to one interquartile range increase in PM2.5 (3.97 µg/m3) was 1.12 (95% confidence interval 1.08-1.15), but there was no clear association with ozone. Indirectly controlling for smoking did not alter the findings. CONCLUSIONS We found associations between SARDs incidence and PM2.5, but no relationships with ozone. Additional studies are needed to better understand interplays between the many constituents of air pollution and rheumatic diseases.
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Affiliation(s)
- Naizhuo Zhao
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Audrey Smargiassi
- Département de Santé Environnementale Et de Santé Au Travail, School of Public Health, Université de Montréal, Montréal, QC, Canada.,Institut National de Santé Publique du Québec, Montréal, QC, Canada.,Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montreal, Canada
| | - Sonia Jean
- Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montreal, Canada.,Université Laval and Bureau d'information Et d'études en Santé Des Populations, Institut National de Santé Publique du Québec (INSPQ), 945, avenue Wolfe, Québec, QC, G1V 5B3, Canada
| | - Philippe Gamache
- Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montreal, Canada
| | - Elhadji-Anassour Laouan-Sidi
- Centre of Public Health Research, University of Montreal and CIUSSS du Centre-Sud-de-L'Île-de-Montréal, Montreal, Canada
| | - Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mark S Goldberg
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Québec, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada. .,Department of Medicine, McGill University, Québec, Canada. .,Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada. .,Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 Boul. de Maisonneuve Ouest, (3F.51), Montreal, QC, H4A 3S5, Canada.
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Kirwin E, MacDonald S, Simmonds K. Profiles in Epidemiology: Dr. Larry Svenson. Am J Epidemiol 2022. [PMID: 34850825 DOI: 10.1093/aje/kwab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. A Population-based Study of Grade 12 Academic Performance in Adolescents With Childhood-onset Chronic Rheumatic Diseases. J Rheumatol 2021; 49:299-306. [PMID: 34725181 DOI: 10.3899/jrheum.201514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aims of this study were (1) to compare grade 12 standardized test results of patients diagnosed with childhood-onset chronic rheumatic diseases (ChildCRD) and unaffected peers; and (2) to identify factors associated with test results of patients with ChildCRD and unaffected peers. METHODS This was a population-based retrospective cohort study. All patients with ChildCRD (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology center in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes. Patients were matched by age, sex, and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 Language Arts Achievement Index (LAI) and the Math Achievement Index (MAI) scores. ChildCRD, sociodemographic, and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. RESULTS Five hundred and forty-one patients with ChildCRD were matched to 2713 unaffected peers. Patients with ChildCRD had lower LAI and MAI scores compared to their peers. More patients with ChildCRD failed or did not take the language arts (51% vs 41%, P < 0.001) and math (61% vs 55%, P = 0.02) tests. On multivariable analysis, ChildCRD, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities (between ChildCRD diagnosis and standardized testing), were associated with worse LAI and MAI results. CONCLUSION This population-based study showed that patients with ChildCRD performed less well than their peers on grade 12 standardized testing, independent of sociodemographic and mental health comorbidities.
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Affiliation(s)
- Lily S H Lim
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Okekchukwu Ekuma
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Ruth Ann Marrie
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Marni Brownell
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Christine A Peschken
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Carol A Hitchon
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Kerstin Gerhold
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Lisa Marie Lix
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
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Gomes T, McCormack D, Kitchen SA, Paterson JM, Mamdani MM, Proulx L, Bayliss L, Tadrous M. Projected impact of biosimilar substitution policies on drug use and costs in Ontario, Canada: a cross-sectional time series analysis. CMAJ Open 2021; 9:E1055-E1062. [PMID: 34815261 PMCID: PMC8612652 DOI: 10.9778/cmajo.20210091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several Canadian provinces have introduced reimbursement policies mandating substitution of innovator biologics with lower-cost biosimilars. We estimated the number of patients affected and cost implications if such policy changes were to be implemented in Ontario, Canada. METHODS We conducted a cross-sectional time series analysis of Ontarians dispensed publicly funded biologics indicated for inflammatory diseases (rheumatic conditions, inflammatory bowel disease: infliximab, etanercept, adalimumab) between January 2018 and December 2019, and forecasted trends to Dec. 31, 2020. The primary source of data was pharmacy claims data for all biologics reimbursed by the public drug program. We modelled the number of patients affected and government expenditures (in nominal Canadian dollars) of several biosimilar policy options, including mandatory nonmedical biosimilar substitution, substitution in new users, introduction of a biosimilar for adalimumab, and price negotiations. In a secondary analysis, we included insulin glargine. RESULTS In 2018, 14 089 individuals were prescribed a publicly funded biologic for inflammatory diseases. A mandatory nonmedical biosimilar substitution would potentially have affected 7209 patients and saved $238.6 million from 2018 to 2020. A new-user substitution would have affected 757 patients and saved $34.2 million. If an adalimumab biosimilar were to become available, 12 928 patients would be affected by a mandatory nonmedical substitution and the 3-year savings would increase to $645.9 million (all biosimilars priced at 25% of innovator biologics). Finally, an expanded nonmedical substitution policy including insulin glargine would affect 115 895 patients and save $288.7 million (not including adalimumab). INTERPRETATION Policies designed to curb rising costs of biologics can have substantially different effects on patients and government expenditures. Such analyses warrant careful consideration of the balance between cost savings and effects on patients.
