Age-adjusted Prevalence Rates Research Articles

A61 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE ACROSS CANADA

Abstract Background Canada has the highest global age-adjusted incidence and prevalence rates of Inflammatory Bowel Disease (IBD). Resulting from compounding prevalence and limited resources, timely access to specialty care is a challenge faced by patients and healthcare providers. Despite this issue, there has been no published research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. Aims To elicit a qualitative data stream to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. To ensure geographic diversity and representation, patients were recruited from urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, and British Columbia. All focus groups were audio recorded, transcribed, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of IBD specialty care access experiences. Results A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Conclusions The complexity of specialty care access for IBD patients in Canada cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in Canada can be better understood and improved on both a provincial and national scale. Funding Agencies CIHRNova Scotia Health Authority Research Fund

The contribution of obesity to the population burden of high metabolic cardiovascular risk among different ethnic groups. The HELIUS study.

The burden of cardiovascular risk is distributed unequally between ethnic groups. It is uncertain to what extent this is attributable to ethnic differences in general and abdominal obesity. Therefore, we studied the contribution of general and abdominal obesity to metabolic cardiovascular risk among different ethnic groups. We used data of 21 411 participants of Dutch, South-Asian Surinamese, African-Surinamese, Ghanaian, Turkish or Moroccan origin in Healthy Life in an Urban Setting (Amsterdam, the Netherlands). Obesity was defined using body-mass-index (general) or waist-to-height-ratio (abdominal). High metabolic risk was defined as having at least two of the following: triglycerides ≥1.7 mmol/l, fasting glucose ≥5.6 mmol/l, blood pressure ≥130 mmHg systolic and/or ≥85 mmHg diastolic and high-density lipoprotein cholesterol <1.03 mmol/l (men) or <1.29 mmol/l (women). Among ethnic minority men, age-adjusted prevalence rates of high metabolic risk ranged from 32 to 59% vs. 33% among Dutch men. Contributions of general obesity to high metabolic risk ranged from 7.1 to 17.8%, vs. 10.1% among Dutch men, whereas contributions of abdominal obesity ranged from 52.1 to 92.3%, vs. 53.9% among Dutch men. Among ethnic minority women, age-adjusted prevalence rates of high metabolic risk ranged from 24 to 35% vs. 12% among Dutch women. Contributions of general obesity ranged from 14.6 to 41.8%, vs. 20% among Dutch women, whereas contributions of abdominal obesity ranged from 68.0 to 92.8%, vs. 72.1% among Dutch women. Obesity, especially abdominal obesity, contributes significantly to the prevalence of high metabolic cardiovascular risk. Results suggest that this contribution varies substantially between ethnic groups, which helps explain ethnic differences in cardiovascular risk.

P043 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE ACROSS CANADA

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence rates, the IBD clinical burden continues to grow. With high demand and limited resources, timely access to specialty healthcare services continues to be a difficulty faced by both patients and healthcare providers. Despite this pervasive issue, there has been no published research to date elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. Aims The aim of the study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for individuals living with IBD from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s &amp; Colitis Canada. To ensure geographic diversity and representation, patients were recruited from both urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member who was involved in their care to the focus groups. Co-facilitated by a researcher and a patient research partner, the focus groups were held in seven provinces across Canada. All focus groups were audio recorded, transcribed verbatim, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences in relation to IBD care access. Results A total of 63 participants were recruited in fourteen focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Preliminary analyses illustrated three patient-identified access barrier themes: 1) Lack of multidisciplinary care (psycho-social and nutrition support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. In response, four solutions were proposed: 1) Integration of holistic care into the clinical practice, 2) Readily accessible psycho-social and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Conclusions The complexity of specialty care access for IBD patients cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in can be better understood and improved on both a provincial and national scale.

