Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study

OBJECTIVE

To evaluate validity and reliability of the food-frequency questionnaire (FFQ) developed for the Korean Genome Epidemiologic Study (KoGES).

METHODS

FFQ was administered twice at 1-year interval (first FFQ (FFQ1) at the beginning and second FFQ (FFQ2) at the end of the study) and diet records (DRs) were collected for 3 days during each of the four seasons from December 2002 to May 2004 for those who attended the health examination center. At the end of the study period, we collected the 12-day DRs of 124 participants. The nutrient intakes from the DRs were compared with both FFQ1 and FFQ2.

RESULTS

The intakes of energy and some nutrients estimated from FFQ1 and FFQ2 were different from those assessed by the DRs. Especially, the consumption of carbohydrates was higher in FFQ1 and FFQ2 than in the DRs. The de-attenuated, age, sex and energy intake adjusted correlation coefficients between the FFQ2 and the 12-day DRs in Korean population ranged between 0.23 (Vitamin A) and 0.64 (carbohydrate). The median for all nutrients was 0.39. The correlations were similar when we compared nutrient densities of both methods. Joint classification of calorie-adjusted nutrient intakes assessed by FFQ2 and 12-day DRs by quartile ranged from 25.8% (vitamin A) to 39.5% (carbohydrate, iron) for exact concordance. Except vitamin A, the proportion of subjects classified into distant quartile was less than 7% in all nutrients. The median of correlations between the two FFQs 1 year apart were 0.45 for all nutrient intakes and 0.39 for nutrient densities.

CONCLUSIONS

We conclude that the FFQ we have developed appears to be an acceptable tool for assessing the nutrient intakes in this population. Further studies for calibration of the FFQ collected from multicenters participating in the KoGES are needed.

SPONSORSHIP

This study was supported by the budget of the National Genome Research Institute, Korea National Institute of Health (2002-347-6111-221).

OPTN/SRTR 2020 Annual Data Report: Heart

As we enter the third year of the new adult heart allocation policy, we are faced with the new challenges of the COVID-19 pandemic. In 2020, new listings (adult and pediatric) decreased slightly, with 4000 new listings in 2020, compared with 4087 in 2019; however, the number of adult heart transplants performed continued to increase, to 3715 in 2020. The number of pediatric heart transplants declined from 509 in 2019 to 465 in 2020. One-year and six-month posttransplant mortality rates in adult recipients have increased slightly since 2015 but have not significantly changed over the past decade. Overall, posttransplant mortality rates for adult recipients were 7.4% at six months and 9.4% at one year for transplants in 2019, 14.0% at three years for transplants in 2017, and 19.1% at five years for transplants in 2015. Although shorter-term posttransplant mortality rates have slightly increased, there has been a steady downward trend in longer-term mortality. Mortality rates for pediatric recipients were 5.7% at six months and 8.1% at one year for transplants in 2019, 11.6% at three years for transplants in 2017, and 15.2% at five years for transplants in 2015.

Prevalence, awareness, treatment, control and risk factors of hypertension in Korea: the Ansan study

OBJECTIVES

To determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in an urban Korean population.

DESIGN AND SETTING

A cross-sectional survey in Ansan-city, Korea.

SUBJECTS AND METHODS

Population-based samples of people aged 18-92 years in Ansan-city, Korea, were selected, yielding 2278 men and 1948 women, and their blood pressures were measured using a highly standardized protocol. Hypertension was defined as a systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or reported treatment with antihypertensive medications, and subclassified according to 1999 WHO-ISH guidelines. Isolated systolic hypertension (ISH) defined as a systolic BP > or = 140 mmHg and diastolic BP < 90 mmHg was also examined. Data were stratified by age and sex.

