Age-sex Standardized Incidence Research Articles

A Population-Based Matched Cohort Study of Digestive System Cancer Incidence and Mortality in Individuals With and Without Inflammatory Bowel Disease.

To study digestive system cancer risks in individuals with inflammatory bowel diseases (IBDs) in the biologic era. We used population-level administrative and cancer registry data from Ontario, Canada, (1994-2020) to compare people with IBD to matched controls (1:10 by sex and birth year) on trends in age-sex standardized cancer incidence and risk ratios of incident cancers and cancer-related deaths. Among 110,919 people with IBD and 1,109,190 controls, colorectal cancer incidence (per 100,000 person-years) declined similarly in people with ulcerative colitis (average annual percentage change [AAPC] -1.81; 95% confidence interval [CI] -2.48 to -1.156) and controls (AAPC -2.79; 95% CI -3.44 to -2.14), while small bowel cancer incidence rose faster in those with Crohn's disease (AAPC 9.68; 95% CI 2.51-17.3) than controls (AAPC 3.64; 95% CI 1.52-5.80). Extraintestinal digestive cancer incidence rose faster in people with IBD (AAPC 3.27; 95% CI 1.83-4.73) than controls (AAPC -1.87; 95% CI -2.33 to -1.42), particularly for liver (IBD AAPC 8.48; 95% CI 4.11-13.1) and bile duct (IBD AAPC 7.22; 95% CI 3.74-10.8) cancers. Beyond 2010, the incidences (and respective mortality rates) of colorectal (1.60; 95% CI 1.46-1.75), small bowel (4.10; 95% CI 3.37-4.99), bile duct (2.33; 95% CI 1.96-2.77), and pancreatic (1.19; 95% CI 1.00-1.40) cancers were higher in people with IBD. Cancer incidence is declining for colorectal cancer and rising for other digestive cancers in people with IBD. Incidence and mortality remain higher in people with IBD than controls for colorectal, small bowel, bile duct, and pancreatic cancers.

Incidence of young-onset dementia in Italy: The Brescia register study.

The goal of the present work was to assess the incidence of dementia with onset before the age of 65 years (i.e., young-onset dementia [YOD]) and define the frequencies of young-onset Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies (DLB) in the general population. The study was conducted from January 1, 2019 to December 31, 2019 in Brescia province (population: 1,268,455). During the study period, all new YOD cases (incident YOD) were counted, and all patients' records reviewed. The incidence was standardized to the Italian general population in 2019. A total of 29 YOD patients were diagnosed. The age-sex standardized incidence rate was 4.58 (95% confidence interval, 3.07-6.58) per 100,000 person-years. No difference in incidence rate between YOD due to AD or FTLD (P=0.83) and between sexes (P=0.81) was observed. YOD incidence increased with age, reaching its peak after 60 years. Presenting neurodegenerative YOD phenotypes encompasses both AD and FTLD. Improved knowledge on YOD epidemiology is essential to adequately plan and organize health services.

Health Inequities in Cancer Incidence According to Economic Status and Regions Are Still Existed Even under Universal Health Coverage System in Korea: A Nationwide Population Based Study Using the National Health Insurance Database.

The purpose of this study is to determine the level of health equity in relation to cancer incidence. We used the National Health Insurance claims data of the National Health Insurance Service between 2005 and 2022 and annual health insurance and medical aid beneficiaries between 2011 and 2021 to investigate the disparities of cancer incidence. We calculated age-sex standardized cancer incidence rates by cancer and year according to the type of insurance and the trend over time using the annual percentage change. We also compared the hospital type of the first diagnosis by cancer type and year and cancer incidence rates by cancer type and region in 2021 according to the type of insurance. The total cancer incidence increased from 255,971 in 2011 to 325,772 cases in 2021. The absolute difference of total cancer incidence rate between the NHI beneficiaries and the medical aid (MA) recipients increased from 510.1 cases per 100,000 population to 536.9 cases per 100,000 population. The odds ratio of total cancer incidence for the MA recipients increased from 1.79 (95% confidence interval [CI], 1.77 to 1.82) to 1.90 (95% CI, 1.88 to 1.93). Disparities in access to hospitals and regional cancer incidence were profound. This study examined health inequities in relation to cancer incidence over the last decade. Cancer incidence was higher in the MA recipients, and the gap was widening. We also found that regional differences in cancer incidence still exist and are getting worse. Investigating these disparities between the NHI beneficiaries and the MA recipients is crucial for implementing of public health policies to reduce health inequities.

