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Critto ME, Enriquez Y, Bravo M, Quevedo LDJ, Weinberg R, Etchegaray A, Koch ES. Impact of emerging virus pandemics on cause-specific maternal mortality time series: a population-based natural experiment using national vital statistics, Argentina 1980-2017. Lancet Reg Health Am 2021; 6:100116. [PMID: 36777885 PMCID: PMC9904057 DOI: 10.1016/j.lana.2021.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. Methods We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). Findings Over this 38-year study, the MMR decreased by 58·6% (69·5 to 28·8 deaths/100,000 live births), transitioning from direct obstetric causes (67·0 to 21·1/100,000 live births; 68·4% decrease) to indirect causes (2·6 to 7·7/100,000 live births; 196·2% increase). The regression analysis showed an average reduction of -2·2%/year (95% CI: -2·9 to -1·4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4·7 and 1·6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. Interpretation The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications. Funding Supported by FISAR www.fisarchile.org.
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Affiliation(s)
- María Elena Critto
- Division of Epidemiology, MELISA Institute, Concepción, Chile,Programa de Doctorado en Sociología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Argentina, Ciudad de Buenos Aires, Argentina
| | - Yordanis Enriquez
- Facultad de Ciencias de la Salud, Universidad Católica Sedes Sapientiae, Lima, Perú
| | - Miguel Bravo
- Division of Epidemiology, MELISA Institute, Concepción, Chile,School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lenin de Janon Quevedo
- Facultad de Ciencias Médicas, Pontificia Universidad Católica de Argentina, Ciudad de Buenos Aires, Argentina
| | - Ruth Weinberg
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Adolfo Etchegaray
- Hospital Universitario Austral, Facultad de Medicina, Universidad Austral, Buenos Aires, Argentina
| | - Elard S. Koch
- Division of Epidemiology, MELISA Institute, Concepción, Chile,Corresponding author. Dr. Elard S. Koch, Division of Epidemiology, MELISA Institute. Dalcahue 1120, Suite 101-103, San Pedro de la Paz, 4133515, Concepción, Chile Telephone: +56 41 246 7242
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Burton A, Tataru D, Driver RJ, Bird TG, Huws D, Wallace D, Cross TJ, Rowe IA, Alexander G, Marshall A. Primary liver cancer in the UK: Incidence, incidence-based mortality, and survival by subtype, sex, and nation. JHEP Rep 2021; 3:100232. [PMID: 33748727 PMCID: PMC7966867 DOI: 10.1016/j.jhepr.2021.100232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND & AIMS The incidence of primary liver cancer (PLC) is increasing in Western Europe. To understand trends over time and the current burden in the UK, a detailed analysis of the epidemiology of PLC and its subtypes was conducted. METHODS Data on PLCs diagnosed during 1997-2017 were obtained from population-based, nationwide registries in the UK. European age-standardised incidence (ASR) and incidence-based mortality rates (ASMR) per 100,000 person-years were calculated overall and by sex and UK-nation. Annual percentage change in rates was estimated using Joinpoint regression. One-, 2-, and 5-year age-standardised net survival was estimated. RESULTS A total of 82,024 PLCs were diagnosed. Both hepatocellular carcinoma (HCC) incidence and mortality rates trebled (ASR 1.8-5.5 per 100,000, ASMR 1.3-4.0). The rate of increase appeared to plateau around 2014/2015. Scottish men consistently had the highest HCC incidence rates. PLC survival increased, driven by a substantial increase in the proportion that are HCC (as prognosis is better than other PLCs) and in HCC survival (change in 1-year survival 24-47%). Intrahepatic cholangiocarcinoma was the most common PLC in women and 1-year survival improved from 22.6% to 30.5%. CONCLUSIONS PLC incidence has been increasing rapidly but, as most risk factors are modifiable, it is largely a preventable cancer. This rate of increase has slowed in recent years, possibly attributable to effective treatment for hepatitis C. As other risk factors such as obesity and diabetes remain prevalent in the UK, it is unlikely the considerable burden of this disease will abate. While improvements in survival have been made, over half of patients are not alive after 1 year, therefore further progress in prevention, early detection, and treatment innovation are needed. LAY SUMMARY Many more people are getting liver cancer, particularly the subtype hepatocellular carcinoma, than 20 years ago. Men in Scotland are most likely to get liver cancer and to die from it. Survival after liver cancer diagnosis is getting longer but still less than half are alive after 1 year.