RESULTS

The overall prevalence of hypertension in this study was 33.7%. Among these, 64.9% had Grade 1 hypertension, 22.5% Grade 2, and 12.5% Grade 3. Age-specific prevalence of hypertension increased progressively with age, from 14.19% in 18 to 24 year-olds to 71.39% in those 75 years or older. Hypertension prevalence was significantly higher in men (41.5%) than in women (24.5%) (P < 0.001). Isolated systolic hypertension had significantly lower prevalence (4.33%) within the population, although in the elderly aged 55 years or more it rose by 11.13%. Overall, 24.6% of hypertensive individuals were aware that they had high blood pressure, as much as 78.6% were being treated with antihypertensive medications, and 24.3% were under control. Hypertension awareness as well as treatment and control rates varied by sex, with women higher in all three rates. Multivariate analysis revealed that age, body mass index and abdomen circumference were significantly associated with prevalence of hypertension both in men and women.

CONCLUSIONS

Hypertension is highly prevalent in Korea. Despite the high rate of treatment, the rates of awareness and control are relatively low, suggesting the nationwide demand for preventing and controlling high blood pressure in Korea in order to avert an epidemic of cardiovascular disease.

Lipase/palladium-catalyzed asymmetric transformations of ketoximes to optically active amines

[reaction: see text] Prochiral ketoximes were asymmetrically transformed to optically active amines in the acetylated forms by coupled lipase/palladium catalysis in the presence of an acyl donor under 1 atm of hydrogen.

Total synthesis of (+/-)-martinellic acid

A 14-step synthesis of martinellic acid (1) that proceeds in 3% overall yield has been completed using the reaction of aniline 11 with Meldrum's acid-activated vinylcyclopropane 4 to give vinyl pyrrolidinone 12, condensation of aldehyde 13 with N-benzylglycine to form an azomethine ylide that cyclizes to give 14, selective reduction of 14 to amino alcohol 16 with LiBH(4) and MeOH, and guanidine formation by reaction of a cyanamide with 3-methyl-2-buten-1-amine in hexafluoro-2-propanol at 120 degrees C as key steps. [structure: see text]

OPTN/SRTR 2019 Annual Data Report: Heart

The new adult heart allocation policy was approved in 2016 and implemented in October 2018. This year's Annual Data Report provides early insight into the effects of this policy. In 2019, new listings continued to increase, with 4086 new candidates. Also in 2019, 3597 heart transplants were performed, an increase of 157 (4.6%) from 2018; 509 transplants occurred in children and 3088 in adults. Short- and long-term posttransplant mortality rates improved. Overall, Mortality rates for adult recipients were 6.4% at 6 months and 7.9% at 1 year for transplants in 2018, 14.4% at 3 years for transplants in 2016, and 20.1% at 5 years for transplants in 2014. Mortality rates for pediatric recipients were 6.3% at 6 months and 8.2% at 1 year for transplants in 2018, 10.3% at 3 years for transplants in 2016, and 17.8% at 5 years for transplants in 2014.

Recurrence after Successful Percutaneous Endoscopic Lumbar Discectomy

The purpose of this study is to investigate the risk factors for recurrence after successful percutaneous endoscopic lumbar discectomy (PELD). Recently, PELD has become the most common surgical technique. However, there are only a few studies on the factors causing the reappearance of the symptoms. Between January 2002 and December 2004, 42 patients with recurrent disc herniation after successful PELD were classified as a recurrent group and 42 patients who underwent PELD with a satisfactory result were randomly selected for a non-recurrent group. For all the patients, we analyzed the medical records and radiological studies retrospectively. The patients' mean age was 47.4 years (range: 18-76) in the recurrent group, while the mean age of the non-recurrent group was 34.4 years (range: 17-66) (p=0.001). The body mass index was 24.9 in the recurrent group and 22.9 in the non-recurrent group (p=0.006). On the radiological studies, the protrusion (p=0.013) and the presence of Modic change (p=0.003) were more frequent in the recurrent group. For the successful PELD, it is desirable for the surgeon to consider the above risk factors carefully.