Markedly decreasing incidence of cause-specific blindness in Saxony (Eastern Germany).

To analyze the recent time trend in Saxony. Data were based on administrative files in Saxony (Eastern Germany) to assess recipients of blindness allowance newly registered between January 1, 2009, and December 31, 2017. We estimated age-sex standardized incidence of all-cause and cause-specific blindness and used Poisson regression to examine age- and sex-adjusted time trends. We identified 5114 new cases of blindness (63.3% female, 59.9% ≥ 80years). We observed a markedly decrease in incidence of blindness: all-causes 2009: 15.7 per 100,000 person years [95% confidence interval: 14.6-17.0]; 2017: 8.9 [8.1-9.8]; age-related macular degeneration 2009: 6.9 [6.1-7.7], 2017: 3.8 [3.3-4.3]; glaucoma 2009: 2.6 [2.2-3.1], 2017: 1.8 [1.4-2.2]; diabetic retinopathy 2009: 1.5 [1.2-1.9], 2017: 0.7 [0.5-1.0]; myopia 2009: 0.7 [0.5-1.1], 2017: 0.4 [0.2-0.5]; optic atrophy 2009: 0.9 [0.6-1.2], 2017: 0.5 [0.3-0.7]; and cataract 2009: 0.5 [0.3-0.8], 2017: 0.1 [0.1-0.3]. The annual reduction was between 5 (glaucoma, relative risk 0.95 [0.92-0.98]) and 16% (cataract, relative risk 0.84 [0.78-0.91]). The age- and sex-standardized incidence of blindness decreased among all common causes of blindness in Saxony in the last decade.

ASSOCIATION BETWEEN NEIGHBORHOOD CHARACTERISTICS AND DEMENTIA: AN ECOLOGICAL ANALYSIS

Research has examined the relationship between neighborhood environments and cognitive decline, yet few have investigated the role of neighborhood characteristics specifically on dementia. This ecologic study examined the geographic distribution of dementia incidence and investigated ecologic associations between census-tract neighborhood characteristics and diagnosed dementia case incidence from 2010-2014 in the South Carolina (SC) Alzheimer’s Disease Registry. Analyses took place on the census-tract level (n=1089) with population ≥1. Neighborhood measures came from the Decennial Census, American Community Survey, Rural Commuting Area Code, and County Health Rankings. To estimate the ecologic association between neighborhood characteristics and dementia incidence, we conducted a zero-inflated, negative binomial mixed-effects model. The overall age-sex standardized dementia incidence rate was 2,885.4 per 100,000 people per census tract from 2010-2014 in SC (95% CI: 2857-2913.7). In an adjusted model, neighborhood characteristics had a significant association with dementia incidence. Rural and small urban census tracts had 62% (IRR=0.38; 95% CI= 0.27-0.54) and 58% (IRR=0.42; 95% CI= 0.29-0.60) lower dementia incidence, respectively, among ≥50 years old compared to urban census tracts while adjusting for neighborhood median-household income, racial composition, commute time, and age structure. The results from this study show a negative relationship between rural neighborhoods and dementia, contrary to previous findings. However, lower access to care in rural neighborhoods can result in lower detection rates and thus could present a reporting bias. Future research should investigate additional census-tract neighborhood characteristics (e.g. green space, pollution rates or psychosocial stress) that contribute to lower dementia rates in rural areas.

Trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003–2015

ABSTRACTBackground: In South Korea, the one-dose varicella vaccine was included in the National Immunization Program for children aged 12–15 months in 2005, and the vaccine coverage reached >95%. The impact of varicella vaccination on varicella and herpes zoster (HZ) was investigated, accounting for demographic changes over time.Methods: We calculated the crude and age-sex standardized incidence rates (IRs) and age-specific IRs of varicella and HZ from 2003 to 2015, using the National Health Information Database including approximately 50 million Koreans. The annual incidence rate ratios (IRRs) were calculated using a negative binomial regression analysis, adjusting for age and sex.Results: The crude varicella IR steadily declined by 67%, from 5.70/1000 to 1.87/1000 person years (IRR per year: 0.91; 95% CI 0.89–0.93), but the adjusted IRs showed a significant decline only during 2010–2015 (adjusted IRR per year: 0.90; 95% CI 0.88–0.93). The greatest decline was found in children ≤4 years of age, whereas the IR increased until 2011 and then declined afterward in children aged 5–9 years, who represented the highest incidence age group in 2013–2015. The crude HZ IR increased from 2.67/1000 to 9.80/1000 person years (IRR per year: 1.12; 95% CI 1.10–1.15), and the adjusted IR also followed the same trend. A similar increasing trend was observed before and after universal vaccination.Conclusions: One-dose varicella vaccination was moderately effective in preventing varicella, but this strategy was insufficient to interrupt varicella transmission in children. Furthermore, the HZ incidence dramatically increased over this decade. The current vaccination strategy against varicella-zoster disease should be reconsidered.

