Age Group Cohort Research Articles

Application of the age-period-cohort model in tuberculosis

Up to now, tuberculosis (TB) remains a global public health problem, posing a serious threat to human health. Traditional methods for analyzing time-varying trends, such as age and period, tend to ignore the poor impact of birth cohorts, which is an important factor in the development of TB. The age-period-cohort (APC) model, a statistical method widely used in recent decades in economics, sociology, and epidemiology, can quantitatively estimate the efficacy of different age, period, and birth cohort groups for TB by separating the effects of these three dimensions and controlling for confounding factors among the time variables. The purpose of this paper is to briefly review the model, focus on the application of the existing APC model in the field of TB, and explain its advantages and disadvantages. This study will help to provides a theoretical basis and reference for using the APC model in TB analysis and prediction.

Projected increases in the prevalence of diabetes mellitus in Aotearoa New Zealand, 2020-2044.

The prevalence of diabetes has been increasing in Aotearoa New Zealand by approximately 7% per year, and is three times higher among Māori and Pacific peoples than in Europeans. The depth of the diabetes epidemic, and the expansive breadth of services required for its management, elevate the need for high-quality evidence on the projected future burden of this complex disease. In this manuscript we have projected the prevalence of diabetes (type 1 and type 2 combined) out to 2040-2044 using age-period-cohort modelling. National-level data from central government on diabetes prevalence (Virtual Diabetes Register) were used to describe recent diabetes prevalence trends (2006-2019) by age group, calendar period and birth cohort, with these trends used to project diabetes prevalence out from 2020 to 2044. Aotearoa New Zealand will experience a significant increase in the absolute volume of prevalent diabetes, rising by nearly 90% to more than 500,000 by 2044. The age-standardised prevalence of diabetes will increase from around 3.9% of the population (268,248) to 5.0% overall (502,358). The prevalence and volume of diabetes diagnoses will increase most drastically for Pacific peoples, most notably Pacific females for whom diabetes prevalence is projected to increase to 17% of the population by 2044. The increases in the future burden of diabetes mellitus projected here will heighten pressure on health services. Immediate action is required to reduce new cases of diabetes and other obesity-related illnesses. Fiscal policies to prevent these diseases, coupled with population-level interventions to more effectively manage and control diabetes, are effective tools for reducing disease burden.

Management and Outcomes of Pulmonary Embolism in Women of Reproductive Age Admitted to Urban Versus Rural Areas Compared to Men.

There are limited and conflicting data on sex and urban-rural disparities in outcomes of patients with pulmonary embolism (PE) in the reproductive age group. Our object was to assess sex disparities in the reproductive age group cohort. All adult non-elective admissions in the reproductive age group (18-49 years) with a primary diagnosis of PE and with no missing sex/age data were identified using the National Inpatient Sample. Females and males were stratified into rural and urban location based on hospital information. Outcomes of interest included in-hospital mortality, complication rates, variations in management, total hospitalization costs, and length of stay. During 01/01/2016 to 12/31/2020, 180,898 PE admissions aged 18-49 years were identified (rural-12,319 [6.8%]). Females comprised 54.8% and 55.1% of the rural and urban cohorts, respectively. Overall, compared to males, females in urban and rural regions had largely comparable rates of definitive PE interventions, except lower rates of catheter directed therapy (4.7 vs. 3.6%, p < 0.001) in females admitted to urban hospitals. Despite younger age, higher comorbidity, and lower utilization of PE interventions, females in both regions had similar unadjusted in-hospital mortality (rural 1.1% vs. 1.0%; p = 0.93 and urban 1.8% vs. 1.7%; p = 0.78) and hospitalization costs compared to males. In conclusion, females of reproductive age group had comparable in-hospital outcomes to males in both urban and rural areas. Females in urban areas had lower utilization of advanced PE interventions, potentially indicating selective management strategies in different settings.