Identification of transacting factors responsible for the tissue-specific expression of human glucose transporter type 2 isoform gene. Cooperative role of hepatocyte nuclear factors 1alpha and 3beta

We investigated transacting factors binding to the cis-element important in tissue-specific expression of the human glucose transporter type 2 isoform (GLUT2) gene. By transient transfection assay, we determined that the 227-base pair fragment upstream of the ATG start site contained promoter activity and that the region from +87 to +132 (site C) was responsible for tissue-specific expression. DNase I footprinting and electrophoretic mobility shift assay indicated that site C contained one binding site for hepatocyte nuclear factor 1 (HNF1) and two binding sites for HNF3. The mutations at positions +101 and +103, which are considered to be critical in binding HNF1 and HNF3, resulted in a 53% decrease in promoter activity, whereas the mutation of the proximal HNF3 binding site (+115 and +117) reduced promoter activity by 28%. The mutations of these four sites resulted in marked decrease (70%) in promoter activity as well as diminished bindings of HNF1 and HNF3. A to G mutation, which causes conversion of the HNF1 and HNF3 binding sequence to the NF-Y binding site, resulted in a 22% decrease in promoter activity. We identified that both HNF1 and HNF3 function as transcriptional activators in GLUT2 gene expression. Coexpression of the pGL+74 (+74 to +301) construct with the HNF1alpha and HNF3beta expression vectors in NIH 3T3 cells showed the synergistic effect on GLUT2 promoter activity compared with the expression of HNF1alpha, HNF3beta, or a combination of HNF1beta and HNF3beta. These data suggest that HNF1alpha and HNF3beta may be the most important players in the tissue-specific expression of the human GLUT2 gene.

Analyses of polycyclic aromatic hydrocarbon-degrading bacteria isolated from contaminated soils

Polycyclic aromatic hydrocarbon (PAH)-degrading bacteria isolated from PAH-contaminated soils were analyzed genotypically and phenotypically for their capacity for metabolism of naphthalene and other PAH substrates. The methods used for the analyses were DNA hybridization using NAH7-derived gene probes, PAH spray plate assays, 14C-PAH mineralization assays, and dioxygenase activity assays. The results of the analyses showed a dominant number of PAH-degrading bacteria with a NAH7-like genotype. The results support the continued use of the nahA probe for contaminated soils to monitor the genetic potential of indigenous microorganisms to degrade PAHs. However, the finding of non-nahA-hybridizing PAH-degrading bacteria show the limitation of NAH7-derived gene probes. Fifteen percent (13/89) of PAH-degrading bacteria isolated were not detected with the nahA gene probe. Four isolates (designated A5PH1, A8AN3, B1PH2, and B10AN1) did not hybridize with any of the NAH7-derived gene probes (nahA, nahG, nahH, and nahR) used in this study. Considering the numerous unculturable microorganisms in nature and their potential genotypes, NAH7-derived gene probes may underestimate the microbial potential to catabolize PAHs. This necessitates development of new gene probes for enumeration and isolation of PAH-degrading bacteria to better understand the in situ microbial potential to degrade PAHs.

Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases

Percutaneous cervical discectomy (PCD) has been developed as an effective treatment option for soft cervical disc herniation. However, no prognostic study of this procedure has yet been made. The purpose of this study was to evaluate the surgical outcome of PCD and to determine the factors predicting excellent outcome. A retrospective review was performed of 111 consecutive patients who underwent PCD with a mean follow-up period of 49.4 months (range, 29-64 months). Under local anesthesia, a percutaneous anterior approach was followed by discectomy with microforceps and endoscopic Ho:YAG laser. The surgical outcomes of the 111 patients based on the Macnab criteria were excellent in 52 patients (46.9%), good in 37 (33.3%), fair in 9 (8.1%), and poor in 13 (11.7%), thereby indicating a symptomatic improvement in 88.3% of the patients. In this study, the two major factors predicting an excellent long-term outcome were the symptom of radiating arm pain (P = 0.02) and the location of lateral disc herniation (P < 0.02). Proper patient selection remains critical for the success of this minimally invasive procedure.

The influence of facet tropism on herniation of the lumbar disc in adolescents and adults

We carried out a study to determine the effect of facet tropism on the development of adolescent and adult herniation of the lumbar disc. We assessed 149 levels in 140 adolescents aged between 13 and 18 years and 119 levels in 111 adults aged between 40 and 49 years with herniation. The facet tropism of each patient was measured at the level of the herniated disc by CT. There was no significant difference in facet tropism between the herniated and the normal discs in both the adolescent and adult groups, except at the L4-L5 level in the adults. Facet tropism did not influence the development of herniation of the lumbar disc in either adolescents or adults.

