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Nasser MI, Kvist AV, Vestergaard P, Eastell R, Burden AM, Frost M. Sex- and Age Group-Specific Fracture Incidence Rates Trends for Type 1 and 2 Diabetes Mellitus. JBMR Plus 2023; 7:e10836. [PMID: 38025040 PMCID: PMC10652176 DOI: 10.1002/jbm4.10836] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/14/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
The incidence of major osteoporotic fractures has declined in men and women in Western countries over the last two decades. Although fracture risk is higher in persons with diabetes mellitus, trends of fractures remain unknown in men and women with diabetes. We investigated the trends in fracture incidence rates (IRs) in men and women with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) in Denmark between 1997 and 2017. We identified men and women aged 18+ years who sustained a fracture (excluding skull and facial fractures) between 1997 and 2017 using the Danish National Patient Registry. We calculated sex-specific IRs of fractures per 10,000 person-years separately in persons with T1D, T2D, or without diabetes. Furthermore, we compared median IRs of the first 5 years (1997-2002) to the median IRs of the last 5 years (2012-2017). We identified 1,235,628 persons with fractures including 4863 (43.6% women) with T1D, 65,366 (57.5% women) with T2D, and 1,165,399 (54.1% women) without diabetes. The median IRs of fractures declined 20.2%, 19.9%, and 7.8% in men with T1D, T2D, and without diabetes, respectively (p-trend <0.05). The median IRs decreased 6.4% in women with T1D (p-trend = 0.35) and 25.6% in women with T2D (p-trend <0.05) but increased 2.3% in women without diabetes (p-trend = 0.08). Fracture IRs decreased in men with both diabetes types and only in women with T2D, highlighting the need for further attention behind the stable trend observed in women with T1D. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Mohamad I Nasser
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB)Odense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Steno Diabetes Center OdenseOdense University HospitalOdenseDenmark
| | - Annika Vestergaard Kvist
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB)Odense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Pharmacoepidemiology Group, Institute of Pharmaceutical SciencesETH ZurichZurichSwitzerland
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
| | - Peter Vestergaard
- Steno Diabetes Center North DenmarkAalborg University HospitalAalborgDenmark
- Department of EndocrinologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg University HospitalAalborgDenmark
| | - Richard Eastell
- Academic Unit of Bone MetabolismUniversity of SheffieldSheffieldUK
- Mellanby Centre for Musculoskeletal ResearchUniversity of SheffieldSheffieldUK
| | - Andrea M Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical SciencesETH ZurichZurichSwitzerland
- Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
| | - Morten Frost
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB)Odense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Steno Diabetes Center OdenseOdense University HospitalOdenseDenmark
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Nyrhi L, Kuitunen I, Ponkilainen V, Huttunen TT, Mattila VM. Incidence of Fracture Hospitalization and Surgery in Women Increases Steadily During the Puerperal and Lactation Period: A Retrospective Register-Based Cohort Study in Finland From 1999 to 2018. J Bone Miner Res 2022; 37:1279-1286. [PMID: 35579492 PMCID: PMC9543855 DOI: 10.1002/jbmr.4571] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
This retrospective cohort study assesses the incidences of major fractures and surgery in women during the puerperium and the lactation period in Finland between January 1, 1999, and December 31, 2018. Using nationwide data from the Finnish Care Register for Health Care and the Finnish Medical Birth Register, all women aged between 15 and 49 years with a fracture hospitalization within 12 months of delivery between 1999 and 2018 were included. During the study period, a total of 3140 fractures after delivery and 152,800 fractures of the female normal population of similar age were hospitalized. The incidence rate after delivery increased from 219/100,000 person-years during the first 4 months to 310 fractures/100,000 person-years during the latter 8 months of the first year after delivery. Altogether, 29% (n = 904/3140) of these fractures were treated operatively. The most common fractures were ankle and distal radius fractures, which made up one-third of all fractures. The incidence of pelvic fracture hospitalization was 15/100,000 person-years at 4 months after delivery, with an operation rate of 22%. Over half of all fractures occurred between 6 and 12 months after delivery (mean 6.6 months). The incidence of fracture hospitalization after delivery increased steadily during the puerperium and the lactation periods but remained lower than in the general population (age-adjusted incidence 554/100,000 person-years) with an incidence rate ratio of 0.51. However, a higher proportion of pelvic fractures were observed in the first months after delivery. Surgical rates were in line with the general population. Fractures of the wrist and ankle made up most of the fractures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Lauri Nyrhi
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.,Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Heart Center, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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Cross AJ, Robbins EC, Pack K, Stenson I, Kirby PL, Patel B, Rutter MD, Veitch AM, Saunders BP, Little M, Gray A, Duffy SW, Wooldrage K. Colonoscopy surveillance following adenoma removal to reduce the risk of colorectal cancer: a retrospective cohort study. Health Technol Assess 2022; 26:1-156. [PMID: 35635015 DOI: 10.3310/olue3796] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Colonoscopy surveillance is recommended for some patients post polypectomy. The 2002 UK surveillance guidelines classify post-polypectomy patients into low, intermediate and high risk, and recommend different strategies for each classification. Limited evidence supports these guidelines. OBJECTIVES To examine, for each risk group, long-term colorectal cancer incidence by baseline characteristics and the number of surveillance visits; the effects of interval length on detection rates of advanced adenomas and colorectal cancer at first surveillance; and the cost-effectiveness of surveillance compared with no surveillance. DESIGN A retrospective cohort study and economic evaluation. SETTING Seventeen NHS hospitals. PARTICIPANTS Patients with a colonoscopy and at least one adenoma at baseline. MAIN OUTCOME MEASURES Long-term colorectal cancer incidence after baseline and detection rates of advanced adenomas and colorectal cancer at first surveillance. DATA SOURCES Hospital databases, NHS Digital, the Office for National Statistics, National Services Scotland and Public Health England. METHODS Cox regression was used to compare colorectal cancer incidence in the presence and absence of surveillance and to identify colorectal cancer