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Affiliation(s)
- Tara Gomes
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont.
| | - Daniel McCormack
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Sophie A Kitchen
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - J Michael Paterson
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Muhammad M Mamdani
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Laurie Proulx
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Lorraine Bayliss
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Mina Tadrous
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
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11
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A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review. Clin Rheumatol 2021. [PMID: 33751280 DOI: 10.1007/s10067‐021‐05700‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has occupied the world agenda since December 2019. With no effective treatment yet, vaccination seems to be the most effective method of prevention. Recently developed vaccines have been approved for emergency use only and are currently applied to large populations. Considering both the underlying pathogenic mechanisms of autoimmune/autoinflammatory rheumatological diseases (AIIRDs) and the immunosuppressive drugs used in treatment, vaccination for COVID-19 deserves special attention in such patients. In this article, we aimed to give simple messages to the clinicians for COVID-19 vaccination in patients with AIIRDs based upon the current evidence regarding the use of other vaccines in this patient group. For this purpose, we conducted a "Pubmed search" using the following keywords: Influenza, Hepatitis B, Pneumococcal, and Shingles vaccines and the frequently used conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Likewise, an additional search was performed for the COVID-19 immunization in patients with AIIRDs and considering such drugs. In summary, patients with AIIRDs should also be vaccinated against COVID-19, preferably when disease activity is under control and when there is no concurrent infection. Low-degree immunosuppression does not appear to decrease antibody responses to vaccines. Ideally, vaccinations should be done before the initiation of any biological DMARDs. Patients receiving rituximab should be vaccinated at least 4 weeks before or 6 months after treatment. Since tofacitinib may also reduce antibody responses, especially in combination with methotrexate, it may be appropriate to discontinue this drug before vaccination and to restart after 14 days of immunization. Key points • COVID-19 vaccinations should preferably be made during remission in patients with autoimmune/autoinflammatory rheumatological diseases. • Low-degree immunosuppression may not interfere with antibody response to vaccines. • Ideally, vaccinations should be made before the initiation of any biological DMARDs. • Timing of vaccination is especially important in the case of rituximab.
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12
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Soy M, Keser G, Atagunduz P, Mutlu MY, Gunduz A, Koybaşi G, Bes C. A practical approach for vaccinations including COVID-19 in autoimmune/autoinflammatory rheumatic diseases: a non-systematic review. Clin Rheumatol 2021; 40:3533-3545. [PMID: 33751280 PMCID: PMC7982510 DOI: 10.1007/s10067-021-05700-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic has occupied the world agenda since December 2019. With no effective treatment yet, vaccination seems to be the most effective method of prevention. Recently developed vaccines have been approved for emergency use only and are currently applied to large populations. Considering both the underlying pathogenic mechanisms of autoimmune/autoinflammatory rheumatological diseases (AIIRDs) and the immunosuppressive drugs used in treatment, vaccination for COVID-19 deserves special attention in such patients. In this article, we aimed to give simple messages to the clinicians for COVID-19 vaccination in patients with AIIRDs based upon the current evidence regarding the use of other vaccines in this patient group. For this purpose, we conducted a “Pubmed search” using the following keywords: Influenza, Hepatitis B, Pneumococcal, and Shingles vaccines and the frequently used conventional and biologic disease-modifying antirheumatic drugs (DMARDs). Likewise, an additional search was performed for the COVID-19 immunization in patients with AIIRDs and considering such drugs. In summary, patients with AIIRDs should also be vaccinated against COVID-19, preferably when disease activity is under control and when there is no concurrent infection. Low-degree immunosuppression does not appear to decrease antibody responses to vaccines. Ideally, vaccinations should be done before the initiation of any biological DMARDs. Patients receiving rituximab should be vaccinated at least 4 weeks before or 6 months after treatment. Since tofacitinib may also reduce antibody responses, especially in combination with methotrexate, it may be appropriate to discontinue this drug before vaccination and to restart after 14 days of immunization.
Key points • COVID-19 vaccinations should preferably be made during remission in patients with autoimmune/autoinflammatory rheumatological diseases. • Low-degree immunosuppression may not interfere with antibody response to vaccines. • Ideally, vaccinations should be made before the initiation of any biological DMARDs. • Timing of vaccination is especially important in the case of rituximab. |
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Affiliation(s)
- Mehmet Soy
- Altınbas University (previously Kemerbas University) Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Bahcelievler MedicalPark Hospital, Istanbul, Turkey. .,, Altunizade Mah. Atif Bey sk. Gokdeniz Sitesi, E-3; Usküdar, Istanbul, Turkey.
| | - Gökhan Keser
- Ege University Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Bornova, Izmir, Turkey
| | - Pamir Atagunduz
- Marmara University Faculty of Medicine Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Melek Yalçin Mutlu
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.,Department of Rheumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Alper Gunduz
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases, İstanbul, Turkey
| | - Gizem Koybaşi
- Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey
| | - Cemal Bes
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.,Department of Rheumatology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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13
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Jaffer S, Foulds HJA, Parry M, Gonsalves CA, Pacheco C, Clavel MA, Mullen KA, Yip CYY, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem. CJC Open 2021; 3:1-11. [PMID: 33458627 PMCID: PMC7801195 DOI: 10.1016/j.cjco.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status. Methods CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group. Results Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada. Conclusions Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.