Incidence of frontotemporal lobar degeneration in Italy: The Salento-Brescia Registry study.

The goal of the present work, based on a collaborative research registry in Italy (the Salento-Brescia Registry), was to assess the incidence of frontotemporal lobar degeneration (FTLD) and to define the frequencies of different FTLD phenotypes in the general population. The study was conducted from January 1, 2017, to December 31, 2017, in 2 Italian provinces: Lecce (in Puglia) in the south (area 2,799.07 km2, inhabitants 802,082) and Brescia (in Lombardy) in the north (area 4,785.62 km2, inhabitants 1,262,678). During the study period, all new cases of FTLD (incident FTLD) were counted, and all patients' records were reviewed. The incidence was standardized to the Italian general population in 2017. In the 2 provinces, 63 patients with FTLD were diagnosed. The incidence rate for FTLD was 3.05 (95% confidence interval [CI] 2.34-3.90) per 100,000 person-years (py), while the age-sex standardized incidence rate was 3.09 (95% CI 2.95-3.23) per 100,000 py. In the Italian population, the lifetime risk was 1:400. There was a progressive increase in FTLD incidence across age groups, reaching its peak in the 75- to 79-year-old group, with an incidence rate of 15.97 (95% CI 8.94-26.33) per 100,000 py. The behavioral variant of frontotemporal dementia was the most common phenotype (37%). No difference in crude incidence rate between the 2 provinces was observed. FTLD is a more common form of dementia than previously recognized, with a risk spanning in a wide age range and with maximum incidence in the mid-70s. Improved knowledge of FTLD epidemiology will help to provide appropriate public health service policies.

Trends in the incidence of work-related traumatic limb amputations in South Korea from 2004 to 2013.

Epidemiological data for work-related traumatic limb amputations are limited worldwide, particularly incidence trends related to workplace characteristics. To investigate nationwide incidence rates and trends for amputations according to industry and establishment size. Retrospective cohort study. Incidence rates were calculated using workers' compensation claims in South Korea from 2004 to 2013. Age-sex standardization was conducted, and trends related to workplace characteristics were statistically analyzed using the chi-square test. The overall incidence rate was 38.8 claims per 100,000 workers. Decreasing trends over time in age-sex standardized incidence were observed. Most claims occurred in manufacturing and construction industries. Incidence within the manufacturing decreased significantly (p < 0.001), but not in the construction (p = 0.130) industry. Small-sized establishments (<50 employees) accounted for 77.8% of claims. Incidence in small establishments significantly decreased between 2004 and 2013 (p < 0.001). A decreasing incidence rate for traumatic amputations in manufacturing and small establishments may imply that preventive measures have been successful in South Korea. If so, these strategies may be useful for other fast-growing Asian economies. Further research is needed to identify the causes of traumatic amputations according to industry and establishment size. Trends in the incidence rate of work-related traumatic limb amputations related to workplace characteristics can provide useful information for policy makers to improve prevention strategies.

2512. The Trend in the Incidence of Herpes Zoster and Effect of Immune Status on Severity and Healthcare Utilization: Population-Based Study of Korea, 2003–2015