risk factors. Risk factors were used to stratify risk groups into higher- and lower-risk subgroups. We examined detection rates of advanced adenomas and colorectal cancer at first surveillance by interval length. Cost-effectiveness of surveillance compared with no surveillance was evaluated in terms of incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained. RESULTS Our study included 28,972 patients, of whom 14,401 (50%), 11,852 (41%) and 2719 (9%) were classed as low, intermediate and high risk, respectively. The median follow-up time was 9.3 years. Colorectal cancer incidence was 140, 221 and 366 per 100,000 person-years among low-, intermediate- and high-risk patients, respectively. Attendance at one surveillance visit was associated with reduced colorectal cancer incidence among low-, intermediate- and high-risk patients [hazard ratios were 0.56 (95% confidence interval 0.39 to 0.80), 0.59 (95% confidence interval 0.43 to 0.81) and 0.49 (95% confidence interval 0.29 to 0.82), respectively]. Compared with the general population, colorectal cancer incidence without surveillance was similar among low-risk patients and higher among high-risk patients [standardised incidence ratios were 0.86 (95% confidence interval 0.73 to 1.02) and 1.91 (95% confidence interval 1.39 to 2.56), respectively]. For intermediate-risk patients, standardised incidence ratios differed for the lower- (0.70, 95% confidence interval 0.48 to 0.99) and higher-risk (1.46, 95% confidence interval 1.19 to 1.78) subgroups. In each risk group, incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained with surveillance were lower for the higher-risk subgroup than for the lower-risk subgroup. Incremental costs per quality-adjusted life-year gained were lowest for the higher-risk subgroup of high-risk patients at £7821. LIMITATIONS The observational design means that we cannot assume that surveillance caused the reductions in cancer incidence. The fact that some cancer staging data were missing places uncertainty on our cost-effectiveness estimates. CONCLUSIONS Surveillance was associated with reduced colorectal cancer incidence in all risk groups. However, in low-risk patients and the lower-risk subgroup of intermediate-risk patients, colorectal cancer incidence was no higher than in the general population without surveillance, indicating that surveillance might not be necessary. Surveillance was most cost-effective for the higher-risk subgroup of high-risk patients. FUTURE WORK Studies should examine the clinical effectiveness and cost-effectiveness of post-polypectomy surveillance without prior classification of patients into risk groups. TRIAL REGISTRATION This trial is registered as ISRCTN15213649. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emma C Robbins
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Iain Stenson
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paula L Kirby
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bhavita Patel
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.,Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | | | - Matthew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Ahn HS, Lee D, Lee SY, Kim YH, Lee JH, Yu DS, Han KD, Park YG, Lee YB. Increased Cardiovascular Risk and All-cause Death in Patients with Behçet Disease: A Korean Nationwide Population-based Dynamic Cohort Study. J Rheumatol 2019; 47:903-908. [PMID: 31371649 DOI: 10.3899/jrheum.190408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behçet disease (BD) is a chronic inflammatory multiorgan disease. An increased risk of cardiovascular disease (CVD) and heightened death rate with BD have been suggested, but to our knowledge, a nationwide large-scale study has not been conducted to date. This study aimed to determine the overall CV risk and death rate in patients with BD versus controls using the Korean National Health Insurance Service claim database. METHODS Patients with BD (n = 5576) with no previous history of CVD were selected from 2010 to 2014. An age- and sex-matched control population of individuals without BD (n = 27,880) was randomly sampled at a ratio of 5:1. Both cohorts were followed for incident CVD or all-cause death until 2015. RESULTS The risks of myocardial infarction (HR 1.72, 95% CI 1.01-2.73) and stroke (HR 1.65, 95% CI 1.09-2.50) were significantly higher in patients with BD than in controls. Patients with BD also had a significantly higher risk of all-cause death (HR 1.82, 95% CI 1.40-2.37) compared to controls. CONCLUSION Korean patients with BD had a higher overall risk of CVD than did those without BD. Therefore, patients with BD must be carefully monitored for the potential development of CVD to ensure that appropriate early treatments are delivered.
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Affiliation(s)
- Hyo-Suk Ahn
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dongjae Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Soo Young Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yeong Ho Kim
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ji Hyun Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dong Soo Yu
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kyung-Do Han
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yong Gyu Park
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
| | - Young Bok Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
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Rosenbauer J, Neu A, Rothe U, Seufert J, Holl RW. Types of diabetes are not limited to age groups: type 1 diabetes in adults and type 2 diabetes in children and adolescents. J Health Monit 2019; 4:29-49. [PMID: 35146246 PMCID: PMC8822252 DOI: 10.25646/5987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/09/2019] [Indexed: 06/14/2023]
Abstract
Based on data from the national diabetes registry DPV (Diabetes patient documentation), the diabetes registry of North Rhine-Westphalia and surveys conducted at hospitals and practices in Baden-Württemberg and Saxony, this study estimates the incidence and prevalence of type 1 diabetes in over-18-year-old adults and type 2 diabetes in 11- to 18-year-old children and adolescents. The national incidence of type 1 diabetes in adults was 6.1 per 100,000 person-years from 2014 to 2016, with slightly lower figures for women compared to men. Annually, around 4,150 adults develop type 1 diabetes. In 2016, the prevalence of type 1 diabetes was estimated at 493 per 100,000 persons and was lower in women at 445 per 100,000 people than in men at 544 per 100,000. Based on this data, there were around 341,000 adults with type 1 diabetes in 2016. For 11- to 18-year-old children and adolescents, the national incidence of type 2 diabetes was 2.8 per 100,000 person-years between 2014 and 2016 and higher for girls than for boys. Annually, around 175 adolescents in this age group develop type 2 diabetes. The incidence estimates for Saxony were higher (4.3 per 100,000 person-years). The prevalence of type 2 diabetes between 2014 and 2016 for 11- to 18-year-old children and adolescents was estimated between 12 and 18 cases per 100,000 persons. During this period, there were about 950 children and adolescents of this age group with type 2 diabetes in Germany.