P757 Focusing on the future: Reducing barriers and improving access to inflammatory bowel disease specialty care across Canada

Abstract Background Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disease which affects nearly two million North Americans, with Canada demonstrating the highest age-adjusted incidence and prevalence rates globally. Resulting from compounding prevalence and limited resources, timely access to IBD care continues to be a widespread issue for patients and healthcare providers. Despite this pervasive issue, there has been no published research to date elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across Canada. The aim of the study was to elicit a qualitative stream of data to better understand phenomena related to access to IBD care from a patient-centered perspective. Methods Patients diagnosed with IBD (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s &amp; Colitis Canada. To ensure geographic diversity and representation, patients were recruited from both urban and rural regions. In order to acquire multiple access perspectives, patients were invited to bring a family member involved in their care to the focus groups. Co-facilitated by a researcher and patient-research partner, all focus groups were audio recorded, transcribed verbatim, and coded for themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences in relation to IBD care access. Results Sixty-three participants were recruited in 14 focus groups across seven provinces. The majority of participants were female (41/63, 65%) and from urban/suburban regions (34/63, 54%). The mean age of participants was 48 years (SD=16 years, range=16 to 77 years). Thematic analyses identified four main barrier themes, each with multiple sub-themes: (1) structure/system issues (i.e. system stagnation), (2) processes (i.e. information management), (3) experiences (i.e. psychosocial support), and (4) patient as partner (i.e. autonomy, power dynamics). In response, four solution themes were proposed: (1) integration of holistic care into the clinical practice, (2) readily accessible psychosocial and nutritional support, (3) increased patient advocacy, and (4) continuity and liaison through provision of a healthcare navigator resource. Conclusion The complexity of IBD specialty care access cannot be underestimated. It is vital to possess a robust understanding of healthcare system structures, processes, and the significant impact these factors have on patients and the care received. Through the use of patient-centered exploration of barriers and facilitators, access to IBD specialty care in can be better understood and improved on both a national and international scale.

Drug Utilization Pattern of Antibiotics: The Role of Age, Sex and Municipalities in Determining Variation.

PurposeThe purpose was to analyze drug prescription and antibiotic use by age and sex in Italy’s Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level.MethodsThis was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient’s municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test.ResultsThere were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged <5 years and in the older adults aged >70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P<0.01), adults and the older adults (rs=0.79; P<0.01), and children and the older adults (rs=0.46; P<0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults.ConclusionA considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended.

Meibomian Gland Dysfunction in a Hospital-Based Population in Central India.

To estimate the prevalence of meibomian gland dysfunction (MGD) in a hospital-based population in India. This cross-sectional study screened 3410 subjects ≥20 years or older attending the outpatient department by systematic random sampling. The patients were subjected to a comprehensive eye examination, Ocular Surface Disease Index questionnaire, fluorescein tear film breakup time, Schirmer I test, lissamine green stain, lid margin changes, and meibomian gland expression. MGD was diagnosed when 1 or both of the following was present in at least 1 eye: reduced or absent meibum secretion and cloudy to inspissated toothpaste-like secretion on digital pressure over the eyelids. The study included 570 subjects with a mean age of 49.3 ± 16.2 (20-84) years. MGD was diagnosed in 317 (55.61%) subjects, of whom 272 (47.7%) had only MGD and 45 (7.9%) had coexisting MGD and aqueous tear deficiency. The age-adjusted prevalence rate of MGD was 48.4% (95% confidence interval: 43.9-52.1). This rate increased significantly with age (P < 0.001) in both men (P < 0.001) and women (P < 0.001). The crude and age-adjusted prevalence of symptomatic MGD (Ocular Surface Disease Index score ≥13) was 26.1% (71/272) and 32.9% (95% confidence interval: 27.4-38.6), respectively. The prevalence of symptomatic MGD significantly declined with increasing age (P = 0.003), and this was reflected in both men (P = 0.013) and women (P = 0.179) but was not statistically significant in the latter. The prevalence of MGD was higher in Indian subjects than that previously reported. Although the total MGD prevalence increased with age, the prevalence of symptomatic MGD decreased. Asymptomatic MGD was more common than symptomatic MGD.