BackgroundAn increase in the incidence of herpes zoster (HZ) is observed in South Korea. However, the effects of changes in population structure and immune status on the incidence and severity of HZ have not been well studied. We investigated longitudinal changes in the incidence of HZ and disease severity over time and according to age and comorbidities.MethodsWe used population-based medical records from the National Health Insurance Service for approximately 50,000,000 subscribers from 2003 to 2015. Herpes zoster cases (period 2003–2015) or its complications (period 2007–2015) were identified using ICD-10 codes (B02-B02.9) and comorbid conditions were also collected. The annual crude incidence rates and age-standardized rates of HZ were calculated using direct standardization to the 2010 Korean Census population. Negative binomial regression was used to analyze the yearly incidence rate ratio (IRR) and the impact of immune status on disease severity. Healthcare utilization was compared across age groups and comorbid conditions.ResultsThe crude and age-sex standardized incidence rate of HZ annually increased over the study period (Figure 1). Such trend was also observed after adjusting for age, sex, immune status, and socioeconomic status (adjusted IRR 1.06, 95% CI 1.05–1.08). The incidence was highest in 61–80 year-olds whereas the relative increase was high in 11–30 year-olds (Figure 2). Incidences of HZ-associated hospitalizations and complications also steadily increased over time as well as across age groups (Figure 3) although the proportions among HZ cases remained stable. Among HZ cases, the risk of complications was higher among elderly population (71 years; IRR 1.1–1.23), patients with comorbidities (IRR 1.17, 95% CI 1.14-1.19), and male patients (IRR 1.19, 95% CI 1.09–1.38). The length of hospital stay (median 12 days [range: 7–25] vs. 8 days [range: 6–14], P < 0.001) was significantly greater in HZ patients with comorbidities than those without.ConclusionThe incidence of HZ has rapidly increased independent of population structure change. It is necessary to establish strategies such as vaccination to reduce the incidence of HZ, and efforts should be made to reduce the disease burden among those with comorbidities.Disclosures All authors: No reported disclosures.

Sleep apnea and subsequent cancer incidence.

In vitro and animal models suggest that the physiological effects of sleep apnea could contribute to cancer risk, yet epidemiologic studies have been inconsistent. We identified a cohort of adults diagnosed with sleep apnea between 2005 and 2014 using regional administrative databases. Linking this cohort to a population-based cancer registry, we identified first incident cancers diagnosed after sleep apnea diagnosis through 2015. We calculated age-sex standardized cancer incidence ratios (SIRs) to compare the observed number of cancers among those with sleep apnea with expected population estimates over a comparable period. Among 34,402 individuals with sleep apnea, 1,575 first incident cancers were diagnosed during follow-up (mean ± SD; 5.3 ± 2.0years). Compared to the general population, cancer incidence (SIR 1.26, 95% CI 1.20-1.32) was elevated among sleep apnea patients. We observed significantly elevated incidence for kidney (SIR 2.24, 95% CI 1.82-2.72), melanoma (SIR 1.71, 95% CI 1.42-2.03), breast (SIR 1.43, 95% CI 1.76-2.00), and corpus uteri (SIR 2.80, 95% CI 2.24-2.47) while risk for lung (SIR 0.66, 95% CI 0.54-0.79) and colorectal cancer (SIR 0.71, 95% CI 0.56-0.89) was lower. These findings suggest an elevated cancer burden, particularly at certain sites, among individuals with diagnosed sleep apnea. Results should be interpreted with caution due to unmeasured confounders (e.g., BMI, diabetes).

Identifying 'corridors of HIV transmission' in a severely affected rural South African population: a case for a shift toward targeted prevention strategies.

BackgroundIn the context of a severe generalized African HIV epidemic, the value of geographically targeted prevention interventions has only recently been given serious consideration. However, to date no study has performed a population-based analysis of the micro-geographical clustering of HIV incident infections, limiting the evidential support for such a strategy.MethodsWe followed 17 984 HIV-uninfected individuals aged 15–54 in a population-based cohort in rural KwaZulu-Natal, South Africa, and observed individual HIV sero-conversions between 2004 and 2014. We geo-located all individuals to an exact homestead of residence (accuracy <2 m). We then employed a two-dimensional Gaussian kernel of radius 3 km to produce robust estimates of HIV incidence which vary across continuous geographical space. We also applied Tango's flexibly shaped spatial scan statistic to identify irregularly shaped clusters of high HIV incidence.ResultsBetween 2004 and 2014, we observed a total of 2 311 HIV sero-conversions over 70 534 person-years of observation, at an overall incidence of 3.3 [95% confidence interval (CI), 3.1-3.4] per 100 person-years. Three large irregularly-shaped clusters of new HIV infections (relative risk = 1.6, 1.7 and 2.3) were identified in two adjacent peri-urban communities near the National Road (P = 0.001, 0.015) as well as in a rural node bordering a recent coal mine development (P = 0.020), respectively. Together the clusters had a significantly higher age-sex standardized incidence of 5.1 (95% CI, 4.7-5.6) per 100 person-years compared with a standardized incidence of 3.0 per 100 person-years (95% CI, 2.9-3.2) in the remainder of the study area. Though these clusters comprise just 6.8% of the study area, they account for one out of every four sero-conversions observed over the study period.ConclusionsOur study has revealed clear ‘corridors of transmission’ in this typical rural, hyper-endemic population. Even in a severely affected rural African population, an approach that seeks to provide preventive interventions to the most vulnerable geographies could be more effective and cost-effective in reducing the overall rate of new HIV infections. There is an urgent need to develop and test such interventions as part of an overall combination prevention approach.