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Affiliation(s)
- Joachim Rosenbauer
- German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-Universität Düsseldorf, Institute for Biometrics and Epidemiology
- German Center for Diabetes Research (DZD), München-Neuherberg
| | | | - Ulrike Rothe
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Health Sciences/Public Health
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg
| | - Reinhard W. Holl
- German Center for Diabetes Research (DZD), München-Neuherberg
- Ulm University, Institute of Epidemiology and Medical Biometry, ZIBMT
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6
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Rees JL, Shah A, Edwards K, Sanchez-Santos MT, Robinson DE, Delmestri A, Carr A, Arden N, Lamb SE, Rangan A, Judge A, Pinedo-Villanueva R, Holt T, Hopewell S, Prieto-Alhambra D, Collins G. Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study. Health Technol Assess 2019; 23:1-104. [PMID: 31043225 DOI: 10.3310/hta23180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). OBJECTIVES To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation. DESIGN A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation. SETTING UK primary and secondary care data. PARTICIPANTS Patients with a first-time TASD between 1997 and 2015. INTERVENTIONS Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis. MAIN OUTCOME MEASURE Re-dislocation rate up to 2 years after the first TASD. METHODS Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997-2015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16-35 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts. RESULTS Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a 'primary' dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation. LIMITATIONS Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions. CONCLUSIONS This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged > 50 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations. FUTURE WORK The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged > 50 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group. STUDY REGISTRATION Independent Scientific Advisory Committee (ISAC) for the Medicines and Healthcare Products Regulatory Agency (ISAC protocol 15_0260). FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Anjali Shah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Maria T Sanchez-Santos
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Danielle E Robinson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Department of Health Sciences, University of York, York, UK.,The James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesbrough, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Tim Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Gary Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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7
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Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ, Crowson CS, Matteson EL, Bongartz T. The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years. J Rheumatol 2017; 45:574-579. [PMID: 29247151 DOI: 10.3899/jrheum.170806] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the incidence of gout over the last 20 years and to evaluate possible changes in associated comorbid conditions. METHODS The medical records were reviewed of all adults with a diagnosis of incident gout in Olmsted County, Minnesota, USA, during 2 time periods (January 1, 1989-December 31, 1992, and January 1, 2009-December 31, 2010). Incident cases had to fulfill at least 1 of 3 criteria: the American Rheumatism Association 1977 preliminary criteria for gout, the Rome criteria, or the New York criteria. RESULTS A total of 158 patients with new-onset gout were identified during 1989-1992 and 271 patients during 2009-2010, yielding age- and sex-adjusted incidence rates of 66.6/100,000 (95% CI 55.9-77.4) in 1989-1992 and 136.7/100,000 (95% CI 120.4-153.1) in 2009-2010. The incidence rate ratio was 2.62 (95% CI 1.80-3.83). At the time of their first gout flare, patients diagnosed with gout in 2009-2010 had higher prevalence of comorbid conditions compared with 1989-1992, including hypertension (69% vs 54%), diabetes mellitus (25% vs 6%), renal disease (28% vs 11%), hyperlipidemia (61% vs 21%), and morbid obesity (body mass index ≥ 35 kg/m2; 29% vs 10%). CONCLUSION The incidence of gout has more than doubled over the recent 20 years. This increase together with the more frequent occurrence of comorbid conditions and cardiovascular risk factors represents a significant public health challenge.
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Affiliation(s)
- Mohanad M Elfishawi
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University
| | - Nour Zleik
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University
| | - Zoran Kvrgic
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University
| | - Clement J Michet
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University
| | - Cynthia S Crowson
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA. .,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University.
| | - Eric L Matteson
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University
| | - Tim Bongartz
- From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA. .,M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University.