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Affiliation(s)
- Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Christine Pacheco
- Pierre-Boucher Hospital, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Marie-Annick Clavel
- Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Ville de Québec, Québec, Canada
| | - Kerri A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cindy Y Y Yip
- HeartLife Foundation of Canada, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Alberta, Canada
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14
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Narváez J, Sánchez-Fernández SÁ, Seoane-Mato D, Díaz-González F, Bustabad S. Prevalence of Sjögren's syndrome in the general adult population in Spain: estimating the proportion of undiagnosed cases. Sci Rep 2020; 10:10627. [PMID: 32606345 PMCID: PMC7327007 DOI: 10.1038/s41598-020-67462-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 11/09/2022] Open
Abstract
To estimate the prevalence of Sjögren's syndrome (SS) in the adult Spanish population we performed a population-based multicenter cross-sectional study. Cases were defined by the American-European Consensus Group criteria proposed in 2002. A total of 4,916 subjects aged 20 years or over were included. The estimated prevalence of SS (including primary and secondary forms) in the adult population in Spain was 0.33% (95% CI 0.21-0.53). Extrapolating to the total population of the country aged ≥ 20 years (around 37.7 million persons), there would be around 125,000 cases of SS in Spain. Considering only primary SS, the estimated prevalence was 0.25% (95% CI 0.15-0.43) or 1 person in 400. The prevalence of primary SS in Spain is comparable to that reported in other European studies with a similar design and diagnostic criteria. Based on these results, primary SS could not be considered a rare (orphan) disease. Only 50% of cases had already been diagnosed with SS prior EPISER 2016 study, confirming the existence of a non-negligible proportion of undiagnosed cases in the general population.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge, Feixa Llarga, s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | | | - Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Federico Díaz-González
- Department of Rheumatology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Sagrario Bustabad
- Department of Rheumatology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
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15
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Incidence and prevalence of rheumatoid arthritis in Saskatchewan, Canada: 2001-2014. BMC Rheumatol 2019; 3:28. [PMID: 31360913 PMCID: PMC6637565 DOI: 10.1186/s41927-019-0077-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/24/2019] [Indexed: 12/23/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic inflammatory and destructive arthritis. Understanding the incidence and prevalence of RA within the province facilitates appropriate health care resource planning. Objective To estimate the incidence/prevalence of RA over time for the overall provincial population, for specific age range categories, and for gender. Methods Saskatchewan Provincial Administrative Health Databases (2001–2014) were utilized as data sources. Two RA case-definitions were employed: 1) > three physician billing diagnoses, at least one of which was submitted by a specialist (rheumatologist, general internist or orthopedic surgeon) within 2 years; 2) > one hospitalization diagnosis (ICD-9-CM code-714, and ICD-10-CA code-M05). Data from these definitions were combined to identify incident and prevalent RA cases. Using this data, annual incidence and prevalence rates were calculated for the provincial population, specified age range categories and gender categories. Results The number of RA cases meeting the case definition increased from 3731 to 6223 over the study period. The incidence of RA disease demonstrated variation within the study period with age and sex adjusted incidence ranging from 33.6 (95% CI 29.9–37.6) per 100,000 to 73.1 (95% CI 67.6–79.0) per 100,000. The prevalence of RA increased over time from 482 (95% CI 466.7–497.7) per 100,000 in 2001–2002 to 683.4 (95% CI 666.6–700.6) per 100,000 in 2014–2015. Both incidence and prevalence rates rose with increasing age. Women were found to have higher incidence and prevalence rates compared to men. Conclusion In Saskatchewan, the overall prevalence of RA is rising while there has been variability in the incidence.
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Nathan PC, Bremner KE, Liu N, Gupta S, Greenberg ML, McBride ML, Krahn MD, de Oliveira C. Resource Utilization and Costs in Adolescents Treated for Cancer in Pediatric vs Adult Institutions. J Natl Cancer Inst 2019; 111:322-330. [PMID: 30053118 PMCID: PMC6410950 DOI: 10.1093/jnci/djy119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
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Affiliation(s)
- Paul C Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Mark L Greenberg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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17
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Missoum H, Alami M, Bachir F, Arji N, Bouyahya A, Rhajaoui M, El Aouad R, Bakri Y. Prevalence of autoimmune diseases and clinical significance of autoantibody profile: Data from National Institute of Hygiene in Rabat, Morocco. Hum Immunol 2019; 80:523-532. [PMID: 30807792 DOI: 10.1016/j.humimm.2019.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
AIM The objective of this study was to explore the prevalence of various autoimmune diseases (AIDs) in a large cohort of patients and to characterize the autoantibody profile in the patients with and without AIDs to confirm the diagnosis and to refine the Moroccan databases. PATIENTS AND METHOD Retrospective study was conducted in the Laboratory of autoimmunity National Institute of Hygiene (NIH) of Rabat in Morocco. A total of 3182 consecutive Moroccan patients (2183 females and 999 males) whose sera were tested for 14 autoantibody profile between 2010 and 2016. RESULTS Only 944 (29.7%) patients were diagnosed with AIDs of those suspected. The prevalence of systemic lupus erythematosus (SLE), intestinal malabsorption (IM) and arthritis polyarthralgia (AP) were the highest (4.2, 4.1 and 4%), subsequently followed by rheumatoid arthritis (RA) (2.8%), cholestatic syndrome (CS) (1.8%), interstitial lung disease (ILD) (1.6%).In females IM, AP and SLE also showed the highest prevalence (5.4%, 5.3% and 4.9% respectively), while of male, SLE showed the highest prevalence (1.9%). The prevalence of ANA was increased in most patients with systemic especially in neuropathy (NP), hemolytic anemia (HA), primary Sjogren's syndrome (pSS), dermatomyositis (DM), thrombocytopenia (Tb), systemic sclerosis (SSc), ANCA-associated vasculitis (AAV), AP, Renal impairment (RI), SLE, and mixed connective tissue disease (MCTD). Anti-dsDNA antibodies were higher in SLE and ENA showed the highest titers in MCTD. Others are relatively specific for certain disease, such as anti β2GP1 for thrombosis syndrome, anti ANCA for primary sclerosing cholangitis (PSC), AAV, ILD and RI, anti CCP2 for RA, ILD and AP. the prevalence of anti AMA was higher in primary biliary cirrhosis (PBC), followed in CS, also, ANA have been identified in up to 25% of patients with primary biliary cirrhosis. The prevalence of anti-SMA was higher in PBC, treated patients for Chronic hepatitis C (HCV), and autoimmune hepatitis (AIH) and anti-PCA was higher in biermer anemia patients with vitamin B12 deficiency (BA/Def vit B12). The prevalence of IgA EMA, IgA tTG and IgA AGA were higher in patients IM and celiac disease (CD). The prevalence of anti thyroperoxidase (TPO) was significantly increased in the autoimmune thyroiditis (AIT). CONCLUSION Our study shows the diagnostic value of auto antibodies in AIDs. It would be interesting to carry out prospective studies on each pathology separately, in order to fill the classic vagaries of the retrospective study and objectively estimate the prevalence in different AIDs. These data on the prevalence of each autoimmune disease are valuable for the public health system.