Epidemiology and Real-World Treatment of Chronic Graft-Versus-Host Disease Post Allogeneic Hematopoietic Cell Transplantation: A US Claims Analysis

Background Chronic Graft-Versus-Host Disease (cGVHD) is a complication of hematopoietic cell transplantation (HCT). While the clinical outcomes of cGVHD are well documented, few studies have assessed its treatment practices in the real-world. The objectives of this study are to quantify the prevalence of cGVHD, to examine provider prescribing patterns, and to evaluate the healthcare cost and resource utilization (HCRU) in a real-world US cGVHD population. Methods This study analyzed de-identified claims from the Medicare FFS 5% sample for beneficiaries enrolled from 2013-2016 and Pharmetrics commercial 2013-2018 databases to identify cGVHD in allogenic HCT patients. cGVHD was identified based on ICD-9/10 diagnosis codes for cGVHD or unspecified GVHD with a first diagnosis &gt;180 days post HCT, or subsequent unspecified GVHD diagnosis &gt;12 months post index diagnosis. Chronic GVHD prevalence was estimated by calculating age-adjusted prevalence rates within the Medicare and Pharmetrics sample populations and applying rates to the total US patient subpopulations as determined by CMS and Census data. Prevalence estimates were based on the last complete year of both Medicare FFS and Pharmetrics data (2016). Longitudinal and Line of Therapy (LOT) analyses were based on data from 2013-2018. A new LOT was defined as starting with the addition of systemic therapy to a patient's cGVHD regimen, regardless of prior lines of therapy or prior treatment. Treatments that stopped and restarted within 60 days were considered continuous treatment. Healthcare costs were calculated by adding the inpatient, outpatient, and pharmacy insurer and beneficiary paid amounts for the commercially insured population. Total HCRU was assessed using the number of inpatient and outpatient visits following the initial cGVHD diagnosis. Results In 2016, the projected prevalence of cGVHD in the US based on the Medicare FFS and Pharmetrics commercial databases was 14,017 individual patients. Within 3 years post allogeneic HCT, 42% of patients developed cGVHD; 66% of cGVHD patients had a prior diagnosis of acute GVHD. The majority of cGVHD patients received at least one systemic therapy; 71% and 47% of cGVHD patients progressed to a second and third LOT, respectively (Table 1). Of patients that received a second and third LOT, the average time from diagnosis to the second and third LOT was approximately 7 months and 10 months, respectively. Over 80% of cGVHD patients received systemic corticosteroid therapy for the treatment of cGVHD within 12 months post diagnosis, and 41% of cGVHD patients were receiving a corticosteroid within the 30 days prior to diagnosis. Within the 12 months post cGVHD diagnosis, most patients received a corticosteroid or a corticosteroid combination as a first LOT (57%), which decreased slightly as patients progressed to second and third line of therapy (49% and 48%, respectively). A total of 25 unique therapeutic agents and over 150 combinations were used in second and third LOT. While newer agents, such as ibrutinib and ruxolitinib, are continuing to increase in utilization among cGVHD patients, these therapies are only used among 1% (ibrutinib) and 1-3% (ruxolitinib) of patients through their first three lines of therapy in the patients captured in Pharmetrics commercial database through June 2018. In the 12 months post diagnosis, cGVHD patients had an average of 21.0 GVHD-related inpatient and outpatient visits (2.8 inpatient and 18.2 outpatient visits). In 2016 the average total annual cost per commercially insured cGVHD patient was $291,357. Conclusion A significant proportion of allogenic HCT patients continue to develop cGVHD, and despite advances in the understanding of cGVHD, corticosteroids remain the mainstay of therapy. However, most cGVHD patients are not adequately managed with first line corticosteroids, and many patients are cycling through several therapies, likely in part due to lack of efficacy and toxicity associated with currently available treatments. Real-world utilization of systemic therapies is highly variable, particularly for patients who progress beyond the first LOT, which highlights the need for evidence-based treatment approaches. cGVHD is a highly burdensome complication of allogenic HCT, and safer, more effective treatments are needed as many patients are not currently well managed on available therapies. Disclosures Bachier: Viracyte: Consultancy; Kadmon Corporation, LLC: Consultancy; Sanofi: Speakers Bureau. Aggarwal:Kadmon Corporation, LLC: Employment, Equity Ownership. Hennegan:Kadmon Corporation, LLC: Consultancy. Milgroom:Kadmon Corporation, LLC: Consultancy. Francis:Kadmon Corporation, LLC: Consultancy. Rotta:Jazz: Speakers Bureau; Kadmon Corporation, LLC: Consultancy.