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8
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Farr JN, Melton LJ, Achenbach SJ, Atkinson EJ, Khosla S, Amin S. Fracture Incidence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study. J Bone Miner Res 2017; 32:2347-2354. [PMID: 28972667 PMCID: PMC5732068 DOI: 10.1002/jbmr.3228] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 11/12/2022]
Abstract
Although fractures in both the pediatric and, especially, the elderly populations have been extensively investigated, comparatively little attention has been given to the age group in between. Thus, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to determine incidence rates for all fractures among young adult (age range, 18 to 49 years) residents of Olmsted County, Minnesota, in 2009 to 2011, and compared the distribution of fracture sites and causes in this young adult cohort with those for older residents aged 50 years or older. During the 3-year study period, 2482 Olmsted County residents aged 18 to 49 years experienced 1 or more fractures. There were 1730 fractures among 1447 men compared with 1164 among 1035 women, and the age-adjusted incidence of all fractures was 66% greater among the men (1882 [95% confidence interval 1793-1971] versus 1135 [95% CI 1069-1201] per 100,000 person-years; p < 0.001). Of all fractures, 80% resulted from severe trauma (eg, motor vehicle accidents) compared with 33% in Olmsted County residents age ≥50 years who sustained a fracture in 2009 to 2011. Younger residents (aged 18 to 49 years), when compared with older residents (aged ≥50 years), had a greater proportion of fractures of the hands and feet (40% versus 18%) with relatively few fractures observed at traditional osteoporotic fracture sites (14% versus 43%). Vertebral fractures were still more likely to be the result of moderate trauma than at other sites, especially in younger women. In conclusion, whereas pediatric and elderly populations often fracture from no more than moderate trauma, young adults, and more commonly men, suffer fractures primarily at non-osteoporotic sites due to more significant trauma. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Joshua N Farr
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shreyasee Amin
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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9
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Steppuhn H, Buda S, Wienecke A, Kraywinkel K, Tolksdorf K, Haberland J, Laußmann D, Scheidt-Nave C. Time trends in incidence and mortality of respiratory diseases of high public health relevance in Germany. J Health Monit 2017; 2:3-33. [PMID: 37168954 PMCID: PMC10165912 DOI: 10.17886/rki-gbe-2017-061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Respiratory diseases are major causes of disease burden and mortality throughout the world. In Germany, alongside acute respiratory infections (ARI), chronic lung diseases - including lung cancer, chronic obstructive pulmonary disease (COPD), and asthma - are of particular socioeconomic importance. ARI incidence rates differ significantly according to age, season and year. They are recorded as weekly consultation rates as reported by selected outpatient and inpatient care facilities. Between 2009 and 2016, the highest incidence rates of severe acute respiratory infection (SARI) were recorded among young children in outpatient (9.4%) and inpatient (0.2%) care. Mortality rates for ARI are also subject to seasonal and annual fluctuations. However, the official statistics on causes of death, which lead to estimates of more than 17,000 annual deaths, provide an inadequate measure of death rates because chronic underlying illnesses are often recorded as the cause of death rather than a more recently acquired acute infection. Therefore, the excess mortality caused by ARI needs to be assessed in the context of influenza outbreaks. Regarding lung cancer, COPD and asthma, the long-term time trends in disease incidence and mortality rates are of particular interest from a health policy perspective. Analyses of data from the official statistics on causes of death for the years 1998 through 2015 show that mortality rates for lung cancer and COPD decreased on average by 1.8% and 1.1% per year respectively, among men, whereas among women they increased by 2.5% (lung cancer) and 2.3% (COPD) annually. Nevertheless, more men than women died of lung cancer or COPD in 2015 in Germany: 29,378 men and 15,881 women died from lung cancer, and 17,300 men and 13,773 women died from COPD. During the same period, the asthma mortality rates decreased on average by 8.3% annually among women and by 11.2% annually among men, and the absolute number of deaths came down to 659 among women and 393 among men. Lung cancer incidence rates have been at similar levels as lung cancer death rates since 1998. No such data are available on time trends in COPD or asthma incidence rates. Coordinated surveillance of respiratory diseases needs to be expanded within the framework of international action plans for disease prevention.
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Affiliation(s)
- Henriette Steppuhn
- Corresponding author Dr Henriette Steppuhn, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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10
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Heidemann C, Scheidt-Nave C. Prevalence, incidence and mortality of diabetes mellitus in adults in Germany - A review in the framework of the Diabetes Surveillance. J Health Monit 2017; 2:98-121. [PMID: 37168946 PMCID: PMC10165910 DOI: 10.17886/rki-gbe-2017-062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Continuous monitoring of the key epidemiological indicators of diabetes is necessary for evaluating the magnitude of diabetes as a public health problem, but is currently not being undertaken in Germany. A comprehensive literature review covering the last decades was conducted to give an overview of population-based studies reporting on diabetes prevalence, diabetes incidence, and diabetes-related mortality among adults in Germany. This review differentiates between known and unknown diabetes, but not between individual types of diabetes. Numerous studies have identified a considerable increase in the prevalence of known diabetes among the adult population over time. Until the 1960s, the prevalence of known diabetes remained below 1%. However, current nationwide estimates for Germany are much higher and range between 7.2% (population aged 18 to 79 years) based on health examination surveys of the Robert Koch Institute (RKI), 8.9% (population aged 18 years and over) based on RKI telephone health interview surveys and 9.9% (among all age groups) based on statutory health insurance data. Few available estimates point to an increase in the incidence of known diabetes since the 1960s. For example, a comparison of data from the diabetes register of the former German Democratic Republic (GDR) in 1960 with current follow-up data from RKI survey participants shows that incidence rates increased from 1.2 (all age groups) to 6.9 (population aged 18 to 79 years) per 1,000 person-years. Data on diabetes-related mortality are also scarce, but indicate that excess mortality persists among people with known diabetes compared to those in the same age group without the condition, despite the finding of decreasing mortality rates among people with known diabetes. For example, the mortality rate based on early data from the GDR diabetes register was 1.9-fold higher among people with known diabetes than among the general population; current mortality follow-up data of RKI survey participants show a 1.7-fold higher mortality rate among people with known diabetes compared to those without the condition. Given the limited data that are currently available and the considerable variation of diagnostic criteria, it is not possible to estimate time trends in the prevalence, incidence or mortality of unknown diabetes. An extension of available health monitoring approaches and an improved use of existing data sources for secondary analysis are needed for a reliable evaluation of dynamics in diabetes epidemiology in Germany. To achieve these goals, a national diabetes surveillance system is currently being established under the auspices of the RKI.