Increasing incidence associated with herpes zoster infection in British Columbia, Canada.

BackgroundRecent studies have shown an increasing incidence of herpes zoster (HZ) infection, which may be related to the introduction of varicella vaccination programs in children. We examined the epidemiology and treatment costs of HZ and post-herpetic neuralgia (PHN) over time in British Columbia, Canada.MethodsThe cohort consisted of all cases with HZ infection from January 1, 1997 and December 31, 2012. Incident zoster was defined as a case (ICD-9 053 or ICD-10 B02) without a previous episode of HZ or PHN in the previous 12 months. We determined the incidence for HZ and PHN and the age-sex standardized rate for the overall population. We determined the association between the varicella vaccination program and increased HZ rates by evaluating the rate ratios in the publicly-funded varicella vaccine period compared to the non-publicly funded period in a regression model. We evaluated the hospitalization rates, treatment by GPs and their associated yearly costs for HZ and PHN.ResultsHZ incidence increased for the entire study period from 3.2 per 1000 population in 1997 to 4.5 in 2012. HZ rates were higher for females than males and all age groups had an increased incidence rate, except the 0–9 year olds, where the rate decreased. Crude and age-sex standardized incidence rates of PHN demonstrated very similar patterns to HZ incidence. Based on the regression model, rates of HZ were higher in the older individuals. No significant increase with HZ incidence was seen during the publically funded varicella vaccination program compared to the non-publicly funded period. From 1997 to 2012, the annual HZ-related costs associated with hospitalizations and GP visits were over $CDN4.9 million and $CDN537,286, respectively; treatment costs for hospitalizations have increased significantly over time. Majority of PHN-related cases are managed by GPs, with a steady increase over time in number of cases and associated annual costs.ConclusionsThe incidence of zoster and PHN is increasing with time, particularly in the elderly population and the risk is greater in the over 65 year olds. Treatment costs for both HZ and PHN represent a significant burden on the Canadian healthcare system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1898-z) contains supplementary material, which is available to authorized users.

Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: A nationwide observational study

Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51years (IQR=39-66). Frequently observed nationalities were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n=36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p=0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p=0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p=0.02) were associated with lower odds of survival. Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

Incidence, prevalence, and trends of general practitioner–recorded diagnosis of peanut allergy in England, 2001 to 2005

Previous descriptions of the epidemiology of peanut allergy have mainly been derived from small cross-sectional studies. To interrogate a large national research database to provide estimates for the incidence, prevalence, and trends of general practitioner (GP)-recorded diagnosis of peanut allergy in the English population. Version 10 of the QRESEARCH database was used with data from 2,958,366 patients who were registered with 422 United Kingdom general practices in the years 2001 to 2005. The primary outcome was a recording of clinician-diagnosed peanut allergy. The age-sex standardized incidence rate of peanut allergy in 2005 was 0.08 per 1000 person-years (95% CI, 0.07-0.08), and the prevalence rate was 0.51 per 1000 patients (95% CI, 0.49-0.54). This translated into an estimated 4000 incident cases (95% CI, 3500-4600) and 25,700 prevalent cases (95% CI, 24,400-27,100) of GP-recorded diagnosis of peanut allergy in England in 2005. During the study period, the incidence rate of peanut allergy remained fairly stable, whereas the prevalence rate doubled. In those under 18 years of age, the crude lifetime prevalence rate was higher in males than females. A significant inverse relationship between prevalence and socioeconomic status was found. These data on GP-recorded diagnosis of peanut allergy from a large general practice database suggest a much lower prevalence in peanut allergy than has hitherto been found. This difference may in part be explained by underrecording of peanut allergy in general practice. Further research is needed to assess the true frequency of peanut allergy in the population and whether there has been a true increase in recent years.