A-021 Evaluation of a Novel N Terminal Pro B Type Natriuretic Peptide Assay as an aid in the Diagnosis of Acute Heart Failure in the Emergency Department

Abstract Background The signs and symptoms of acute heart failure (AHF) may overlap with other conditions and lead to diagnostic difficulty in the undifferentiated patient with dyspnea. The particularly high negative predictive value (NPV) of natriuretic peptides (NPs) in excluding AHF have rendered these assays especially useful in evaluating dyspnea in acute care setting. This study was conducted to assess the diagnostic performance of a novel N-terminal pro-B type natriuretic peptide (NT-proBNP) assay in the intended use patient population in the emergency department (ED). Methods A multicenter study was conducted in the U.S. on individuals presenting to the ED with dyspnea and a suspicion of AHF. Blood specimens were collected and tested using the Beckman Coulter Access NT-proBNP assay on the DxI 9000 Immunoassay Analyzer. Test results were compared to an adjudicated diagnosis clinical endpoint performed by an independent Clinical Events Committee blinded to the Access NT-proBNP result. Performance included NPV and sensitivity of an age-independent cut point of &amp;lt;300 ng/L to exclude AHF, and the positive predictive value (PPV) of the age-dependent cut points of &amp;gt;450, &amp;gt;900, and &amp;gt;1800 ng/L for ages &amp;lt;50 years, 50-75 years, and &amp;gt;75 years, respectively, for the diagnosis of AHF. The sample size required to achieve a 95% two tailed confidence interval (CI) was 150 subjects per age group to provide clinical performance at 90% (±10%) sensitivity. Sample size was based upon CLSI EP24-A2, Assessment of the Diagnostic Accuracy of Laboratory Tests Using Receiver Operating Characteristic Curves. Sensitivity and specificity were calculated at a series of cutoff points and plotted in separate receiver operation curves (ROC) for an overall age-independent rule-out analysis and for individual age-dependent groups separately. Area under the receiver operator characteristic curve (AUROC) was reported with 95% 2-sided CI. NPV and PPV with respective 95% 2-sided score CI was computed for the overall age-independent cut point and for each age group cohort. Results Of 490 enrolled patients, 41% were adjudicated with AHF with a median (Q1, Q3) age of 60 (47-76) years, and distributions of 46.1% female, 60.8% White and 38.2% Black. The assay had an AUROC for AHF of 0.88 (P&amp;lt;0.001), comparable to other commercially available NT-proBNP assays. The rule-out cut point of &amp;lt;300 ng/L had 96% sensitivity and NPV of 95%. Age-dependent cut points had sensitivity of 84%, 90%, and 87%, specificity of 81%, 70% and 61%, and PPV of 72%, 62%, and 74%, respectively. Conclusions The Access NT-proBNP assay demonstrated high clinical performance in the diagnosis and exclusion of acute HF in the undifferentiated dyspneic patient population and performed similarly well to validated assays used in current clinical practice. Given the continued increase in importance and reach of natriuretic peptide testing, these results are useful to extend availability of this assay to a larger audience.

The Effect of Values and Parents’ Relationship With Children on Children’s Academic Achievements in School: The Intra-Cohort Comparison Among 18-52-Year-Old Lithuanians

The study aims to reveal links on how academic achievements are dependent on children’s values and their relationship with parents in Lithuania from a study of 18–52-year-old Lithuanians. Three age cohort groups were distinguished, and each cohort represents different historical and socialization (pre)conditions and experiences of the education system and society context. A general assumption was tested that each generation had different (material vs. post-material) value orientations and relationship(s) with parent(s) (reactive vs. stimulating parent-child relation), which influences academic achievements. The results showcase that there is a significant relationship between academic achievements and personal values and experiences of parenting style. Stimulating parenting style is associated with a higher degree of academic success, while reactive parenting has decreased achievements in all the cohorts. Post-material value orientations (especially self-direction as the value) are strongly linked with academic success. Inter-cohort differences indicate the importance that personal values and parenting has had greater effect on the younger generation’s academic achievements compared to the older ones. A general inter-cohort tendency was found to be that parenting has had a greater effect across all the generations on being more successful in school than personal values. Stimulating parenting style via self-direction as the value has had a mediating effect on academic achievements as well.