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Affiliation(s)
- Christin Heidemann
- Corresponding author Dr Christin Heidemann, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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11
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Mahjoub Z, Jean S, Leclerc JT, Brown JP, Boulet D, Pelet S, Grondin C, Dumont J, Belzile ÉL, Michou L. Incidence and Characteristics of Atypical Femoral Fractures: Clinical and Geometrical Data. J Bone Miner Res 2016; 31:767-76. [PMID: 26588590 DOI: 10.1002/jbmr.2748] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 06/08/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 11/09/2022]
Abstract
Despite the multitude of studies published on atypical femoral fractures (AFFs), a profile for patients at risk does not exist. This study aimed first at estimating AFF incidence over a 19-month-period in Quebec City using the ASBMR Task force criteria to define AFF. The medical records of patients hospitalized for hip or femoral fracture between June 1, 2009, and December 31, 2010, were reviewed. Thirty-six cases of atypical fractures were identified during the 19-month period, representing an AFF incidence of 7.0 (range, 4.7 to 9.3) cases per 100,000 person-years. In the second part of the study, data regarding the characteristics suspected of increasing the risks of AFF were collected from medical and pharmacological records, proximal femur radiographs, and patient interviews. The data regarding each patient with an AFF during years 2008-2011 were compared to two controls with a hip or femoral fragility fracture or a traumatic fracture, paired for age and sex. Twenty patients with AFF were added to the 36 patients with AFF selected in the first part, thereby 56 patients with AFF were investigated. The association between the occurrence of AFF and bisphosphonates (BPs) use was proven statistically significant in multivariate analysis, odds ratio (OR) = 10.39 (95% CI, 2.22 to 48.58; p = 0.0029). Compared to controls, patients with AFF had excessive femoral offset (43.1 mm versus 38.3 mm, p = 0.0007), proximal femoral neck angle in varus (128.9 degrees versus 134.0 degrees, p < 0.0001), and had greater proximal cortical thickness. This retrospective study confirms the low incidence of AFF, confirms its significant association with exposure to BPs, and reveals the possible contribution of proximal femoral geometry in AFF occurrence.
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Affiliation(s)
- Zeineb Mahjoub
- Department of Rheumatology, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Sonia Jean
- Institut National de Santé Publique du Québec, Québec, Québec, Canada.,Department of Medicine, Université Laval, Québec, Québec, Canada
| | - Jean-Thomas Leclerc
- Department of Orthopedic Surgery, Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, Québec, Canada.,Division of Orthopedic Surgery, Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Jacques P Brown
- Department of Rheumatology, CHU de Québec-Université Laval, Québec, Québec, Canada.,Department of Medicine, Université Laval, Québec, Québec, Canada.,Centre hospitalier universitaire (CHU) de Québec Research Centre, Québec, Québec, Canada
| | - Dominic Boulet
- Division of Orthopedic Surgery, Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Stéphane Pelet
- Department of Orthopedic Surgery, Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, Québec, Canada.,Division of Orthopedic Surgery, Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Charlotte Grondin
- Department of Rheumatology, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Jeannette Dumont
- Centre hospitalier universitaire (CHU) de Québec Research Centre, Québec, Québec, Canada
| | - Étienne L Belzile
- Department of Orthopedic Surgery, Centre hospitalier universitaire (CHU) de Québec-Université Laval, Québec, Québec, Canada.,Division of Orthopedic Surgery, Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Laetitia Michou
- Department of Rheumatology, CHU de Québec-Université Laval, Québec, Québec, Canada.,Department of Medicine, Université Laval, Québec, Québec, Canada.,Centre hospitalier universitaire (CHU) de Québec Research Centre, Québec, Québec, Canada
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Peschken CA, Hitchon CA, Garland A, Bernstein CN, Chen H, Fransoo R, Marrie RA. A Population-based Study of Intensive Care Unit Admissions in Rheumatoid Arthritis. J Rheumatol 2015; 43:26-33. [PMID: 26628597 DOI: 10.3899/jrheum.150312] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We aimed to determine the incidence of and mortality after critical illness in rheumatoid arthritis (RA) compared with the general population, and to describe the risks for and characteristics of critical illness in patients with RA. METHODS We used population-based administrative data from the Data Repository at the Manitoba Centre for Health Policy from 1984 to 2010, and linked clinical data from an intensive care unit (ICU) database to identify all persons with RA in the province requiring ICU admission. We identified a population-based control group, matched by age, sex, socioeconomic status, and region of residence. The incidence of ICU admission, reasons for, and mortality after ICU admission were compared between populations using age- and sex-standardized rates, rate ratios, Cox proportional hazards models, and logistic regression models. RESULTS We identified 10,078 prevalent and 5560 incident cases of RA. After adjustment, the risk for ICU admission was higher for RA (HR 1.65, 95% CI 1.50-1.83) versus the matched general population. From 2000-2010, the annual incidence of ICU admission among prevalent patients was about 1% in RA, with a crude 10-year incidence of 8%. Compared with the general population admitted to ICU, 1 year after ICU admission, mortality was increased by 40% in RA. Cardiovascular disorders were the most common reason for ICU admission in RA. CONCLUSION Patients with RA have a higher risk for admission to the ICU than the general population and increased mortality 1 year after admission. Even with advances in management, RA remains a serious disease with significant morbidity.