P3772Risk factors for future development of atrial fibrillation are not evident among apparently healthy individuals with paroxysmal atrial fibrillation

Abstract Background Atrial fibrillation (AF) is one of the important factors of cardiovascular morbidity and mortality and to find not only patients with persistent AF but also individuals with paroxysmal AF among apparently healthy people is a crucial strategy for decreasing number of patients with serious cardio-embolic stroke. However, screening ability using previously known risk factors for future development of AF has not been examined in individuals with paroxysmal AF. Methods A total of 59730 male individuals, aged 40 years or older who underwent multiple comprehensive physical check-ups including 12 lead electrocardiogram (ECG) from 2012 to 2015 were enrolled. Persistent AF was defined a case that consecutively manifested AF till the last checkup. Paroxysmal AF was defined as a case who transiently manifested AF in each of the checkup and subsequently manifested sinus rhythm at the last checkup. Non-AF was defined as a case that never manifested AF in any of checkup. Age-adjusted prevalence rates and their 95% confidence intervals of known-risk factors in the first survey were estimated by logistic regression analysis separately by the three groups (non-AF (n=58602), paroxysmal AF (n=392) and persistent AF (736)). Results Age-adjusted prevalence rates (95% confidence interval) of risks factors for AF are shown in the table. Already known risk factors were evidently manifested in persistent AF group, however, prevalence rates of these factors in paroxysmal AF group were not different from the rates in non-AF group. Conclusion The repeated measurements of ECG study indicated that individuals who would develop paroxysmal AF in the near future did not have typical risk factors for AF and a screening test using risk factors for AF have no chance to find a high-risk individual for paroxysmal AF.

Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

AimHyperglycaemia in pregnancy (HIP) is one of the most common complications of pregnancy. This study aims to examine the projected HIP prevalence in 2030 and 2045 using multiple methods. MethodsThe International Diabetes Federation Diabetes Atlas 2019 prevalence was projected to 2030 and 2045 by: (1) carrying forward the 2019 age-adjusted prevalence rates; (2) applying a linear regression of the past four editions of the IDF Diabetes Atlas; (3) applying a regression of the previous editions with the most consistent trend, followed by extrapolation from the 9th edition HIP estimate. ResultsRespectively, for 2030 and 2045, Method 1 projected a declining HIP rate with prevalences of 14.0% and 13.3%, Method 2 projected an increasing HIP prevalence at 16.5% and 18.3%, Method 3 predicted stabilisation of the rate from 16.0% to 15.8%. ConclusionAssuming other factors remain unchanged, our best estimation of age-adjusted HIP will show stabilisation between 2019 and 2045 of 15.8% to 16.0%. However, this estimate is confounded by the heterogeneity of studies and the influence of different gestational diabetes mellitus diagnostic criteria. To provide accurate future comparisons we recommend standardising the diagnostic criteria to the International Association of Diabetes in Pregnancy Study Groups.

Abstract P167: Trends in Hypertension Prevalence, Awareness, and Control Based on the New Definition of Hypertension; A National Health and Nutrition Examination Survey-Based Study

Introduction: Hypertension is a significant risk factor for cardiovascular morbidity and mortality. According to the recent guideline, the criteria for diagnosing hypertension is now 130/80mmhg. This study seeks to gain a better understanding of the prevalence of hypertension, its awareness, and control in the United States population over the last 10 years using the new criteria for hypertension. Methods: NHANES is a stratified multistage probability sampling of the civilian noninstitutionalized population of the United States. We used the last five cycles available (2007-2016) to conduct a prevalence study applying statistical methods to account for the survey technique and non-response. Result: The mean age was 47.33 years (95%CI, 46.82-29.09), females constituted 51.9% of the population(n=28147), non-Hispanic white 66.63%, non-Hispanic black, 11.40%, Mexican American 8.55%. About 39% of the population studied were obese (BMI greater than or equal to 30). The crude ten years prevalence of hypertension was 38.85%, there was an increasing trend from 37.58% in the 2007-2008 cycle to 41.12% in the 2015-2016 cycle; this increase is statistically significant&lt;0.001. In subgroup analysis, 40.12% of non-Hispanic whites were hypertensive compared 48.61% of the black population and 28.65% of Mexican Americans. The age-adjusted prevalence rate of hypertension using the new guideline is 37%, ranging from 12.68% in age 20-39 years to 73.81% in people above 60 years. Non-Hispanic white had an adjusted 10 years prevalence of 35.66%, a minimal trend of 36.02 to 37.14% from 2005-2006 cycle to 2015-2016 cycle while Non-Hispanic black had a trend from 46.88-51.34%,p&lt;0.0001. Awareness of being hypertensive went down from 64.02% in 2005-2006 cycle to 59.90% in the 2015-2016 cycle and control went down from 64.01% to 59.91%. Conclusion: We were able to demonstrate the significant increase in hypertension prevalence with an increasing trend based on the new guidelines. Also, there is a downward trend in awareness and control; we have demonstrated again, the significant racial disparities in hypertension with about half of the black population being hypertensive. Our study showed that there is a need to intensify effort to combat this epidemic.