Advances in statistical methods for cancer surveillance research: an age-period-cohort perspective.

Analysis of Lexis diagrams (population-based cancer incidence and mortality rates indexed by age group and calendar period) requires specialized statistical methods. However, existing methods have limitations that can now be overcome using new approaches. We assembled a "toolbox" of novel methods to identify trends and patterns by age group, calendar period, and birth cohort. We evaluated operating characteristics across 152 cancer incidence Lexis diagrams compiled from United States (US) Surveillance, Epidemiology and End Results Program data for 21 leading cancers in men and women in four race and ethnicity groups (the "cancer incidence panel"). Nonparametric singular values adaptive kernel filtration (SIFT) decreased the estimated root mean squared error by 90% across the cancer incidence panel. A novel method for semi-parametric age-period-cohort analysis (SAGE) provided optimally smoothed estimates of age-period-cohort (APC) estimable functions and stabilized estimates of lack-of-fit (LOF). SAGE identified statistically significant birth cohort effects across the entire cancer panel; LOF had little impact. As illustrated for colon cancer, newly developed methods for comparative age-period-cohort analysis can elucidate cancer heterogeneity that would otherwise be difficult or impossible to discern using standard methods. Cancer surveillance researchers can now identify fine-scale temporal signals with unprecedented accuracy and elucidate cancer heterogeneity with unprecedented specificity. Birth cohort effects are ubiquitous modulators of cancer incidence in the US. The novel methods described here can advance cancer surveillance research.

Self-perceived Functional Disabilities due to Chronic Musculoskeletal Knee Pain among Elderly People Residing at Ahmedabad City, India: A Mixed Method Approach with a Community Perspective

AbstractIntroduction:One of the disabilities perceived by elderly people which has the most profound effect on day-to-day living is knee osteoarthritis. The present study focused on elderly people with objectives of assessing the prevalence of functional disabilities due to chronic musculoskeletal knee pain with concerned determinants. Assessment of quality of life (QoL) and exploring various perceptions regarding debility were ancillary objectives.Methodology:A cross-sectional study with a mixed method approach was conducted among elderly people at urban field practice area of one of the tertiary health-care institutes of Ahmedabad city, Gujarat. The calculated sample size of 220 was collected by systematic random sampling. A pretested, validated, semistructured questionnaire including Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index with information pertaining to pain, stiffness, and functional disability was used to collect quantitative part. For qualitative assessment, in-depth interviews were taken using interview guide.Results:The prevalence of chronic knee pain was 70%, of which 63% had functional disability. Various determinants such as gender, age, socioeconomic class, occupation, and body mass index were found to have a statistically significant association with severity of knee pain/functional disability. Qualitative research revealed that majority of participants were dissatisfied with their current QoL, primarily due to dependent attitude for quotidian chores, while some of them perceived socially isolated due to compromised physical capacity. Acceptance for ailment with belief of “condition is common unpreventable fate in old-age” and surgical intervention with adverse/futile outcome in a few peer age-group cohorts enrooted attitude of not visiting any health-care facility among study participants.Conclusion:More than three-fifth of the study participants had severe/extreme WOMAC score which was most probable reason for perceived dissatisfied life quality. More than three-fifth of the study participants had severe/extreme WOMAC score representing reason for perceived dissatisfied life quality. Adopted common ethnicity of demeanor in routine chores found statistically significant association with functional disability, while certain beliefs were decisive for initiating or sustained treatment.

Defining Characteristics of Middle-Aged and Geriatric Orthopedic Trauma in New York City over a 7-Year Period