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Affiliation(s)
- Christine A Peschken
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba.
| | - Carol A Hitchon
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
| | - Allan Garland
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
| | - Charles N Bernstein
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
| | - Hui Chen
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
| | - Randy Fransoo
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
| | - Ruth Ann Marrie
- From the Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, and the IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.C.A. Peschken, MD, MSc, FRCPC, Associate Professor, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba; C.A. Hitchon, MD, MSc, Department of Internal Medicine, University of Manitoba; A. Garland, MD, MA, Department of Internal Medicine, and Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba;C.N. Bernstein, MD, Department of Internal Medicine, and IBD Clinical and Research Centre, University of Manitoba; H. Chen, MSc, Manitoba Centre for Health Policy, University of Manitoba; R. Fransoo, PhD, Department of Community Health Sciences, and Manitoba Centre for Health Policy, University of Manitoba; R.A. Marrie, MD, PhD, Department of Internal Medicine, and Department of Community Health Sciences, University of Manitoba
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Rosengren BE, Karlsson M, Petersson I, Englund M. The 21st-century landscape of adult fractures: cohort study of a complete adult regional population. J Bone Miner Res 2015; 30:535-42. [PMID: 25280349 DOI: 10.1002/jbmr.2370] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 02/04/2014] [Revised: 09/12/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022]
Abstract
Recent reports on adult fracture epidemiology have focused mainly on the hip in the elderly, in whom increasing rates lately have changed to a decline. New reports of the preponderance of nonhip fractures in health expenditure call for a wider scope. We therefore examined current overall and site-specific fracture epidemiology in adults. We ascertained all fractures diagnosed in inpatient and outpatient care in all men and women aged 20 years or older in Skåne County, Sweden, from 1999 to 2010 (10 million person-years). For each fracture type, we estimated age-specific and sex-specific rates and evaluated potential time trends. We found 205,908 fractures yielding an overall fracture rate of 192 per 10,000 person-years. The age-standardized overall fracture rate increased by 1.2 per 10,000 and year (95% confidence interval, 0.8 to 1.5), but time trends were different for different fracture types, age strata, and for men and women. For example, in both women and men aged ≥50 years the rates of proximal humerus fracture increased (0.6 and 0.2 per 10,000 and year, respectively) while hip fracture rates declined (-1.0 and -0.3 per 10,000/year, respectively). Overall age-specific number of fractures increased with age in women but was stable in men. The increasing overall fracture rate is a major concern in the context of a growing and aging population. Effective and affordable preventive strategies and treatments should be an urgent priority to meet the challenges, especially in older women in whom most fractures occur. Comprehensive current detailed data, as provided in this study, may serve as reference for projections and for cost calculations of fracture care in other settings before results of similar examinations are available there.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics, Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Rendina D, De Filippo G, Ralston SH, Merlotti D, Gianfrancesco F, Esposito T, Muscariello R, Nuti R, Strazzullo P, Gennari L. Clinical characteristics and evolution of giant cell tumor occurring in Paget's disease of bone. J Bone Miner Res 2015; 30:257-63. [PMID: 25196811 DOI: 10.1002/jbmr.2349] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 05/11/2014] [Revised: 08/17/2014] [Accepted: 08/23/2014] [Indexed: 12/29/2022]
Abstract
Patients with Paget's bone disease (PDB) have an increased risk of developing giant cell tumor (GCT). This study was performed to evaluate the clinical characteristics and evolution of GCT complicating PDB and to compare these clinical characteristics to those observed in two large PDB cohorts, the PDB Italian Registry and the United Kingdom's Multi-Centre Randomised Controlled Trial of Symptomatic Versus Intensive Bisphosphonate Therapy for Paget's Disease (PRISM) study. A systematic literature review identified 117 cases of PDB complicated by GCT (PDB-GCT), which involved the skeletal sites affected by PDB (110 patients) or the extraskeletal tissues adjacent to affected bones (7 patients). In contrast to what previously reported for GCT patients without GCT patients (83.2%) were white and one-fourth of them (24.8%) had multifocal GCTs. Compared to PDB patients without GCT, PDB-GCT patients showed a higher male/female ratio (2.1 versus 1.2) and more severe disease (age at PDB onset 52.1 ± 12.1 versus 63.3 ± 10.6 years; number of affected sites 6.1 ± 2.9 versus 2.34 ± 1.6; prevalence of polyostotic PDB 93.3% versus 60.6%). The mortality rate of PDB-GCT patients was higher than those occurring in GCT patients without PDB (about 50% versus 0% to 5% at 5 years) or in PDB patients without GCT (log rank = 29.002). Moreover, up to 98% of PDB-GCT cases had elevated total alkaline phosphatase levels at neoplasm diagnosis, suggestive of active PDB. Importantly, PDB-GCT patients from Southern Italy (45.6% of all GCT patients) showed a higher prevalence of multifocal GCT (51.7%) and of positive familial history for PDB (70.8%) and GCT (65.0%). Finally, indirect evidence suggests a decline in the incidence of GCT in PDB patients. The occurrence of GCT in PDB patients is associated with severe disease and reduced life expectancy of affected patients. The increased prevalence of familial diseases in PDB-GCT patients from Southern Italy suggests a founder effect. The observed changes over time in the incidence of GCT in PDB patients could be related to improved clinical management and/or living conditions of patients.
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Affiliation(s)
- Domenico Rendina
- Department of Medicine and Surgery, Federico II University, Naples, Italy
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Rahman MM, Cibere J, Goldsmith CH, Anis AH, Kopec JA. Osteoarthritis incidence and trends in administrative health records from British Columbia, Canada. J Rheumatol 2014; 41:1147-54. [PMID: 24737915 DOI: 10.3899/jrheum.131011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To calculate the incidence rates of osteoarthritis (OA) and to describe the changes in incidence using 18 years of administrative health records. METHODS We analyzed visits to health professionals and hospital admission records in a random sample (n = 640,000) from British Columbia, Canada, from 1991/1992 through 2008/2009. OA was defined in 2 ways: (1) at least 1 physician diagnosis or 1 hospital admission; and (2) at least 2 physician diagnoses in 2 years or 1 hospital admission. Crude and age-standardized rates were calculated, and the annual relative changes were estimated from the Poisson regression models. RESULTS In 2008/2009, the overall crude incidence rate (95% CI) of OA using definition 1 was 14.6 (14.0-14.8); [12.5 (12.0-13.0) among men and 16.3 (15.8-16.8) among women] per 1000 person-years. The rates were lower by about 44% under definition 2. For the period 2000/2001-2008/2009, crude incidence rates based on definition 1 varied from 11.8 to 14.2 per 1000 person-years for men, and from 15.7 to 18.5 for women. Annually, on average, crude rates rose by about 2.5-3.3% for both men and women. The age-adjusted rates increased by 0.6-0.8% among men and showed no trend among women. CONCLUSION Our study generated updated incidence rates of administrative OA for the Province of British Columbia. Physician-diagnosed overall incidence rates of OA varied with the case definitions used; however, trends were similar in both case definitions. Age-adjusted rates among men increased slightly during the period 2000/2001-2008/2009. These findings have implications for projecting future prevalence and costs of OA.