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Key Words
- AAPC, average annual percentage change
- APC, annual percentage change
- ASMR, age-standardised mortality rate
- ASR, age-standardised incidence rate
- BASL, British Association for the Study of the Liver
- DAA, direct-acting antivirals
- DCO, death certificate only
- HCC, hepatocellular carcinoma HCV, hepatitis C virus
- Hepatocellular carcinoma
- ICCA, intrahepatic cholangiocarcinoma
- ICD-10, International Classification of Diseases 10th Edition
- ICD-O, International Classification of Diseases for Oncology
- Incidence
- Intrahepatic cholangiocarcinoma
- Mortality
- NAFLD, non-alcoholic fatty liver disease
- NCRAS, National Cancer Registration and Analysis Service
- NI, Northern Ireland
- PLC, primary liver cancer
- Primary liver cancer
- Survival
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Affiliation(s)
- Anya Burton
- HCC-UK/British Association for the Study of the Liver (BASL), Lichfield, UK
- National Cancer Registration and Analysis Service, National Disease Registration Service, Public Health England, London, UK
- Corresponding author. Address: National Cancer Registration and Analysis Service, National Disease Registration Service, Public Health England, 2 Rivergate, Temple Quay, Bristol, BS1 6EH, UK. Tel.: +44 1179 689 124.
| | - Daniela Tataru
- National Cancer Registration and Analysis Service, National Disease Registration Service, Public Health England, London, UK
| | - Robert J. Driver
- Leeds Institute for Medical Research at St. James’s, University of Leeds, Leeds, UK
| | - Thomas G. Bird
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Knowledge Directorate, Public Health Wales, Cardiff, UK
| | - David Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Timothy J.S. Cross
- Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
| | - Ian A. Rowe
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Leeds Liver Unit, St. James's University Hospital, Leeds, UK
| | - Graeme Alexander
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK
| | - Aileen Marshall
- Sheila Sherlock Liver Centre, The Royal Free Hospital, London, UK
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Abstract
OBJECTIVE The Budd-Chiari Syndrome (BCS) is a rare disorder characterized by hepatic venous outflow obstruction. The primary objectives of our study were to assess temporal trends in the prevalence of BCS among hospitalized patients in the United States using the National Inpatient Sample (NIS) database and to evaluate demographics, risk factors, and common presentation of BCS. METHODS Data were extracted from the NIS to identify patients >18 years of age using all listed diagnosis of BCS from 1998 to 2017 and analyzed. RESULTS Between 1998 and 2017, we identified a total of 8435 hospitalizations related to BCS. Over the 19-year period, the hospitalization rate for BCS increased consistently from 4.96 per 1,000,000 US population in 1998 to 10.44 per 1,000,000 in 2017, with an annual percentage change increase of 4.41% (95% confidence interval [CI]: 4.23%-4.59%, P < 0.0001). The most common risk factor (7.75%) was myeloproliferative disorder (essential thrombocythemia, polycythemia vera, myelofibrosis, chronic myeloid leukemia) followed (7.32%) by a hypercoagulable state (primary thrombophilia, protein C deficiency, factor V Leiden mutation, antiphospholipid antibody syndrome or prothrombin gene mutation) and paroxysmal nocturnal hemoglobinuria (1.63%). Cirrhosis was present in 18.7%, Portal vein thrombosis in 7.9%, and inferior vena cava thrombosis in 6.4%. The most common manifestations of BCS were ascites (29.9%) or acute kidney injury (18.8%) followed by hepatic encephalopathy (9.6%) and acute liver failure (5.6%). CONCLUSION This large population-based study from the United States showed increasing hospitalizations related to BCS. Common presentation was ascites and acute kidney injury.
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Key Words
- APC, annual percentage change
- APLA, antiphospholipid antibody
- BCS, Budd–Chiari syndrome
- Budd Chiari syndrome
- CI, confidence interval
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazard ratio
- ICD, International Classification of Diseases
- IVC, inferior vena cava
- NIS
- NIS, National Inpatient Sample
- PNH, paroxysmal nocturnal hemoglobinuria
- complications
- epidemiology
- risk factors
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Affiliation(s)
- Joseph J. Alukal
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Talan Zhang
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J. Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,Address for correspondence: Paul J. Thuluvath, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, USA.