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Affiliation(s)
- Hakima Missoum
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco; Laboratory Autoimmunity, Department of Immunology, National Institute of Hygiene, Rabat, Morocco.
| | - Mohammed Alami
- Laboratory of Microbiology and Molecular Biology, Faculty of Science, Mohammed V University, Rabat, Morocco
| | | | - Naima Arji
- National Institute of Hygiene, Rabat, Morocco
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | | | - Rajae El Aouad
- Hassan II Academy of Science and Technology Rabat, Morocco
| | - Youssef Bakri
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
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McCormick N, Marra CA, Sadatsafavi M, Kopec JA, Aviña‐Zubieta JA. Excess Productivity Costs of Systemic Lupus Erythematosus, Systemic Sclerosis, and Sjögren's Syndrome: A General Population–Based Study. Arthritis Care Res (Hoboken) 2018; 71:142-154. [DOI: 10.1002/acr.23573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Natalie McCormick
- Arthritis Research CanadaRichmond, and The University of British Columbia Vancouver British Columbia Canada
| | - Carlo A. Marra
- Arthritis Research Canada, Richmond, and The University of British Columbia, Vancouver, British Columbia, Canada, and University of Otago Dunedin New Zealand
| | | | - Jacek A. Kopec
- Arthritis Research CanadaRichmond, and The University of British Columbia Vancouver British Columbia Canada
| | - J. Antonio Aviña‐Zubieta
- Arthritis Research CanadaRichmond, and The University of British Columbia Vancouver British Columbia Canada
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Bernstein DN, Kurucan E, Menga EN, Molinari RW, Rubery PT, Mesfin A. Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients. Spine J 2018; 18:1861-1866. [PMID: 29631060 DOI: 10.1016/j.spinee.2018.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with non-cervical spine involvement. PURPOSE The objective of this study was to compare patient characteristics, comorbidities, and complications in patients with and without RA undergoing primary non-cervical spinal fusions. STUDY DESIGN/SETTING This is a retrospective national database review. PATIENT SAMPLE A total of 52,818 patients with adult spinal deformity undergoing non-cervical spinal fusions (1,814 patients with RA and 51,004 patients without RA). OUTCOME MEASURES The outcome measures in the study include patient characteristics, as well as complication and mortality rates. MATERIALS AND METHODS Using the Nationwide Inpatient Sample from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients aged ≥18 years old with and without RA undergoing primary non-cervical spinal fusions. Univariate analysis was used to determine patient characteristics, comorbidities, and complication values for each group. Bivariate analysis was used to compare the two groups. Significance was set at p<.05. RESULTS Patients with RA were older (p<.001), were more likely to be women (p<.001), had increased rates of osteoporosis (p<.001), had a greater percentage of their surgeries reimbursed by Medicare (p<.001), and more often had weekend admissions (p=.014). There was no difference in all the other characteristics. Patients with RA had higher rates of iron deficiency anemia, congestive heart failure, chronic pulmonary disease, depression, and fluid and electrolyte disorders (all, p<.001). Patients without RA had higher rates of alcohol abuse (p=.027). There was no difference in all the other complications. There was no difference in mortality rate (p=.99). Total complications were greater in patients with RA (p<.001). Patients with RA had higher rates of infection (p=.032), implant-related complications (p=.010), incidental durotomies (p=.001), and urinary tract infections (p<.001). No difference existed among the other complications. CONCLUSIONS Patients with RA have an increased number of comorbidities and complication rates compared with patients without RA. Such knowledge can help surgeons and patients with RA have beneficial preoperative discussions regarding outcomes.
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Affiliation(s)
- David N Bernstein
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Etka Kurucan
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Emmanuel N Menga
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Robert W Molinari
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Paul T Rubery
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
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20
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Lim LSH, Feldman BM, Lix LM. Alternative Design and Analytical Techniques for Longitudinal Rheumatology Studies: Improved Understanding of Outcomes. Rheum Dis Clin North Am 2018; 44:189-201. [PMID: 29622291 DOI: 10.1016/j.rdc.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Longitudinal cohort designs (with three or more measurement occasions) are invaluable to investigate between- and within-individual variation in outcomes. However, traditional longitudinal designs require a lengthy implementation and data collection period and impose a substantial burden on participants and investigators. We discuss alternative longitudinal designs, including planned missing data designs and retrospective cohort studies with secondary data, which require a shorter period for data accrual and reduce participant burden while maintaining statistical power. We also discuss analysis strategies to maximize data use and produce unbiased estimates of treatment effectiveness, including models for recurrent or multistate events and time-varying covariates.