Trends in the epidemiology and prescribing of medication for eczema in England.

The prevalence of eczema, particularly in younger children, increased substantially over the second half of the 20th century. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of eczema. To investigate recent trends in the recorded incidence, lifetime prevalence, prescribing and consulting behaviour of patients with eczema in England. QRESEARCH is one of the world's largest national aggregated health databases containing the records of over nine million patients. We extracted data on all patients with a recorded diagnosis of eczema and calculated annual age-sex standardized incidence and lifetime period prevalence rates for each year from 2001-2005. We also analysed the consulting behaviour of these patients when compared with the rest of the QRESEARCH database population. The number of eczema prescriptions issued to people in England was also estimated. The age-sex standardized incidence of eczema was 9.58 per 1000 person-years in 2001 and increased to 13.58 per 1000 patients in 2005 (p<0.001). By 2005, eczema affected an estimated 5,773,700 (95% confidence intervals [CI] 5,754,100-5,793,400) individuals in England, who, on average, consulted a general practitioner 4.02 (95% CI 4.01-4.03) times a year. During the study period, the number of eczema related prescriptions increased by 56.6% (95% CI 56.6-56.7), so by 2005 an estimated 13,690,300 (95% CI 13,643,200-13,737,600) prescriptions were issued. Recorded incidence and lifetime prevalence of eczema in England continue to increase. Similar increases have also been observed in the estimated number of eczema prescriptions issued to the English population.

Trends in the epidemiology and prescribing of medication for allergic rhinitis in England

To investigate recent trends in the recorded incidence, lifetime prevalence and prescribing of symptom relief medication for allergic rhinitis in England. Analysis of primary healthcare datasets. The UK prevalence of allergic rhinitis has increased very significantly over recent decades. Analysis of primary healthcare datasets offers the possibility to advance understanding about the changing epidemiology and management of allergic rhinitis. QRESEARCH is one of the world's largest national aggregated health databases containing the records of over nine million patients. We extracted data on all patients with a recorded diagnosis of allergic rhinitis and calculated annual age-sex standardized incidence and lifetime period prevalence rates for each year from 2001-2005. We also analysed prescribing trends for antihistamines and drugs used in nasal allergy in those with a recorded diagnosis of allergic rhinitis. Age-sex standardized incidence, lifetime prevalence rates and prescribing trends for symptom relief medication for allergic rhinitis in England. The age-sex standardized incidence of allergic rhinitis was 5.57 per 1000 person-years in 2001 and increased by 33.0% to 7.41 per 1000 person-years in 2005 (P<0.001). Lifetime age-sex standardized prevalence of a recorded diagnosis of allergic rhinitis increased by 43.2% from 46.35 per 1000 in 2001 to 66.37 per 1000 in 2005 (P<0.001). Over this period a 41.7% overall increase in prescriptions for antihistamines and drugs used in nasal allergy was observed (antihistamines 45.5%, drugs used in nasal allergies 35.5%). Recorded incidence and lifetime prevalence of allergic rhinitis have increased substantially in recent years. A similar increase in prescriptions for antihistamines and drugs used in nasal allergy in patients with allergic rhinitis is also observed.

Trends in national incidence, lifetime prevalence and adrenaline prescribing for anaphylaxis in England

Analysis of primary healthcare datasets offers the possibility to increase understanding of the epidemiology of acute uncommon conditions such as anaphylaxis, but these datasets remain under-exploited. To investigate recent trends in the recorded incidence, lifetime prevalence and prescribing of adrenaline for anaphylaxis in England. QRESEARCH is one of the world's largest national aggregated health databases containing the records of over nine million patients. We extracted data on all patients with a recorded diagnosis of anaphylaxis and calculated annual age-sex standardized incidence and lifetime period prevalence rates for each year from 2001-2005. We also analysed trends in adrenaline prescribing in those with a recorded diagnosis of anaphylaxis. National population figures were used to estimate numbers of people in England that have experienced anaphylaxis at some point in their lives. The age-sex standardized incidence of anaphylaxis was 6.7 per 100,000 person-years in 2001 and increased by 19% to 7.9 in 2005. Lifetime age-sex standardized prevalence of a recorded diagnosis of anaphylaxis was 50.0 per 100,000 in 2001 and increased by 51% to 75.5 in 2005. Prescribing of adrenaline increased by 97% over this period. By the end of 2005 there were an estimated 37,800 people that had experienced anaphylaxis at some point in their lives. Recorded incidence, lifetime prevalence and prescribing of adrenaline for anaphylaxis all showed substantial increases in recent years. An estimated 1 in 1,333 of the English population have at some point in their lives experienced anaphylaxis.