ObjectivesExamine the patterns and defining characteristics of middle-aged and geriatric patients who sustain orthopedic trauma in New York City. Study DesignRetrospective cohort study. Methods11,677 patients >55 years old treated for traumatic orthopedic injuries were grouped into cohorts based on their age group (cohorts of 55-64, 65-74, 75-84, 85-94, ≥95 years) and year of presentation (2014-2021). Each patient was reviewed for demographics/comorbidities, injury mechanism/type, mortality data. Comparative analyses were conducted. ResultsThe average age of our cohort was 74 years old. The majority of patients were female (69%) and sustained their injuries via a ground level fall. The most common injuries sustained by patients occurred at the upper extremity (40%), hip (26%), and lower extremity (25%) with 820 (7%) patients sustaining polytrauma. The incidence of hip fractures and pelvic injuries increased with older age. Older patients had a higher rate of mortality through 1-year in addition to a longer length of stay. In contrast, the incidence of injury to the upper and lower extremity decreased with older age. ConclusionsThe rate of mortality out through 1-year following orthopedic trauma increased as patients got older. Significantly more women experienced a traumatic injury during 2014-2021. As age increased, ground level falls were the most common mechanism of injury with injuries more likely to occur in the axial skeleton, notably the hip and pelvis. Younger patients experienced higher rates of upper and lower extremity trauma. Providers should keep these patterns in mind to optimize care for middle-aged and geriatric trauma patients.

Investment, Savings, and Spending Habits of Indian Digital Natives/Millennials: A Comparative Study of Age Group Cohorts

This research work attempted to study and compare the investment pattern, spending level, and saving habits of three age cohorts, namely pre-millennials (born before the 1980s), millennials (born between 1981 &amp; 1996), and post-millennials (born after 1996) in India. Secondary data from the surveys conducted by YouGov, Mint News, and the Centre for Policy Research (CPR) during the years 2019 and 2020 were used in the study. Major statistical tools used for the study were descriptive statistics, ranking, and chi-square analysis. The demographic study results showed that the money saved by these cohorts varied according to their income levels, and income influenced saving habits more than the age factor. In terms of investment, more proportion of the money was saved in deposit/savings schemes rather than market-related investments. While considering the spending pattern, purchasing vehicles, houses, travel, future needs and priorities, income levels, and financial security were found to play a major role. Post-millennials and millennials preferred savings and investment by purchasing fixed assets and paying for education; whereas pre-millennials saved for retirement, contingencies, and children’s education.

Outcomes of young patients following mechanical thrombectomy for stroke: A systematic review and meta-analysis.

Young patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS. Following PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes. Our analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18-49/50 years, 18-54/55 years, and 18-64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients. Following mechanical thrombectomy for AIS, patients aged 18-65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH.Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18-65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage.While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.

Physical and Psychosocial Symptoms of Young Adult Patients Referred to the Supportive Care Mobile Team.

Young adult (YA) aged cancer patients have unique psychosocial needs with studies indicating more symptoms and emotional distress compared to older patients. Our study aimed to compare clinical characteristics and symptom distress between YAs and older adults. We retrospectively studied 896 randomly selected patients across 3 age groups: 18-39 YAs (n = 297), 40-64 (n = 300), and 65 and older (n = 299). We compared medical, psychosocial history, Morphine Equivalent Daily Dose (MEDD), Edmonton Symptom Assessment Scale (ESAS) scores, and Eastern Cooperative Oncology Group (ECOG) scores at the time of initial inpatient consultation with supportive care. YAs were more frequently female and white, with higher ECOG scores, had more self-reported psychiatric history and worse ESAS sleep scores compared to the other age cohort groups. YAs had higher pain expression than those of 65 years and older. YAs were more likely to have children younger than 18 years old, which was associated with worse pain, sleep, and financial distress. In general, YAs did not report higher symptoms distress, with the exception of insomnia and self-reported psychiatric history. Importantly, YAs with children was associated with higher ratings of pain, sleep difficulties, and financial distress. Overall, results suggest YAs may benefit from specialized services to address their unique psychosocial needs.