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Affiliation(s)
- Lily Siok Hoon Lim
- Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba, 501F-715 McDermot Avenue, Winnipeg, Manitoba R3E 3P4, Canada.
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada; Department of Pediatrics, Faculty of Medicine, Institute of Health Policy Management and Evaluation, Dana Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M6, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada
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de Oliveira C, Bremner KE, Liu N, Greenberg ML, Nathan PC, McBride ML, Krahn MD. Costs of cancer care in children and adolescents in Ontario, Canada. Pediatr Blood Cancer 2017; 64. [PMID: 28500732 DOI: 10.1002/pbc.26628] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/22/2017] [Accepted: 04/11/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cancer in children and adolescents presents unique issues regarding treatment and survivorship, but few studies have measured economic burden. We estimated health care costs by phase of cancer care, from the public payer perspective, in population-based cohorts. METHODS Children newly diagnosed at ages 0 days-14.9 years and adolescents newly diagnosed at 15-19.9 years, from January 1, 1995 to June 30, 2010, were identified from Ontario cancer registries, and each matched to three noncancer controls. Data were linked with administrative records describing resource use for cancer and other health care. Total and net (patients minus controls) resource-specific costs ($CAD2012) were estimated using generalized estimating equations for four phases of care: prediagnosis (60 days), initial (360 days), continuing (variable), final (360 days). RESULTS Mean ages at diagnosis were 6 years for children (N = 4,606) and 17 years for adolescents (N = 2,443). Mean net prediagnosis phase 60-day costs were $6,177 for children and $1,018 for adolescents. Costs for initial, continuing, and final phases were $138,161, $15,756, and $316,303 per 360 days for children, and $62,919, $7,071, and $242,008 for adolescents. The highest initial phase costs were for leukemia patients ($156,225 per 360 days for children and $171,275 for adolescents). The final phase was the most costly ($316,303 per 360 days for children and $242,008 for adolescents). CONCLUSIONS Costs for children with cancer are much higher than for adolescents and much higher than those reported in adults. Comprehensive population-based long-term estimates of cancer costs are useful for health services planning and cost-effectiveness analysis.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark L Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Department of Pediatrics, Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary L McBride
- Cancer Control Research Program, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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McCormick N, Reimer K, Famouri A, Marra CA, Aviña-Zubieta JA. Filling the gaps in SARDs research: collection and linkage of administrative health data and self-reported survey data for a general population-based cohort of individuals with and without diagnoses of systemic autoimmune rheumatic disease (SARDs) from British Columbia, Canada. BMJ Open 2017; 7:e013977. [PMID: 28637725 PMCID: PMC5541381 DOI: 10.1136/bmjopen-2016-013977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Systemic autoimmune rheumatic diseases (SARDs) are a group of debilitating autoimmune diseases, including systemic lupus erythematosus and related disorders. Assessing the healthcare and economic burden of SARDs has been challenging: while administrative databases can be used to determine healthcare utilisation and costs with minimal selection and recall bias, other health, sociodemographic and economic data have typically been sourced from highly selected, clinic-based cohorts. To address these gaps, we are collecting self-reported survey data from a general population-based cohort of individuals with and without SARDs and linking it to their longitudinal administrative health data. PARTICIPANTS Using administrative data from the province of British Columbia (BC), Canada, we established a population-based cohort of all BC adults receiving care for SARDs during 1996-2010 (n=20 729) and non-SARD individuals randomly selected from the general population. BC Ministry of Health granted us contact information for 12 000 SARD and non-SARD individuals, who were recruited to complete the surveys by mail or online. FINDINGS TO DATE Four hundred individuals were initially invited to participate, with 135 (34%) consenting and 127 (94%) submitting the first survey (72% completed online). Sixty-three (49.6%) reported ≥1 SARD diagnosis. The non-SARDs group (n=64) was 92% female with mean age 57.0±11.6 years. The SARDs group (n=63) was 94% female with mean age 56.5±13.1 years. Forty-eight per cent of those with SARDs were current-or-former smokers (mean 10.6±16.2 pack-years), and 33% were overweight or obese (mean body mass index of 24.4±5.3). FUTURE PLANS Health and productivity data collected from the surveys will be linked to participants' administrative health data from the years 1990-2013, allowing us to determine the healthcare and lost productivity costs of SARDs, and assess the impact of patient-reported variables on utilisation, costs, disability and clinical outcomes. Findings will be disseminated through scientific conferences and peer-reviewed journals.