Heterogeneity in Incidence Rates of Schizophrenia and Other Psychotic Syndromes

Convention suggests uniformity of incidence of schizophrenia and other psychoses; variation would have implications for their causes and biological characteristics. To investigate variability in the incidence of psychotic syndromes in terms of place, ethnicity, age, and sex. Three-center, prospective, comprehensive survey of clinically relevant first-onset psychotic syndromes over a 2-year period (1997-1999). Census data provided the denominator. Southeast London, Nottingham, and Bristol, England. One million six hundred thousand person-years yielded 568 subjects aged 16 to 64 years with clinically relevant psychotic syndromes. The World Health Organization Psychosis Screen and the Schedules for Clinical Assessment in Neuropsychiatry to classify, blind to ethnicity, all DSM-IV psychotic syndromes and the subclasses of schizophrenia, other nonaffective disorders, affective disorders, and substance-induced psychosis. All syndromes showed a characteristic age distribution. Schizophrenia was significantly more common in men (incidence rate ratio [IRR], 2.3 [95% confidence interval (CI), 1.7-3.1]); affective disorders occurred equally in men and women (IRR, 1.0 [95% CI, 0.7-1.3]). All psychoses were more common in the black and minority ethnic group (crude IRR, 3.6 [95% CI, 3.0-4.2]). Differences in age, sex, and study center accounted for approximately a quarter of this effect (adjusted IRR, 2.9 [95% CI, 2.4-3.5]) in each psychosis outcome. The age-sex standardized incidence rate for all psychoses was higher in Southeast London (IRR, 49.4 [95% CI, 43.6-55.3]) than Nottingham (IRR, 23.9 [95% CI, 20.6-27.2]) or Bristol (IRR, 20.4 [95% CI, 15.1-25.7]). Rates of all outcomes except affective disorders remained significantly higher in Southeast London when the model was expanded to control for ethnicity. There is significant and independent variation of incidence of schizophrenia and other psychoses in terms of sex, age, ethnicity, and place. This confirms that environmental effects at the individual, and perhaps neighborhood level, may interact together and with genetic factors in the etiology of psychosis.

The incidence of thrombotic thrombocytopenic purpura-hemolytic uremic syndrome: all patients, idiopathic patients, and patients with severe ADAMTS-13 deficiency.

Accurate estimates of the incidence of thrombotic thrombocytopenic purpura (TTP) are important to assess the resources required for current treatments as well as to anticipate the need to develop new treatments. Previous estimates have been indirect and have not reported data on patients with ADAMTS-13 deficiency. To determine the incidence of patients with TTP-hemolytic uremic syndrome (HUS) in three categories: all patients with clinically suspected TTP-HUS, patients with idiopathic TTP-HUS, and patients with severe ADAMTS-13 deficiency. Incidence rates were estimated from the Oklahoma TTP-HUS Registry, analyzing all 206 consecutive patients from January 1, 1996 to June 30, 2004 who were treated with plasma exchange for their initial episode of clinically suspected TTP-HUS. ADAMTS-13 activity was measured in 186 (90%) of the 206 patients. The age-sex-race standardized annual incidence rates were 11.29 x 10(6) (95% CI: 9.70-12.88) for all patients with clinically suspected TTP-HUS; 4.46 x 10(6) (95% CI: 3.43-5.50) for patients with idiopathic TTP-HUS; and 1.74 x 10(6) (95% CI: 1.06-2.41) for patients with severe ADAMTS-13 deficiency (<5% activity). In all three categories, the incidence rates were greater for women and for blacks. For patients with severe ADAMTS-13 deficiency, the age-sex standardized incidence rate ratio of blacks to non-blacks was 9.29 (95% CI: 4.33-19.93). Accurate incidence rate estimates for all patients with clinically suspected TTP-HUS, idiopathic TTP-HUS, and TTP associated with severe ADAMTS-13 deficiency have been determined. The greater incidence among women and blacks is comparable with their increased risk for other autoimmune disorders.