Psychosocial and emotional consequences in siblings of children with epilepsy

Abstract Background: Chronic illness such as epilepsy in children tends to affect the entire family. Siblings of these children, who are usually in the same age group cohort, may have various psychological consequences. Data are sparse on the psychological state of siblings who share the same family environment as the child suffering from epilepsy. Aim: To explore the emotional impact and psychosocial domains of siblings of children suffering from epilepsy. Materials and Methods: This was a qualitative study. The siblings of the children with epilepsy were interviewed with the help of a semistructured questionnaire exploring the domains of their perceived severity of the sibling’s epilepsy, their psychological reactions, their perception of parental behavior, family environment, and social life. Their narratives were transcribed into themes. The psychological reactions of the children were analyzed for correlation with sociodemographic factors, epilepsy characteristics, and the themes generated from other domains. Results: Overall, 80.48% children reported a feeling of anxiety, 60.97% reported parental negligence, 63.41% perceived high expectations from them by parents, and 31.7% perceived a disturbed family environment. The psychological reaction of anxiety correlated significantly with the perceived severity of illness (P = 0.005), whereas loneliness correlated with perceived harsh and punitive parenting (P = 0.003), a disturbed family environment (P = 0.024), and lack of recreation (P = 0.047). Conclusion: Children with siblings suffering from epilepsy have various psychological effects that are influenced by their perception of parental behavior and family environment.

Age- and Diagnosis-Based Trends for Unplanned Pediatric Rehospitalizations in the United States.

Background and objectives: Hospital readmission rate helps to highlight the effectiveness of post-discharge care. There remains a paucity of plausible age-based categorization especially for ages below one year for hospital readmission rates.Methods: Data from the 2017 Healthcare Cost and Utilization Project National Readmissions Database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. Results: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant diagnoses leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages one to four years, dehydration, asthma and bronchiolitis were negative predictors of unplanned readmission. Conclusions: Thirty-day unplanned readmissions remain a problem leading to billions of taxpayer dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

Impact of Persisting Amblyopia on Socioeconomic, Health, and Well-Being Outcomes in Adult Life: Findings From the UK Biobank

ObjectivesThis study aimed to investigate associations between persisting amblyopia into adulthood and its “real-life” impacts and inform the current debate about the value of childhood vision screening programs. MethodsAssociations between persisting amblyopia and diverse socioeconomic, health, and well-being outcomes were investigated in multivariable-adjusted (sex, age, ethnicity, deprivation) regression models, with 126 400 participants (aged 40-70 years) of the UK Biobank with complete ophthalmic data. Analysis by age group (cohort 1, 60-70 years; cohort 2, 50-59 years; cohort 3, 40-49 years) assessed temporal trends. ResultsOf 3395 (3%) participants with confirmed amblyopia, overall 77% (2627) had persisting amblyopia, declining from 78% in cohort 1 to 73% in cohort 3. The odds of persisting amblyopia were 5.91 (5.24-6.66) and 2.49 (2.21-2.81) times greater in cohort 1 and cohort 2, respectively, than cohort 3. The odds were also higher for more socioeconomically deprived groups and for white ethnicity. Reduced participation in sport, adverse general and mental health, and well-being were all independently associated with persisting amblyopia, with the strongest associations in the youngest cohorts. Associations with lower educational attainment and economic outcomes were only evident in the oldest cohort. ConclusionsThere has been a decline in the overall frequency of persisting amblyopia since the introduction of universal child vision screening in the United Kingdom. Nevertheless, most adults treated for amblyopia in childhood have persisting vision deficits. There was no evidence that persisting amblyopia has vision-mediated effects on educational, employment-related, or economic outcomes. The observed adverse outcomes were largely those not directly mediated by vision. Patients undergoing treatment should be counseled about long-term outcomes.

Young and Aged Employees in the Russian Labour Market: Confrontation or Complementarity?

This article presents an analysis of research results on two categories of workers and job candidates - the youngest (under 25 years old) and the oldest (retired and pre-retirement). These age group cohorts are under the greatest pressure in the Russian labour market: the greatest difficulties in getting a job, age discrimination, etc. Paradoxically, these groups show not a difference but rather a similarity in their value orientations. They often experience latent and obvious discrimination from HR managers. As a result, in many respects these groups tend to have similar views about the labour market and their "life chances" to build a career and maintain income stability. The younger and older age groups are ready to interact with each other, but stereotypes about old age (prevalent in the country) make this process difficult. State policies that support certain age groups in the labour market often intensify intergenerational conflicts rather than hinder them. The Corona Virus pandemic has significantly affected the position of the youngest and oldest people in the labour market, putting them in a situation where they cannot apply for good jobs and have to accept any work.