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Affiliation(s)
- M Mushfiqur Rahman
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia.
| | - Jolanda Cibere
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Charlie H Goldsmith
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Aslam H Anis
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Jacek A Kopec
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
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Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 2014; 29:581-9. [PMID: 23959594 PMCID: PMC3929546 DOI: 10.1002/jbmr.2072] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [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: 05/22/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 11/07/2022]
Abstract
To assess recent trends in fracture incidence from all causes at all skeletal sites, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to estimate rates for Olmsted County, MN, USA, residents in 2009 to 2011 compared with similar data from 1989 to 1991. During the 3-year study period, 2009 to 2011, 3549 residents ≥50 years of age experienced 5244 separate fractures. The age- and sex-adjusted (to the 2010 US white population) incidence of any fracture was 2704 per 100,000 person-years (95% confidence interval [CI] 2614 to 2793) and that for all fractures was 4017 per 100,000 (95% CI 3908 to 4127). Fracture incidence increased with age in both sexes, but age-adjusted rates were 49% greater among the women. Overall, comparably adjusted fracture incidence rates increased by 11% (from 3627 to 4017 per 100,000 person-years; p = 0.008) between 1989 to 1991 and 2009 to 2011. This was mainly attributable to a substantial increase in vertebral fractures (+47% for both sexes combined), which was partially offset by a decline in hip fractures (-25%) among the women. There was also a 26% reduction in distal forearm fractures among the women; an increase in distal forearm fractures among men aged 50 years and over was not statistically significant. The dramatic increase in vertebral fractures, seen in both sexes and especially after age 75 years, was attributable in part to incidentally diagnosed vertebral fractures. However, the fall in hip fracture incidence, observed in most age groups, continues the steady decline observed among women in this community since 1950. More generally, these data indicate that the dramatic increases in the incidence of fractures at many skeletal sites that were observed decades ago have now stabilized.
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Affiliation(s)
- Shreyasee Amin
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Bartels CM, Buhr KA, Goldberg JW, Bell CL, Visekruna M, Nekkanti S, Greenlee RT. Mortality and cardiovascular burden of systemic lupus erythematosus in a US population-based cohort. J Rheumatol 2014; 41:680-7. [PMID: 24532834 DOI: 10.3899/jrheum.130874] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the mortality and cardiovascular disease (CVD) burden among a population-based cohort of patients with systemic lupus erythematosus (SLE) with previously described late mean onset and low rates of organ-threatening disease. METHODS This retrospective population-based cohort study investigated incident cases of SLE diagnosed from 1991-2008 and followed through March 2009 to examine rates of death and CVD events: myocardial infarction, stroke, or congestive heart failure hospitalization. Cases were identified using the 1997 update of the 1982 American College of Rheumatology SLE criteria. Searches included electronic records, chart audits, and state death matches, with physician review. Age-matched and sex-matched population comparisons facilitated relative event rate calculations. RESULTS Seventy incident SLE cases had late mean onset (52 years), with an incidence of 5 cases per 100,000/year. Matched comparisons showed similar baseline rates of hypertension, hyperlipidemia, and diabetes. However, patients with SLE experienced more CVD in the 2 years preceding SLE diagnosis (OR 3.8, 95% CI 1.8, 8.0). The estimated 10-year mortality rates were 26% for SLE subjects versus 19% for comparisons, hazard ratio (HR) 2.1, p<0.01. Adjusted for prior CVD, SLE cases still demonstrated increased hazards of mortality (HR 1.9, p=0.01) and CVD event or death (HR 1.8, p=0.01). CONCLUSION This incident SLE cohort demonstrated nearly doubled mortality and CVD event hazards compared to age-matched and sex-matched comparisons, even after accounting for higher CVD events in the 2 years preceding SLE diagnosis. This raises research questions regarding delayed SLE diagnosis versus accelerated CVD prior to SLE, particularly in older-onset SLE.