Statins inhibit matrix metalloproteinase release from human lung fibroblasts

Pleiotropic effects of statins have been reported to include inhibition of matrix metalloproteinase (MMP) release from macrophages and endothelial cells. We evaluated whether statins would inhibit MMP release from human lung fibroblasts, which play a major role in remodelling processes. Monolayer and three-dimensional (3D) collagen gel cultures of fibroblasts were used. Cytokines (tumour necrosis factor-alpha and interleukin-1alpha) were used to induce MMP release and mRNA expression. Collagen degradation induced by cytokines and neutrophil elastase (NE) was evaluated by quantifying hydroxyproline. Atorvastatin inhibited MMP-1 and -3 release and mRNA expression in both culture systems. Similar results were obtained with simvastatin and fluvastatin. In 3D cultures where cytokines also stimulated MMP-9 release, atorvastatin also inhibited MMP-9 release. In 3D cultures, cytokines together with NE induced collagen degradation, which was also inhibited by atorvastatin. The effect of atorvastatin was reversed by mevalonate and geranylgeranyl-pyrophosphate but not by farnesyl-pyrophosphate. The current data suggest that statins may modulate remodelling processes mediated by fibroblasts by inhibiting MMP release.

Hydrolysis and acidogenesis of particulate organic material in mesophilic and thermophilic anaerobic digestion

The purpose of this study was to evaluate the effect of pH and inorganic nutrient supplementations for anaerobic hydrolysis and acidogenesis of particulate organic materials at both mesophilic (35 degrees C) and thermophilic (55 degrees C) temperatures. Hydrolysis and acidogenesis of a synthetic sludge was observed in batch operation for the evaluation of the pH effect. pH was uncontrolled in one reactor and controlled at 4.5, 5.5, and 6.5 in the other three reactors at both temperatures. The greatest degree of hydrolysis and acidogenesis occurred when the pH was controlled at 6.5. The pH of the uncontrolled reactor dropped to 3.4 at both temperatures severely retarding hydrolysis and acidogenesis. Concentrations of acetic and n-butyric acids predominated with lower concentrations of propionic acid at both temperatures in all reactors. Lactic acid was produced as the earliest intermediate but as the reaction proceeded, short chain VFAs were produced as final end products with a decrease in lactic acid. The higher the pH, the earlier this trend was observed. For the controlled reactors at pH 6.5, the soluble COD production and the VSS reduction peaked in 4 days at 55 degrees C whereas it took about 11 days at 35 degrees C to obtain the same result. During the linear SCOD production period at a pH of 6.5 the hydrolysis rate of the thermophilic reactor was greater than that for mesophilic. Thermophilic conditions appeared to be more sensitive to pH than mesophilic ones for both hydrolysis and acidogenesis. Additional experiments were conducted to establish the effect of inorganic nutrient (Ca, Fe, Co, and Ni) supplementation on hydrolysis and acidogenesis at both temperatures. It has, prior to this, been assumed that only methanogenesis benefited from trace metal supplementation. However, the results demonstrated the importance of inorganic nutrient supplementation to optimize hydrolysis and acidogenesis at both temperatures.

Studies toward gymnodimine: development of a single-pot Hua reaction for the synthesis of highly hindered cyclic imines

[structure: see text]. In studies directed toward gymnodimine and related marine toxins, a single-pot variation of the Hua cyclic imine synthesis has been developed. The reaction involves generation of N-trimethylsilyl lactams in situ followed by alkyllithium addition leading directly to cyclic imines. Importantly, this reaction proceeds efficiently with highly hindered alpha,alpha-dialkyl lactams, provided 1,2-dimethoxyethane (DME) is used as solvent, leading to stable cyclic imines. Overall, this transformation allows a one-pot coupling of an alkyliodide and a lactam to give a cyclic imine.