Changes in food intake from 1999 to 2012 among Mexican children and women.

Previous studies have shown that intake of sugary drinks in Mexico has increased, while intake of whole milk has decreased. Yet, in-depth analyses of the changes in solid foods, overall and in specific generations and urban/rural subpopulation, are scarce. We aimed to analyse changes in solid foods intake in Mexican children, adolescent girls and adult women through a single 24-h dietary recall from the Mexican Nutrition Survey 1999 (n 5627) and 2012 (n 6712). Foods were classified into twenty-two healthy and unhealthy food groups without considering beverages. We estimated the crude and adjusted change in the energy contribution of solid foods by age group and birth cohort and tested if the changes differed by urban/rural area. The contribution of fruits, vegetables and unsweetened dairy increased, while sweet bread from bakery decreased. However, the total contribution of healthy food groups (67-70 % kj in 1999) decreased -4·3 and -7·2 percentage points (pp) (P < 0·05) among children and adolescents, respectively, but only -1·7 pp (P > 0·05) among adult women. Likewise, those born in 1980-1984 changed little in comparison with those born in 1993-1997, and there were greater increases in unhealthy foods in urban compared with rural areas. In conclusion, from 1999 to 2012, there were negative changes in the intake of foods, specifically healthy foods, which mainly affected Mexican youth. These findings, along with previous reports on the increased intake of sugary drinks in the same population, that emphasise the need to reinforce strategies aimed at improving dietary intake of the Mexican population need to be reinforced.

Abstract 16998: Gender and Age Specific Baseline Predictors of MACE in PEACE Trial Identified by Machine Learning

Introduction: The NHLBI supported Prevention of Events with Angiotensin-Converting Enzyme (ACE) Therapy trial (PEACE) (NCT00000558) found that the addition of ACE inhibitor trandolapril to conventional therapy in 8290 patients with stable coronary artery disease and preserved ejection fraction provided no benefit against MACE (cardiovascular death, nonfatal myocardial infarction, or the need for coronary revascularization), the composite primary endpoint. We reused publicly available individual patient-level PEACE data from NHLBI Data Repository (BioLINCC) to perform hypothesis-generating secondary analyses by machine learning (ML) using random survival forest (RSF) to identify gender and age group specific predictors for MACE. Methods: RSF was performed on 50 baseline variables for the MACE outcome in male and female and in age group (&lt;60, 60-69, &gt;69) cohorts. The top ten predictors identified in each cohort were included in a multivariate analysis using a Cox proportional hazards model with a multiple regression approach. Results: The top 10 predictors for the MACE selected by RSF are shown in Figure 1. Expected cardiovascular (CV) risk predictors like blood pressure, Canadian CV Society angina classification (CCS), age, and a history of various CV procedures consistently emerge amongst the top ten predictors of the primary MACE outcome across all gender and age specific subgroups. Interestingly, RSF also identified renal function biomarkers like serum potassium and glomerular filtration rate as common top ten predictors. Conclusion: Using ML, we uncovered in an unbiased fashion, gender and age groups specific unanticipated top predictors for MACE in PEACE trial. This underscores the value of gender and age specific predictors to examine the efficacy and outcomes of therapeutic interventions in advancing precision and personalized medicine.

Non–COVID-19 excess deaths by age and gender in the United States during the first three months of the COVID-19 pandemic

ObjectivesThe first three months of the COVID-19 pandemic has disrupted healthcare systems, creating an environment by which deaths have occurred that are not directly due to COVID-19, but have occurred owing to the healthcare and societal environment resulting from COVID-19. The objective of this research is to quantify such excess deaths, partitioned by age group and gender. Study designThis is a data analysis. MethodsExcess deaths by age and gender are estimated using provisional death data available from the Centers for disease control and prevention (CDC) over the time period from March 1, 2020 through May 30, 2020. Previous year fatality and population data are used as the benchmark. ResultsSeveral of the eighteen age and gender cohorts experienced statistically significant excess deaths. The results also indicate that COVID-19 has been protective for one of the age and gender cohorts. ConclusionsThere have been more excess deaths in several age group and gender cohorts during the first three months of the pandemic, beyond direct deaths directly attributable to COVID-19. These non–COVID-19 excess deaths are most apparent in the 25- to 44-year age group for women and 15- to 54-year age group for men. Further research is needed to assess the cause of such excess deaths and introduce safeguards to reduce such deaths in the future.