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Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
| | - Kathryn Reimer
- Arthritis Research Canada, Richmond, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Richmond, Canada
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - J. Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, Canada
- Division of Rheumatology, Department of Medicine, The University of British Columbia, Vancouver, Canada
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23
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de Oliveira C, Bremner KE, Liu N, Greenberg ML, Nathan PC, McBride ML, Krahn MD. Costs for Childhood and Adolescent Cancer, 90 Days Prediagnosis and 1 Year Postdiagnosis: A Population-Based Study in Ontario, Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:345-356. [PMID: 28292479 DOI: 10.1016/j.jval.2016.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Childhood and adolescent cancers are uncommon, but they have important economic and health impacts on patients, families, and health care systems. Few studies have measured the economic burden of care for childhood and adolescent cancers. OBJECTIVES To estimate costs of cancer care in population-based cohorts of children and adolescents from the public payer perspective. METHODS We identified patients with cancer, aged 91 days to 19 years, diagnosed from 1995 to 2009 using cancer registry data, and matched each to three noncancer controls. Using linked administrative health care records, we estimated total and net resource-specific costs (in 2012 Canadian dollars) during 90 days prediagnosis and 1 year postdiagnosis. RESULTS Children (≤14 years old) numbered 4,396: 36% had leukemia, 21% central nervous system tumors, 10% lymphoma, and 33% other cancers. Adolescents (15-19 years old) numbered 2,329: 28.9% had lymphoma. Bone and soft tissue sarcoma, germ cell tumor, and thyroid carcinoma each comprised 12% to 13%. Mean net prediagnosis costs were $5,810 and $1,127 and mean net postdiagnosis costs were $136,413 and $62,326 for children and adolescents, respectively; the highest were for leukemia ($157,764 for children and $172,034 for adolescents). In both cohorts, costs were much higher for patients who died within 1 year of diagnosis. Inpatient hospitalization represented 69% to 74% of postdiagnosis costs. CONCLUSIONS Treating children with cancer is costly, more costly than treating adolescents or adults. Substantial survival gains in children mean that treatment may still be very cost-effective. Comprehensive age-specific population-based cost estimates are essential to reliably assess the cost-effectiveness of cancer care for children and adolescents, and measure health system performance.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark L Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Ng R, Bernatsky S, Rahme E. Disease characterization of systemic lupus erythematosus (SLE) patients in Quebec. Lupus 2017; 26:1005-1011. [PMID: 28178878 DOI: 10.1177/0961203317692435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by an array of organ manifestations that can appear during flares and disappear during remissions. The objectives of this study were: (i) to examine SLE manifestation groups longitudinally in an SLE cohort; and (ii) to assess the association between early antimalarial treatment and renal manifestations. Methods Seven SLE manifestation groups-cutaneous, hematologic, lung, musculoskeletal, neuropsychiatric, serositis, renal-were tracked using Kaplan-Meier survival curves in an incident SLE cohort from Quebec health administrative data ( n = 2010). A subgroup with provincial drug insurance coverage was followed over time to examine the association between early antimalarial treatment (within three months after SLE diagnosis) and renal manifestations using a Cox proportional hazards survival model. Results Cutaneous manifestations was the most common manifestation at SLE diagnosis (30.0%, 95% CI: 27.7-32.2%). About two-thirds (66.2%, 95% CI: 63.4-68.9%) of patients had evidence of at least one SLE manifestation at diagnosis, which increased to 87.2% (95% CI: 84.2-90.3%) by the end of follow-up. After adjusting for age, sex, early concomitant systemic steroid therapy, Charlson comorbidity index, primary care visits in the year prior and other SLE manifestations at baseline, no statistically significant association was established between antimalarial therapy and renal manifestations. Conclusion This study provides insight regarding organ manifestations within a population-based sample. Most patients identified with SLE had other diagnostic evidence that supports an underlying diagnosis of SLE. No protective effects for antimalarial agents against renal manifestations could be established in this population-based cohort.
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Affiliation(s)
- R Ng
- 1 Research Institute of the McGill University Health Centre, Medicine, Montreal, Canada
| | - S Bernatsky
- 2 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Medicine - Rheumatology, Montreal, Canada
| | - E Rahme
- 3 McGill University Health Centre, Clinical Epidemiology, Montreal, Canada
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25
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Yang Z, Ren Y, Liu D, Lin F, Liang Y. Prevalence of systemic autoimmune rheumatic diseases and clinical significance of ANA profile: data from a tertiary hospital in Shanghai, China. APMIS 2016; 124:805-11. [PMID: 27328803 DOI: 10.1111/apm.12564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/11/2016] [Indexed: 01/20/2023]
Abstract
It is necessary and useful to explore prevalence of various systemic autoimmune rheumatic diseases (SARDs) in patients with suspicion of having SARDs and to characterize antinuclear antibodies (ANA) profile for identifying different populations (SARDs and non-SARDs). A total of 5024 consecutive patients with available medical records were investigated, whose sera had been tested for ANA profile, including ANA, anti-dsDNA and anti-extractable nuclear antigen (ENA) antibodies, between 31 January 2012 and 26 March 2014. Only 594 (11.8%) patients were diagnosed with SARDs of those suspected with SARDs. The prevalence of systemic lupus erythematosus (SLE) was highest (3.2%), followed by rheumatoid arthritis (RA) (2.5%), primary Sjögren's syndrome (pSS) (1.7%), ankylosing spondylitis (AS) (1.5%), etc. Of females, SLE also showed the highest prevalence (6%), while of males, AS showed the highest prevalence (1.9%). The prevalence of most SARDs was closely associated with age, except mixed connective tissue disease (MCTD), and the variation characteristics among different age groups were different among various SARDs. The prevalence of ANA was significantly increased in most SARD patients [especially in SLE, systemic sclerosis (SSc) and MCTD]. For anti-ENA antibodies, in contrast to some autoantibodies associated with multiple SARDs (e.g. anti-SSA, SSB, nRNP), others were relatively specific for certain diseases, such as anti-dsDNA, Sm, histone, nucleosome and Rib-P for SLE, anti-SCL-70 for SSc and anti-Jo-1 for polymyositis/dermatomyositis (PM/DM). Of note, ANA profile appeared to be of little significance for AS, ANCA-associated vasculitis (AAV), polymyalgia rheumatic (PMR), adult-onset Still's disease (ASD) and Behcet's disease (BD). The younger were more likely to have the presence of anti-dsDNA, Sm, histone or Rib-P for SLE, and anti-SSA for RA or MCTD. No significant differences for frequencies of ANA and anti-ENA autoantibodies were found between sexes in most SARDs, with the exception of RA and AS. The present study suggests that, of patients with SARDs-like clinical manifestations, the proportion of those with true SARDS is small, for most of whom tests for autoantibodies are necessary and useful to help make a prompt and precise diagnosis.