The use of statins for the treatment of depression in patients with acute coronary syndrome

This study aimed to investigate the effect of statins for the treatment of depression in individuals with acute coronary syndrome (ACS). We used 1-year follow-up data of a 24-week double-blind, placebo-controlled trial of escitalopram and a naturalistic prospective observational cohort study. Of 446 participants with comorbid depressive disorders and ACS at baseline, 300 participated in a randomised escitalopram trial and the remaining 146 participated in a naturalistic observational study. The participants in the two studies were approached for a 1-year follow-up investigation. Treatment response rates, defined as a ⩾ 50% reduction in the Hamilton Depression Rating Scale (HAM-D) and Beck Depression Inventory (BDI) scores, were used as the outcome variables. In the escitalopram trial, both HAM-D and BDI response rates were highest in patients taking escitalopram and statins together and lowest in patients receiving neither medication. Logistic regression analyses revealed that statin use was significantly associated with higher response rates on both the HAM-D and BDI at 1 year, whereas no such associations were found for escitalopram. In the naturalistic observational study, the response rates at 1 year did not differ significantly by statin use. Instead, the HAM-D response rate was significantly higher in patients taking lipophilic statins than in those who did not. In conclusion, statins may be effective for the treatment of depression independent of medical status and escitalopram use, and they may potentiate the antidepressant action of serotonergic antidepressants in patients with ACS.

Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation

A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35 +/- 0.79 to 2.12 +/- 1.17, postoperatively (P < 0.01). The mean disc height decreased from 6.81 +/- 1.08 to 5.98 +/- 1.07 mm (P < 0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria.

Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women

Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

Geographical difference in the prevalence of isolated systolic hypertension in middle-aged men and women in Korea: the Korean Health and Genome Study

To compare geographical difference in the prevalence of isolated systolic hypertension (ISH) in between urban (Ansan) and rural (Ansung) Korean adults aged 40-69 years, 4351 men and 4604 women enrolled in the Korean Health and Genome Study were analysed. Information was collected regarding gender, alcohol intake, smoking status, household income, occupation, and years of education by trained interviewers. Eligible subjects included untreated hypertensive and normotensive subjects. ISH was defined as a systolic blood pressure (SBP) > or = 140 mmHg and diastolic BP <90 mmHg. The overall age-adjusted prevalence of ISH was 4.1%. The prevalence of ISH in Ansung (5.7%) was higher than in Ansan (2.5%, P < 0.05). Also it increased with increments of age, from 1.0 to 12.8% in Ansung (P < 0.05) and from 0.3 to 13.0% in Ansan (P < 0.05). In those with body mass index (BMI) > or = 30.0 kg/m2 in Ansung, the prevalence of ISH in women was twice as much as in men. The prevalence of ISH in obese men and women with a waist-hip ratio > or =1.0 and > or = 0.85, respectively, was more than that of nonobese men and women in both areas. In Korea, because of industrialization, the age distribution was skewed and the Korean population in rural areas is more aged. ISH will become a truly major health problem in rural area, because ISH is related to age, BMI and waist-hip ratio. Therefore, the Korean government will be required to institute different policies in the hypertension management to target populations in rural and urban areas.

OPTN/SRTR 2019 Annual Data Report: Intestine

Intestine transplant can be life-saving and can improve quality of life for patients with intestinal failure. Medical and surgical advances in treatment of intestinal failure over the past 10 to 15 years have resulted in fewer patients being added to the waiting list for intestine transplant alone or for intestine transplant in combination with liver transplant (and sometimes other organs). Consequently, fewer transplants are being performed. The numbers of listings and transplants fell to new lows in 2019. The number of programs performing transplants in at least one patient in 2019 was the lowest in the last decade, equal to 2014, at 15. Graft failure plateaued over the past decade, but early graft loss has increased in the past 2 years, notably in recipients of a combined liver and intestine allograft. Five-year patient survival for transplants in 2012-2014 varied little by graft type.