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Affiliation(s)
- Christie M Bartels
- From the Department of Medicine, Rheumatology Section, and Department of Biostatistics, University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wisconsin; Division of Rheumatology, Marshfield Clinic, and Epidemiology Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin; Division of Internal Medicine-Pediatrics, Health East Woodbury Clinic, Woodbury, Minnesota; Division of Internal Medicine, Springfield Clinic, Springfield, Illinois, USA
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Jebakumar AJ, Udayakumar PD, Crowson CS, Gabriel SE, Matteson EL. Occurrence and effect of lower extremity ulcer in rheumatoid arthritis -- a population-based Study. J Rheumatol 2014; 41:437-43. [PMID: 24429171 DOI: 10.3899/jrheum.130392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the occurrence, risk factors, morbidity, and mortality associated with lower extremity (LE) ulcers in patients with rheumatoid arthritis (RA). METHODS Retrospective review of Olmsted County, Minnesota, USA, residents who first fulfilled the 1987 American College of Rheumatology criteria for RA in 1980-2007 with followup to death, migration, or April 2012. Only LE ulcers that developed after the diagnosis of RA were included. RESULTS The study included 813 patients with 9771 total person-years of followup. Of them, 125 developed LE ulcers (total of 171 episodes), corresponding to a rate of occurrence of 1.8 episodes per 100 person-years (95% CI: 1.5, 2.0 per 100 person-yrs). The cumulative incidence of first LE ulcers was 4.8% at 5 years after diagnosis of RA and increased to 26.2% by 25 years. Median time for the LE ulcer to heal was 30 days. Ten of 171 episodes (6%) led to amputation. LE ulcers in RA were associated with increased mortality (HR 2.42; 95% CI 1.71, 3.42), adjusted for age, sex, and calendar year. Risk factors for LE ulcers included age (HR 1.73 per 10-yr increase; 95% CI 1.47, 2.04), rheumatoid factor positivity (HR 1.63; 95% CI 1.05, 2.53), presence of rheumatoid nodules (HR 2.14; 95% CI 1.39, 3.31), and venous thromboembolism (HR 2.16; 95% CI 1.07, 4.36). CONCLUSION LE ulcers are common among patients with RA. The cumulative incidence increased by 1% per year. A significant number require amputation. Patients with RA who have LE ulcers are at a 2-fold risk for premature mortality.
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Affiliation(s)
- Adlene J Jebakumar
- From the Department of Health Sciences Research and the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Abstract
OBJECTIVE To determine how duration of observation affects estimation of incidence and prevalence of systemic lupus erythematosus (SLE). METHODS SLE incidence and prevalence estimates from data periods as brief as 3 years (2001-2003) were compared to estimates from a 15-year period (1989-2003). RESULTS The 15-year period incidence was 5.6/100,000 (95% CI 5.0-6.1) and the prevalence was 59.1/100,000 (95% CI 57.4-60.8). When a 3-year period was used, incidence was overestimated by 238.1% and prevalence underestimated by 66.0%. CONCLUSION SLE incidence and prevalence estimates vary considerably according to the observation period; more than 5 years of data is likely required.
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Affiliation(s)
- Ryan Ng
- Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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Harrold LR, Salman C, Shoor S, Curtis JR, Asgari MM, Gelfand JM, Wu JJ, Herrinton LJ. Incidence and prevalence of juvenile idiopathic arthritis among children in a managed care population, 1996-2009. J Rheumatol 2013; 40:1218-25. [PMID: 23588938 DOI: 10.3899/jrheum.120661] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few studies based in well-defined North American populations have examined the occurrence of juvenile idiopathic arthritis (JIA), and none has been based in an ethnically diverse population. We used computerized healthcare information from the Kaiser Permanente Northern California membership to validate JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population. METHODS We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases, 9th edition, diagnosis code of 696.0, 714, or 720 in computerized clinical encounter data during 1996-2009. In a random sample, we then reviewed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms. Finally, we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA. RESULTS A diagnosis of JIA was confirmed in 69% of individuals with at least 1 relevant code. Forty-five percent were newly diagnosed during the study period. The age- and sex-standardized incidence rate of JIA per 100,000 person-years was 11.9 (95% CI 10.9-12.9). It was 16.4 (95% CI 14.6-18.1) in girls and 7.7 (95% CI 6.5-8.9) in boys. The peak incidence rate occurred in children aged 11-15 years. The prevalence of JIA per 100,000 persons was 44.7 (95% CI 39.1-50.2) on December 31, 2009. CONCLUSION The incidence rate of JIA observed in the Kaiser Permanente population, 1996-2009, was similar to that reported in Rochester, Minnesota, USA, but 2 to 3 times higher than Canadian estimates.
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Affiliation(s)
- Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Meyers Primary Care Institute and Fallon Clinic, Worcester, Massachusetts 01605, USA.
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Salih Sahib A, Al-Kaisy AA, Al-Biati HAKJ. How to decrease the incidence of eschar formation during the use of topical povidone-iodine ointment in the treatment of burns. Ann Burns Fire Disasters 2006; 19:11-7. [PMID: 21991013 PMCID: PMC3188014] [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] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Indexed: 05/31/2023]
Abstract
The aim of this study was to prevent eschar formation in thermally injured patients during the use of povidoneiodine ointment by modifying therapeutic protocols depending on normal events in healing process. Sixty thermally injured patients of different age groups, sex, and occupation with different burn sizes were involved in the study, allocated to two groups. Group A was made up of 17 patients treated with topical povidone-iodine ointment in addition to other prescribed drugs according to the burn unit regimen, while group B was comprised of 43 patients treated with topical povidone-iodine ointment for the first four days post-injury followed by topical silver sulphadiazine cream until discharge and with other prescribed drugs according to the burn unit regimen. In both groups the following were studied, using standard methods: oxidative stress parameters; thyroid, liver, and renal function test; microbiology; mortality rate; healing time and economic aspects. It was found that treatment of burn patients with topical povidone-iodine ointment for the first four days post-injury followed by topical silver sulphadiazine cream reduced the incidence of eschar formation from 100% to 2.3%, in addition to maintaining improvement in burn outcome when using povidone-iodine ointment during the full course of treatment. It is concluded that for the modification of treatment protocols in burns designed to obtain normal wound healing and at the same time to avoid the undesirable effects of the treatment given, the use of topical povidone-iodine ointment for the first four days post-injury, followed by topical silver sulphadiazine cream, was a good application. In addition, this study clearly shows the importance of the therapeutic targeting of oxidative stress in burn treatment, especially during the first four days post-injury, a period when blood levels of oxidative stress parameters are at a maximum.
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Affiliation(s)
- A Salih Sahib
- Clinical Pharmacy, Diyala Health Directorate, Diyala, Iraq
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