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Affiliation(s)
- Zaixing Yang
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yingpeng Ren
- Department of Laboratory Medicine, Taizhou First People's Hospital, Zhejiang, China
| | - Donghong Liu
- Department of Laboratory Medicine, Taizhou First People's Hospital, Zhejiang, China
| | - Feng Lin
- Department of General Surgery, Taizhou First People's Hospital, Zhejiang, China
| | - Yan Liang
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Bernatsky S, Smargiassi A, Barnabe C, Svenson LW, Brand A, Martin RV, Hudson M, Clarke AE, Fortin PR, van Donkelaar A, Edworthy S, Bélisle P, Joseph L. Fine particulate air pollution and systemic autoimmune rheumatic disease in two Canadian provinces. ENVIRONMENTAL RESEARCH 2016; 146:85-91. [PMID: 26724462 DOI: 10.1016/j.envres.2015.12.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To estimate the degree to which fine particulate (PM2.5) air pollution is associated with systemic autoimmune rheumatic diseases (SARDs). METHODS We used population-based administrative data from Alberta (1993-2007) and Quebec (1989-2011). SARD algorithms included ≥2 physician billing codes, or ≥1 rheumatology billing code, or ≥1 hospitalization diagnostic code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that any given resident was a SARD case, based on the algorithms. Mean 2001-2006 residential ambient PM2.5 levels were assigned using satellite-derived data for dissemination area regions in Alberta and CLSC regions in Quebec. The sum of individual level probabilities provided the estimated total cases per region in each province, according to age, sex, urban-versus-rural residence, income, and PM2.5 levels. In Alberta, we ran separate models for First-Nations (FN) and non-First Nations subgroups. Bayesian logistic regression modeling generated odds ratio (OR) estimates for being a SARD case, accounting concurrently for demographics, as well as an interaction term between age and sex. RESULTS Our data suggested that the probability of being a SARD case was higher among females versus males and for residents aged >45 versus younger, with the highest ORs for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels in both provinces. CONCLUSION Our data suggest that PM2.5 exposure may be associated with an increased risk of SARDs.
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Affiliation(s)
- Sasha Bernatsky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2; Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, V Pavilion 687, Pine Avenue West, Montreal, QC, Canada H3A 1A1.
| | - Audrey Smargiassi
- Département de santé environnementale et de santé au travail, Université de Montréal, Pavillon Marguerite d'Youville, École de santé publique, C.P. 6128, Succursale Centre-Ville, Montréal, QC, Canada; Institut National de Santé Publique du Québec, 190 Crémazie Blvd. E, Montréal, QC, Canada H2P 1E2
| | - Cheryl Barnabe
- Department of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4; Department of Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - Lawrence W Svenson
- Department of Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4; Surveillance and Assessment Branch, Alberta Ministry of Health, 10025 Jasper Avenue, Edmonton, Canada AB T5J 1S6; Canada School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, Canada AB T6G 1C9; Canada Department of Community Health Sciences, University of Calgary, 2500 Hospital Drive NW, Calgary, Canada AB T2N 1N4
| | - Allan Brand
- Département de santé environnementale et de santé au travail, Université de Montréal, Pavillon Marguerite d'Youville, École de santé publique, C.P. 6128, Succursale Centre-Ville, Montréal, QC, Canada; Institut National de Santé Publique du Québec, 190 Crémazie Blvd. E, Montréal, QC, Canada H2P 1E2
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Rd. PO BOX 15000, Halifax, NS, Canada B3H 4R2; Harvard-Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138, USA
| | - Marie Hudson
- Department of Medicine, McGill University, 1001 Decarie Boulevard, Mail Drop Number D05-2214, Suite D05-2212, Montreal, QC, Canada H4A 3J1; Division of Rheumatology, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, QC, Canada H3T 1E2
| | - Ann E Clarke
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2; Division of Allergy and Clinical Immunology, McGill University Health Centre, 1547 Avenue des Pins, Montréal, QC, Canada H3G 1B3
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, Pavilion Ferdinand-Vandry 1050, ave de la Médecine, bureau 4633, Université Laval, Québec, QC, Canada G1V 0A6
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, 6310 Coburg Rd. PO BOX 15000, Halifax, NS, Canada B3H 4R2
| | - Steven Edworthy
- Department of Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4; Department of Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada T2N 1N4
| | - Patrick Bélisle
- Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, V Pavilion 687, Pine Avenue West, Montreal, QC, Canada H3A 1A1
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, Canada H3A 1A2; Division of Clinical Epidemiology, McGill University Health Centre, Royal Victoria Hospital, V Pavilion 687, Pine Avenue West, Montreal, QC, Canada H3A 1A1
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Shigayeva A, Rudnick W, Green K, Chen DK, Demczuk W, Gold WL, Johnstone J, Kitai I, Krajden S, Lovinsky R, Muller M, Powis J, Rau N, Walmsley S, Tyrrell G, Bitnun A, McGeer A. Invasive Pneumococcal Disease Among Immunocompromised Persons: Implications for Vaccination Programs. Clin Infect Dis 2015; 62:139-47. [DOI: 10.1093/cid/civ803] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 07/28/2015] [Indexed: 12/31/2022] Open
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28
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Bernatsky S, Smargiassi A, Johnson M, Kaplan GG, Barnabe C, Svenson L, Brand A, Bertazzon S, Hudson M, Clarke AE, Fortin PR, Edworthy S, Bélisle P, Joseph L. Fine particulate air pollution, nitrogen dioxide, and systemic autoimmune rheumatic disease in Calgary, Alberta. ENVIRONMENTAL RESEARCH 2015; 140:474-8. [PMID: 25988990 PMCID: PMC4492844 DOI: 10.1016/j.envres.2015.05.