Transient hypogammaglobulinaemia of infancy: many patients recover in adolescence and adulthood

Transient hypogammaglobulinaemia of infancy (THI) is a relatively rare disorder where there is an exaggeration of the physiological nadir of immunoglobulin (Ig)G between loss of transplacentally acquired maternal IgG and production by the infant. Patients may be vulnerable to infections during the period of hypogammaglobulinaemia. The precise time to recovery in all infants is currently unknown. We sought to determine the clinical features and time-course of recovery for patients with THI. We reviewed our experience with THI over the last three decades in order to describe clinical and laboratory features, as well as the time-course of recovery. Forty-seven patients were identified with THI. Only thirty-seven per cent remitted by 4 years of age, while some patients did not recover until the third or fourth decade. In keeping with previous studies, the majority (25 of 47) presented with recurrent infections, nine had a family history of immunodeficiency and 13 had adverse reactions to food as their dominant clinical manifestation. Chronic tonsillitis developed in 10 patients and symptoms improved following surgery. The group with food allergies recovered sooner than those presenting with infections or with a family history immunodeficiency. Eight patients failed to respond to at least one routine childhood vaccine. Two have IgA deficiency and four individuals recovering in adolescence and adulthood continue to have borderline/low IgG levels. None have progressed to common variable immunodeficiency disorders (CVID). THI is a misnomer, as the majority do not recover in infancy. Recovery from THI can extend into adulthood. THI must be considered in the differential diagnosis of adolescents or young adults presenting with primary hypogammaglobulinemia.

Clinical feature and outcome of pediatric cerebrovascular disease: a neurosurgical series

To investigate the clinical features and surgical outcome of pediatric cerebrovascular disease (CVD), we retrospectively reviewed 280 children (up to 15 years of age) who underwent neurosurgical procedures for CVD between 1979 and 1998. Open surgery (n=448), endovascular procedures (n=22), and stereotactic radiosurgery (n=14) were the main neurosurgical procedures adopted. Clinical features and surgical outcomes were described according to the etiology of the CVD and the number of years of management. The mean duration of follow-up was 34 months. The mean age was 7.1 years, and the male-to-female ratio was 1.2:1. The most frequent CVD was moyamoya disease (62%). The surgical mortality related to CVD was 0.7%. Eighty-seven percent had Karnofsky Performance Scale scores of more than 70. We demonstrate increasing detection rates and improving outcomes in recent years. The clinical course in this study shows that recovery from CVD in children is good after neurosurgical procedures.

Bronchiectasis is associated with delayed diagnosis and adverse outcomes in the New Zealand Common Variable Immunodeficiency Disorders cohort study

Common variable immunodeficiency disorders (CVID) are multi-system disorders where target organ damage is mediated by infective, autoimmune and inflammatory processes. Bronchiectasis is probably the most common disabling complication of CVID. The risk factors for bronchiectasis in CVID patients are incompletely understood. The New Zealand CVID study (NZCS) is a nationwide longitudinal observational study of adults, which commenced in 2006. In this analysis, the prevalence and risk factors for bronchiectasis were examined in the NZCS. After informed consent, clinical and demographic data were obtained with an interviewer-assisted questionnaire. Linked electronic clinical records and laboratory results were also reviewed. Statistical methods were applied to determine if variables such as early-onset disease, delay in diagnosis and increased numbers of infections were associated with greater risk of bronchiectasis. One hundred and seven adult patients with a diagnosis of CVID are currently enrolled in the NZCS, comprising approximately 70% of patients known to have CVID in New Zealand. Fifty patients (46·7%) had radiologically proven bronchiectasis. This study has shown that patients with compared to those without bronchiectasis have an increased mortality at a younger age. CVID patients with bronchiectasis had a greater number of severe infections consequent to early-onset disease and delayed diagnosis. Indigenous Māori have a high prevalence of CVID and a much greater burden of bronchiectasis compared to New Zealand Europeans. Diagnostic latency has not improved during the study period. Exposure to large numbers of infections because of early-onset disease and delayed diagnosis was associated with an increased risk of bronchiectasis. Earlier diagnosis and treatment of CVID may reduce the risk of bronchiectasis and premature death in some patients.