Cardiovascular Disease and hospital admissions in African immigrants and former Soviet Union immigrants: A retrospective cohort study

BackgroundPrevious studies reported low prevalence of cardiovascular disease (CVD) despite an increasing prevalence of metabolic abnormalities in immigrants who moved from low CVD-risk regions to Western countries. Nevertheless, little is known about hospital admissions due to CVD in immigrants. MethodsA retrospective cohort study of East Africa immigrants (EAI), Former Soviet Union immigrants (FSUI) and native-born Israelis (NBI) over 11-year period. Associations between ethnicity, age, sex, CVD, and hospital admission were assessed using logistic and Poisson regression models. Incidence density rates per person-years were calculated. ResultsThe age-adjusted prevalence rates of ischemic heart disease in EAI, FSUI and NBI, respectively, were 1.8%, 8.2%, and 5.8%, respectively (p < 0.001). The corresponding rates for stroke were 2.6%, 3.5%, and 2.5%, respectively. Multivariate odds ratios for all CVD were found to be significantly lower in EAI for both sexes. Hospitalizations rate due to CVD were 9, 17, and 6 per 1000 person-years in EAI, FSUI and NBI, respectively (p < 0.001). EAI were more likely to be hospitalized due to hypertensive disease, cerebral vascular diseases and heart disease, in comparison to NBI and FSUI. However, when controlling for CVD risk factors profile, EAI had similar admission rates to NBI. EAI were more likely to be hospitalized in internal medicine, geriatrics, and neurology departments, and less likely to be admitted to intensive care units or surgical department. ConclusionsEAI had low rates of all types of CVD, and low risk of hospitalization after controlling for CVD risk factors profile.

Prevalence of Stroke in Fayoum Governorate, Egypt: A Community-Based Study

Background: Stroke is a highly prevalent disease with consequent mortality and morbidity. Few community based studies have been conducted only in upper Egypt to estimate prevalence of stroke. Objectives: This study was designed to find out the prevalence of stroke in Fayoum Governorate & to study some associated risk factors. Methods: through this community based cross-sectional study 4784 participants aged more than or equal to 18 years old were enrolled. A multi-stage random sample technique was followed to choose the study sample. A predesigned interviewer-administered structured questionnaire was used. Suspected stroke case by screening questionnaire was referred to the neurologist. Results: The Crude prevalence of stroke was 16 out of 1000 with confidence interval of proportion (12.6%-19.7%). The age adjusted local (Fayoum 2017 census) prevalence rate was 7.97 out of 1000, age adjusted prevalence rate (Egypt population 2017) was 1.05 out of 1000. Age-adjusted World Health Organization standard world population prevalence rate was 1.69 out of 1000. The crude prevalence of ischemic stroke was significantly higher than hemorrhagic stroke 11.9 versus 3.9 out of 1000 population. The most prevalent risk factor was smoking among males, followed by obesity then hypertension. The prevalence of stroke was significantly higher among participants affected with hypertension, diabetes, heart diseases, obesity, and smoking. Logistic regression analysis showed that having hypertension, diabetes, heart diseases, atrial fibrillation, obesity, and smoking were reported risk factors of stroke. Conclusions: The prevalence of stroke in Fayoum governorate was 1.6%. Hypertension, diabetes, heart diseases, obesity, and smoking were reported risk factors of stroke.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study