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To estimate the association between fine particulate (PM2.5) and nitrogen dioxide (NO2) pollution and systemic autoimmune rheumatic diseases (SARDs). METHODS Associations between ambient air pollution (PM2.5 and NO2) and SARDs were assessed using land-use regression models for Calgary, Alberta and administrative health data (1993-2007). SARD case definitions were based on ≥2 physician claims, or ≥1 rheumatology billing code; or ≥1 hospitalization code (for systemic lupus, Sjogren's Syndrome, scleroderma, polymyositis, dermatomyositis, or undifferentiated connective tissue disease). Bayesian hierarchical latent class regression models estimated the probability that each resident was a SARD case, based on these case definitions. The sum of individual level probabilities provided the estimated number of cases in each area. The latent class model included terms for age, sex, and an interaction term between age and sex. Bayesian logistic regression models were used to generate adjusted odds ratios (OR) for NO2 and PM2.5. pollutant models, adjusting for neighbourhood income, age, sex, and an interaction between age and sex. We also examined models stratified for First-Nations (FN) and non-FN subgroups. RESULTS Residents that were female and/or aged >45 had a greater probability of being a SARD case, with the highest OR estimates for older females. Independently, the odds of being a SARDs case increased with PM2.5 levels, but the results were inconclusive for NO2. The results stratified by FN and non-FN groups were not distinctly different. CONCLUSION In this urban Canadian sample, adjusting for demographics, exposure to PM2.5 was associated with an increased risk of SARDs. The results for NO2 were inconclusive.
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Affiliation(s)
- Sasha Bernatsky
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Audrey Smargiassi
- Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montréal, Canada
| | - Markey Johnson
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Larry Svenson
- Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Allan Brand
- Département de Santé Environnementale et de Santé au Travail, Université de Montréal, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montréal, Canada
| | - Stefania Bertazzon
- Department of Geography, University of Calgary, Calgary, Alberta, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montréal, Quebec, Canada
| | - Ann E Clarke
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Allergy and Clinical Immunology, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, Université Laval, Quebec city, Quebec, Canada
| | - Steven Edworthy
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Canada; Surveillance and Assessment, Alberta Ministry of Health, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Albert, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Patrick Bélisle
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
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Rider LG, Dankó K, Miller FW. Myositis registries and biorepositories: powerful tools to advance clinical, epidemiologic and pathogenic research. Curr Opin Rheumatol 2014; 26:724-41. [PMID: 25225838 PMCID: PMC5081267 DOI: 10.1097/bor.0000000000000119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Clinical registries and biorepositories have proven extremely useful in many studies of diseases, especially rare diseases. Given their rarity and diversity, the idiopathic inflammatory myopathies, or myositis syndromes, have benefited from individual researchers' collections of cohorts of patients. Major efforts are being made to establish large registries and biorepositories that will allow many additional studies to be performed that were not possible before. Here, we describe the registries developed by investigators and patient support groups that are currently available for collaborative research purposes. RECENT FINDINGS We have identified 46 myositis research registries, including many with biorepositories, which have been developed for a wide variety of purposes and have resulted in great advances in understanding the range of phenotypes, clinical presentations, risk factors, pathogenic mechanisms, outcome assessment, therapeutic responses, and prognoses. These are now available for collaborative use to undertake additional studies. Two myositis patient registries have been developed for research, and myositis patient support groups maintain demographic registries with large numbers of patients available to be contacted for potential research participation. SUMMARY Investigator-initiated myositis research registries and biorepositories have proven extremely useful in understanding many aspects of these rare and diverse autoimmune diseases. These registries and biorepositories, in addition to those developed by myositis patient support groups, deserve continued support to maintain the momentum in this field as they offer major opportunities to improve understanding of the pathogenesis and treatment of these diseases in cost-effective ways.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, Program of Clinical Research, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Katalin Dankó
- Division of Immunology, 3rd Dept. of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Frederick W. Miller
- Environmental Autoimmunity Group, Program of Clinical Research, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), DHHS, Bethesda, MD
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Stringer E, Bernatsky S. Validity of juvenile idiopathic arthritis diagnoses using administrative health data. Rheumatol Int 2014; 35:575-9. [PMID: 25270916 DOI: 10.1007/s00296-014-3142-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
Administrative health databases are valuable sources of data for conducting research including disease surveillance, outcomes research, and processes of health care at the population level. There has been limited use of administrative data to conduct studies of pediatric rheumatic conditions and no studies validating case definitions in Canada. We report a validation study of incident cases of juvenile idiopathic arthritis in the Canadian province of Nova Scotia. Cases identified through administrative data algorithms were compared to diagnoses in a clinical database. The sensitivity of algorithms that included pediatric rheumatology specialist claims was 81-86%. However, 35-48% of cases that were identified could not be verified in the clinical database depending on the algorithm used. Our case definitions would likely lead to overestimates of disease burden. Our findings may be related to issues pertaining to the non-fee-for-service remuneration model in Nova Scotia, in particular, systematic issues related to the process of submitting claims.
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Affiliation(s)
- Elizabeth Stringer
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada,
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Shiff NJ, Lix LM, Joseph L, Duffy C, Tucker LB, Svenson LW, Belisle P, Bernatsky S. The prevalence of systemic autoimmune rheumatic diseases in Canadian pediatric populations: administrative database estimates. Rheumatol Int 2014; 35:569-73. [DOI: 10.1007/s00296-014-3136-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
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