Population Pharmacokinetic Analysis of Dalteparin in Pediatric Patients With Venous Thromboembolism.

This article describes the population pharmacokinetics (PK) of dalteparin in pediatric patients with venous thromboembolism (VTE). A prospective multicenter open‐label study was conducted in children who required anticoagulation for the treatment of VTE. The study population included children with and without cancer. The goal was to describe the pharmacokinetics of dalteparin using anti‐Xa as a surrogate marker and to determine the dose required to achieve therapeutic anti‐Xa levels (0.5‐1.0 IU/mL). The anti‐Xa data were supplemented with 2 published studies and analyzed using population pharmacokinetic approaches. The pharmacokinetics of dalteparin following subcutaneous injection in pediatric patients was described by a 1‐compartment model with linear absorption and elimination. Body weight was added as a covariate on both CL/F and Vd/F as a power function with fixed exponents of 0.75 and 1.0, respectively. The estimates of CL/F and Vd/F in the full model were 929 mL/h and 7180 mL, respectively, for a reference female patient aged 12 years with body weight of 43 kg. Body weight‐normalized CL/F decreased with age. Cancer status and sex did not have significant effects on CL/F and Vd/F. Simulations were conducted to select starting doses of dalteparin that would rapidly achieve therapeutic anti‐Xa levels. These simulations suggested that the recommended starting doses of dalteparin administered subcutaneously in pediatric patients of different age cohort groups for treatment of VTE were 150 IU/kg every 12 hours (1 month to <2 years), 125 IU/kg every 12 hours (≥2 to <8 years), and 100 IU/kg every 12 hours (≥8 to <19 years).

Impacts of Human Papillomavirus Immunization Programs on Rates of Anogenital Warts in British Columbia, Canada, 2000 to 2017.

In 2008, British Columbia (BC) implemented a school-based quadrivalent human papillomavirus (HPV-4) immunization program for girls born in 1994 or later. In 2015, an expanded clinic-based program included men who report sex with men (MSM) born in 1989 or later. To evaluate the impacts of HPV-4 programs on anogenital warts (AGWs), diagnosis rates were measured among women who report sex with men (WSM), men who report sex with women (MSW), and MSM. Diagnoses of AGW were ascertained from 16 sexually transmitted infection clinics. Rates were calculated as new AGW diagnoses over person-years (py) at risk and stratified by age group, calendar period, and birth cohort. Adjusted relative rates (aRR) were estimated using multivariable Poisson regression. There were 204,832 clinic visits by 85,158 individuals: 28,366 (33%) WSM, 35,688 (42%) MSW, and 14,534 (17%) MSM. After adjusting for age and period, AGW rates in the 1994-1996 birth cohort decreased by 56% overall (1.21 vs. 2.72 cases/100 py; aRR, 0.44; 95% confidence interval [CI], 0.34-0.59), 65% among WSM (0.97 vs. 2.77 cases/100 py; aRR, 0.35; 95% CI, 0.22-0.57), 58% among MSW (1.60 vs. 3.78 cases/100 py; aRR, 0.42; 95% CI, 0.28-0.65), and 41% among MSM (1.14 vs. 1.19 cases/100 py; aRR, 0.59; 95% CI, 0.38-0.91) versus the 1991-1993 birth cohort. The HPV-4 programs had significant impacts on lowering AGW rates in BC. The greatest decrease was among WSM eligible for the school-based program, followed by birth cohorts of men who likely have sex with HPV-4 eligible women. The smallest decrease among MSM may reflect the later introduction of the clinic-based program.