IntroductionFew studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. MethodsCross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. ResultsThe prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD.The crude prevalence of ED was 17.2% (95% confidence interval: 15.8•18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40•69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. ConclusionsSIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD.The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases. SIMETAP-ED study

IntroductionFew studies conducted in primary care setting report about age-adjusted prevalence rates of erectile dysfunction (ED). Aims of SIMETAP-ED study were to determine crude and age-adjusted prevalence rates of ED diagnosis, to compare these rates with other similar studies, and to compare prevalence rates of cardiovascular risk factors (CVRF), cardiovascular diseases (CVD), metabolic diseases and chronic kidney disease (CKD) between populations with and without ED. MethodsCross-sectional observational study conducted in primary care setting. Population-based random sample: 2934 adult men. Response rate: 66%. A clinical interview was conducted to diagnose ED using a question derived from ED definition. The medical records of patients were reviewed to identify their CVRF and diseases associated with ED. The age-adjustments were standardized to Spanish population. ResultsThe prevalence rates of metabolic diseases, CVD, CVRF, and CKD in population with ED were higher than population without ED, highlighting the CVD.The crude prevalence of ED was 17.2% (95% confidence interval: 15.8–18.6). The age-adjusted prevalence rates of ED were 0.71% in men under 40 years, 12.4% in men over 18 years, 10.8% in men aged 40–69 years, 18.9% in men over 40 years, and 48.6% in men over 70 years. ConclusionsSIMETAP-ED study showed association of ED with metabolic diseases, CKD, CVRF, and highlighting CVD.The age-adjusted prevalence of ED was 12.4% in adult men, 19% in men over 40 years, and almost 50% in men over 70 years.

Incidence and prevalence of Parkinson's disease in the Italian region of Umbria: a population-based study using healthcare administrative databases.

Parkinson's disease is known to pose a significant burden on society in industrialized countries. However, few studies have been conducted in Italy using administrative healthcare databases for epidemiological purposes. We wanted to estimate the incidence and prevalence rates of Parkinson's disease in the Italian region of Umbria by means of linkage between several sources of administrative healthcare data: hospitalization episodes, exemptions from medical charges, drug prescriptions from general practitioners and physicians working in the public sector. Using a pre-defined algorithm, we estimated incident and prevalent cases of Parkinson's disease for the year 2016. The regional incidence rate, adjusted with Italian standard population data, was 0.40 new cases/1000 person-years (0.41 in females, 0.39 in males). We estimated that 5550 subjects were affected by Parkinson's disease, leading to an age-adjusted prevalence rate of 5.42/1000 inhabitants. Prevalence and incidence increased with age and male gender. However, due to the longer life expectancy of females, the absolute number of prevalent cases was greater among females. The heterogeneity of spatial distribution of disease was high. A considerable proportion of prevalent cases was hospitalized in 2016. The most recurrent reasons for hospitalization episodes were disorders related to the nervous system, respiratory system, cardiovascular system, and musculoskeletal and connective tissue apparatus. The study findings support the feasibility of future epidemiological studies of Parkinson's disease with administrative data as well as the need for an integrative care pathway for the patients with Parkinson's disease.

Reporting heterogeneity in the measurement of hypertension and diabetes in India

Public health research in India frequently depends on self-reported data, which is usually a compromised method. Policies and programs based upon such data may not be efficient enough to estimate the actual burden of the diseases. Previous studies have looked at the issues of discrepancies between self-reported and measured estimates. However, the majority of them have failed to examine the reasons for such disparities. This pivotal research gap is decoded in this study, which explores the determinants of heterogeneity between self-reported and clinically-diagnosed hypertension and diabetes. The study utilizes the data from the fourth round of the District Level Household and Facility Survey, 2012–13, and has considered 860,501 nationally representative samples of respondents aged 18 years and above from 18 demographically developed states of India. Age-adjusted prevalence rates of hypertension/diabetes and a multinomial logistic regression model are utilized to draw inferences from the data. The findings bring out heterogeneity by comparing respondents’ Clinical, Anthropometric, and Biochemical (CAB) test results with their self-reported data. Heterogeneity included respondents who self-reported themselves as not suffering from hypertension/diabetes while their CAB test indicated otherwise, and those who had self-reported being hypertensive/ diabetic even though their CAB test data information proved otherwise. Additionally, respondent’s age, sex, wealth, and occupation are the major determinants of heterogeneous reporting. The study suggests that the estimates obtained by self-reporting underrate the actual scenario. Thus, large-scale surveys should focus on collecting data using clinical diagnostic tools to access the actual burden of disease in the community.