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Abuhamed J, Nikkilä A, Lohi O, Auvinen A. Trends of computed tomography use among children in Finland. Eur J Radiol Open 2020; 7:100290. [PMID: 33335951 DOI: 10.1016/j.ejro.2020.100290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives CT is an essential diagnostic tool in health care. However, CT delivers relatively high levels of radiation which has been associated with an increased risk of childhood cancer. To address this, we evaluated patterns and time trends of CT use among children in Finland during the period in which changes in pediatric CT imaging practices were reported in several countries. Methods Data on CTs performed on children younger than 15 years were obtained from Finland’s largest eight hospitals. CT data included the period 1996–2010 with an estimated coverage of more than 80 % of pediatric CT imaging in Finland. Joinpoint regression was used for trends analysis. CT radiation doses were estimated based on a Finnish dosimetry survey. Results A total of 48,807 pediatric CTs were performed in 1996–2010. More boys (55.5 %) were scanned than girls (42.8 %). CT numbers increased up to 2002, then decreased significantly (-6.9 % per year, 95 % CI: -10.4 to -3.2) towards 2005 and to a lesser extent thereafter, particularly among younger children. All CT types decreased in recent years, except for chest, spine, and extremities. The frequency of head CTs related to the diagnoses of intracranial injury, migraine and headache decreased towards the end of the study period. The estimated annual average effective dose from the three most common CT examinations was 0.004 mSv per child in the population. Conclusions The frequency of pediatric CTs in Finland started to decrease after 2002. Apart from chest and orthopedic CTs, the utilization of pediatric CT imaging declined in recent years, most likely explained by improved awareness of medical radiation risks and reliance on alternative modalities such as MRI and ultrasound.
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Doycheva I, Zhang T, Amjad W, Thuluvath PJ. Diabetes and Hepatocellular Carcinoma: Incidence Trends and Impact of Liver Disease Etiology. J Clin Exp Hepatol 2020; 10:296-303. [PMID: 32655232 PMCID: PMC7335702 DOI: 10.1016/j.jceh.2019.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) remains the leading cause of cancer-related death among patients with type 2 diabetes mellitus (T2DM). We aimed to assess the independent role of T2DM on HCC risk among patients with different liver disease etiologies. METHODS We analyzed the United Network for Organ Sharing database of all adults registered for liver transplantation (LT) between February 27, 2002 and December 31, 2017. For initial analyses, patients were divided into four groups: nonalcoholic steatohepatitis (NASH) and all other etiologies with or without T2DM. For additional analyses, we divided them based on underlying etiology. Logistic regression was used to evaluate the impact of T2DM with NASH and other etiologies on HCC risk. RESULTS Overall, 24,149 (21.6%) of the listed patients had HCC. Of those, 23.9% had T2DM. When compared with nondiabetics, patient with NASH and T2DM had the highest risk of HCC (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.52-1.86), followed by patients with other etiologies and diabetes. After adjusting for other risk factors, these associations remained unchanged. Registrants with T2DM and NASH, cryptogenic cirrhosis, hepatitis C, and alcoholic liver disease were at higher risk of HCC than those without diabetes, but in patients with chronic hepatitis B or primary biliary cholangitis, diabetes did not increase the HCC risk. Between 2004 and 2016, the annual percentage change of HCC incidence increased for all patients with NASH and hepatitis C regardless of their diabetes status. For those with hepatitis B, this trend was significant only for diabetics. CONCLUSIONS The additive risk of T2DM for HCC development was highest in patients with NASH. HCC risk may vary depending on the underlying etiology.
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Key Words
- ALD, alcoholic liver disease
- APC, annual percentage change
- CI, confidence interval
- HBV, hepatitis B virus
- HCC incidence
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NAFLD, nonalcoholic liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- T2DM, type 2 diabetes mellitus
- UNOS
- UNOS, United Network for Organ Sharing
- fatty liver
- liver cancer
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Affiliation(s)
- Iliana Doycheva
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Talan Zhang
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Waseem Amjad
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA
| | - Paul J. Thuluvath
- Institute of Digestive Heath and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA,University of Maryland School of Medicine, Baltimore, MD, USA,Address for correspondence. Paul J Thuluvath, Institute of Digestive Health and Liver Diseases Mercy Medical Center, 301 St. Paul Place, Baltimore, MD, 21202, USA.
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