06 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE

Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated disease that affects approximately two million North Americans. Canada has the highest age-adjusted incidence and prevalence rates of IBD globally. Given its cumulative prevalence, the IBD clinical burden in North America continues to grow. Limitations in accessing specialty healthcare services is not a new issue facing patients and healthcare providers. Despite this persistent problem, no research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across diverse geographic regions has been conducted. The aim of the current study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. IBD patients (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. Patients were recruited from both urban and rural locales to ensure adequate representation from geographically diverse regions. Focus groups provided a powerful and more naturalistic tool through which a focused understanding of the patient experience was derived. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Patient demographics were collected to contextualize observed themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences. Eastern Canadian focus groups have been completed, with recruitment underway for the Western Canadian focus groups. A total of 20 participants were recruited as of October 2018. The majority of participants were male (11/20, 55%) and were from urban/suburban regions (10/20, 50%). The mean age of participants was 44 years of age (SD=12 years, range=24 to 67 years). Preliminary analyses show that the main patient-identified barriers to accessing IBD care fall into the following categories: 1) Lack of multidisciplinary care (including psycho-social support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. Solutions identified by patients included: 1) Integration of more holistic care into the clinical practice, 2) Readily accessible psychiatric and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Healthcare access for IBD patients is complex. It is important to not only have a robust understanding of the healthcare system structure and processes but also the significant impact these factors have on patients. Access improvement research can be best tackled through patient-centered exploration of themes related to access to care.

06 FOCUSING ON THE FUTURE: REDUCING BARRIERS AND IMPROVING ACCESS TO IBD SPECIALTY CARE

Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated disease that affects approximately two million North Americans. Canada has the highest age-adjusted incidence and prevalence rates of IBD globally. Given its cumulative prevalence, the IBD clinical burden in North America continues to grow. Limitations in accessing specialty healthcare services is not a new issue facing patients and healthcare providers. Despite this persistent problem, no research elucidating the patient perspective using qualitative approaches to compare and contrast the patient experience across diverse geographic regions has been conducted. The aim of the current study was to elicit a qualitative stream of data to better understand phenomena related to access to healthcare for Canadians living with IBD from a patient-centered perspective. IBD patients (≥18 years of age) were recruited from gastroenterology clinics and communities through IBD specialists and Crohn’s & Colitis Canada. Patients were recruited from both urban and rural locales to ensure adequate representation from geographically diverse regions. Focus groups provided a powerful and more naturalistic tool through which a focused understanding of the patient experience was derived. Co-facilitated by a researcher and a patient research partner, the focus groups were held in Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Patient demographics were collected to contextualize observed themes. Themes were distilled through qualitative thematic analysis using Atlas.ti software to ascertain congruence or discordance of patient experiences. Eastern Canadian focus groups have been completed, with recruitment underway for the Western Canadian focus groups. A total of 20 participants were recruited as of October 2018. The majority of participants were male (11/20, 55%) and were from urban/suburban regions (10/20, 50%). The mean age of participants was 44 years of age (SD=12 years, range=24 to 67 years). Preliminary analyses show that the main patient-identified barriers to accessing IBD care fall into the following categories: 1) Lack of multidisciplinary care (including psycho-social support), 2) Diagnostic delay, and 3) Inability to effectively receive and provide communication with healthcare providers. Solutions identified by patients included: 1) Integration of more holistic care into the clinical practice, 2) Readily accessible psychiatric and nutritional support, 3) Increased patient advocacy, and 4) Continuity and liaison through provision of a healthcare navigator resource. Healthcare access for IBD patients is complex. It is important to not only have a robust understanding of the healthcare system structure and processes but also the significant impact these factors have on patients. Access improvement research can be best tackled through patient-centered exploration of themes related to access to care.

Prevalence and risk factors of refractive error: a cross-sectional Study in Han and Yi adults in Yunnan, China

BackgroundFew studies have investigated the prevalence of refractive error (RE) in older adults in China, and most have focused on East China. Our study determined the prevalence and risk factors of RE in Han and Yi adults aged 40–80 years in rural and urban areas in Yunnan Province, Southwest China.MethodsOur cross-sectional study is part of the China National Health Survey (CNHS). The age-adjusted prevalence rates of RE in Han and Yi adults aged 40–80 years in Yunnan were compared. We used a multivariate logistic regression model to identify risk factors for myopia and hyperopia.ResultsAmong 1626 participants, the age-adjusted prevalence rates of myopia, hyperopia, high myopia and astigmatism were 26.35% (95%CI 24.01–28.70%), 19.89% (95%CI 18.16–21.61%), 2.64% (95%CI 1.75–3.53%), and 56.82% (95%CI 54.31–59.34%). Compared to the Yi population, the Han population had higher prevalence of myopia (31.50% vs 16.80%, p < 0.0001), high myopia (3.34% vs 1.31%, p = 0.049) and astigmatism (60.07% vs 50.67%, p = 0.026) but lower prevalence of hyperopia (16.58% vs 27.37%, p < 0.0001). In the multivariate logistic regression, individuals aged 45–49 (p < 0.001), 50–54 (p < 0.001), 55–59 (p = 0.014), and 60–64 years (p = 0.005) had a lower myopia risk than those aged 40–44 years, and individuals aged 50–54 (p = 0.002), 55–59, 60–64 and 65 years and older (all p < 0.001) had a higher hyperopia risk than those aged 40–44 years. Myopia was also associated with height (p = 0.035), time spent in rural areas (p = 0.014), undergraduate/graduate education level (p = 0.001, compared with primary school or lower education level) and diabetes (p = 0.008). The Yi population had a higher risk of hyperopia than the Han population (p = 0.025). Moreover, hyperopia was related to time spent in rural areas (p < 0.001) and pterygium (p = 0.019).ConclusionsOur study investigated the overall prevalence of RE in older adults in rural and urban areas of Southwest China. Compared to the Yi population, the Han population had a higher prevalence of myopia, high myopia and astigmatism but a lower risk of hyperopia. The prevalence of myopia in the Han population in underdeveloped Southwest China was similar to that of residents in East China or of Chinese Singaporeans under urban or rural settings.

Trends in Polypharmacy in Japan: A Nationwide Retrospective Study.

To describe and examine trends in polypharmacy according to age in Japan from 2010 to 2016. Retrospective observational study. Outpatient settings. Japanese individuals aged 20 and older. We analyzed pharmacy claims data that the Japanese Ministry of Health, Labor, and Welfare provided in the Survey of Medical Care Activities in Public Health Insurance from 2010 to 2016. The use of 5 or more oral prescription medications per month was defined as polypharmacy and of 10 or more as excessive polypharmacy. Regression analysis was used to estimate trends in polypharmacy with annual percentage changes. Using number of medications (polypharmacy vs excessive polypharmacy), trends in polypharmacy and crude and age-adjusted rates of polypharmacy per 1,000 persons were calculated according to year and age group (20-34, 35-49, 50-64, 65-79, ≥ 80). We analyzed 240 million pharmacy claims data. The age-adjusted monthly prevalence rate of polypharmacy increased from 85.2 to 93.8 per 1,000 persons per month and of excessive polypharmacy from 13.6 to 14.0 per 1,000 persons per month from 2010 to 2016 in the entire study population. The highest rate of polypharmacy (per 1,000 persons) was observed in 2016 in those aged 80 and older (326.8), followed by those aged 65 to 79 (167.3). The polypharmacy rate increased by 6.3% (95% confidence interval (CI)=4.0-8.7) per year from 2010 to 2012, then decreased by 0.7% (95% CI=-1.3-0.0) per year from 2012 to 2016. The rate of excessive polypharmacy increased by 4.5% (95% CI=1.1-8.0) per year from 2010 to 2013 and then decreased by 3.7% (95% CI=-6.7 to -0.6) per year from 2013 to 2016. The overall trend of polypharmacy in Japan increased during the study period, although the increase ceased in 2013 and then declined from 2013 to 2016. Policy changes in Japan might be responsible for some of the changes. J Am Geriatr Soc 66:2267-2273, 2018.