Age-specific Incidence Rate Ratios Research Articles

The impact of the National Shingles Vaccination Program on the epidemiology of herpes zoster among adults ≥ 60 years in Victoria, Australia.

In November 2016, Australia recommended herpes zoster (HZ) vaccination for adults aged ≥ 60 years and implemented a National Shingles Vaccination Program (NSVP) offering free HZ vaccination to adults aged 70-79 years. This study investigated trends in HZ epidemiology among Victorian adults aged ≥ 60 years and the impact of the NSVP in this population. We conducted epidemiological analyses of routinely collected HZ surveillance data for Victorian adults aged ≥ 60 years who were notified as having a HZ illness or vaccination between 2012 and 2021. Annual incidence rates are presented for vaccinations, case notifications, emergency department presentations, hospitalisations and deaths by five-year age groups. Age-specific incidence rate ratios are calculated comparing the period prior to (1 January 2012 to 31 October 2016) and following (1 November 2016 to 31 December 2021) NSVP implementation. HZ vaccination rates were highest among those eligible to receive free vaccination (70-79 years), but appear to have plateaued across all age groups and remained below full coverage. Incidence rate ratios showed a statistically significant increase (p < 0.01) in HZ notifications across all age-groups. Emergency presentations and hospitalisations showed a statistically significant decline (p < 0.05) among the 70-79 year old age groups; however, these rates remained consistent or increased among other age groups for whom vaccination is recommended. Mortality rates declined, particularly among those aged 85+ years. HZ continues to cause significant disease among the older adult population in Victoria. The findings of this study suggest the NSVP has led to some changes in the epidemiology of HZ among the 70-79 years old age group in Victoria; however, there is less evidence that it has influenced other age groups for whom vaccination is recommended. An evaluation of the NSVP and epidemiology of HZ at a national level is required to identify strategies to improve vaccination coverage among the target populations.

Fractures in people with epilepsy: A nationwide population-based cohort study.

The objective of this study was to determine the age, gender, and site-specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018. PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site-specific fractures. We also calculated gender and age-specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios (RR) were estimated for the number and type of ASM as well as comorbid conditions. Out of 13 818 prevalent epilepsy cases, 6383 (46.2%) were females, and 7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during the study period and ~8 people out of 1000 in the general population. The most frequent sites in terms of PP both in PWE and controls, were fractures of the lower arm, hip and femur, and lower leg. Significant differences in PP for all fracture locations were observed between PWE and controls (P < 0.001). The noticeable differences of ∼100 times higher PP were observed for fractures of the skull and jaw in PWE. IRR of any fracture in PWE was 272.84/10 000 person-years; higher in the older age groups and among people who received >2 ASM. Fracture risk was increased with the use of >2 ASM (OR: 1.56; 95% CI: 1.32-1.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10-1.38). This population-based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE.

Long term trends of breast cancer incidence according to proliferation status

BackgroundLong-term breast cancer incidence trends according to proliferation status are poorly described. We studied time-trends in breast cancer incidence, using mitotic count and Ki-67 as markers of proliferation.MethodsAmong 83,298 Norwegian women followed for breast cancer occurrence 1961–2012, 2995 incident breast cancers were diagnosed. Ki-67 was assessed using immunohistochemistry on tissue microarrays and mitoses were counted on whole sections. We compared incidence rates according to proliferation status among women born 1886–1928 and 1929–1977, estimating age-specific incidence rate ratios. We performed multiple imputations to account for unknown proliferation status. Mean values of Ki-67 and mitotic counts were calculated, according to age and birth year. We performed separate incidence analyses for HER2+ and triple negative breast cancers.ResultsAmong women aged 40–69 years, incidence rates of tumours with low-proliferative activity were higher among those born in 1929 or later, compared to before 1929, according to Ki-67 and mitotic count. Incidence rates of tumours with high-proliferative activity were also higher in women born in 1929 or later compared to before 1929 according to Ki-67, but not according to mitotic count. Mean values of Ki-67 and mitotic count varied according to age and birth year. In subtype-specific analyses we found an increase of high-proliferative HER2+ tumours according to Ki-67 in women born in 1929 or later, compared to before 1929.ConclusionsThere has been a temporal increase in both low- and high-proliferative breast cancers.

Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis.

Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions. We describe rates of stress-related presentations (SRPs) among school-aged adolescents (11-17 years) during school terms and holidays, and explore differences by age and gender. Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. We estimated incidence rate ratios for weekly SRPs in term time versus holidays from 2014-2015 to 2017-2018, using negative binomial regression models, stratified by age and gender. We estimated the cumulative incidence of any SRP between 11 and 17 years by analysing prior hospital admission histories of adolescents with an SRP in 2017-2018. Over the 4-year study period, 305 491 SRPs in 171 013 school-aged adolescents accounted for 31% of emergency admissions for this group. SRPs were predominantly for mental health problems or self-harm (38%), or pain (35%). Weekly admission rates for SRPs were higher in term time than holidays for all ages (age-specific incidence rate ratios were 1.15-1.49 for girls and 1.08-1.60 for boys). Rates were highest for girls aged 14 and 15 years. The estimated cumulative incidence of any SRP between 11 and 17 years was 7.9% for girls and 4.1% for boys. Hospital admissions for SRPs are common among adolescents, affecting around two girls and one boy in every classroom. Higher rates in term time than holidays suggest that school factors may contribute.

Sustained Declines in Age Group-Specific Rotavirus Infection and Acute Gastroenteritis in Vaccinated and Unvaccinated Individuals During the 5 Years Since Rotavirus Vaccine Introduction in England.

The introduction of an oral live-attenuated monovalent rotavirus vaccine (Rotarix®) into the UK infant immunization program in July 2013 was associated with large reductions in laboratory-confirmed rotavirus infections and hospitalizations due to acute gastroenteritis (AGE) within 12 months. Here we report the 5-year impact of the program in England. Individuals with laboratory-confirmed rotavirus infections during 2000-2018 and all-cause hospitalizations for AGE during 2007-2018 were identified using national electronic records. Age-specific incidence rate ratios (IRR) and estimated numbers of cases averted in each of the 5 postvaccination years were calculated. There were 206 389 laboratory-confirmed rotavirus infections and 3 657 651 hospitalizations for all-cause AGE. Reductions of 69-83% in laboratory-confirmed rotavirus infections in all age groups and 77-88% in infants aged <1 year in each of the 5 postvaccine years are reported, with 11 386-11 633 cases averted annually. All-cause AGE hospitalizations were reduced by 12-35% across all age-groups and by 25-48% in <1 year-olds in the 5 postvaccine years, with 24 474-49 278 hospitalizations averted annually. There was strong evidence of indirect (herd) protection, with at least 50% and up to 80% of the non-specific end point of all-cause gastroenteritis (AGE) hospitalizations averted being in unvaccinated age-groups, primarily older adults. Seasonal changes include a possible shift from annual to biennial peaks with lower peak incidence and longer seasons. There were large and sustained declines in both laboratory-confirmed rotavirus infections and AGE hospitalizations across all age groups in each of the 5 years since the introduction of the UK rotavirus program.

Abstract 1182: Racial and ethnic disparities in incidence of Langerhans Cell Histiocytosis differ across age groups

Abstract Introduction: Langerhans cell histiocytosis (LCH) is a myeloid neoplasia with median diagnosis age of 30 months. We recently reported an increased risk for LCH in children of Hispanic parents using data from the Texas Cancer Registry. However, less is known about racial/ethnic disparities among adults diagnosed with LCH. Therefore, we sought to compare the incidence of LCH by race/ethnicity in the United States among pediatric, adolescent/young adult (AYA), and adult cases using Surveillance, Epidemiology, and End Results (SEER-18) program data. Methods: LCH incidence data were obtained from the SEER-18 program, 2000-2016. Race/ethnicity was categorized as: non-Hispanic white (NHW); non-Hispanic black (NHB); non-Hispanic Asian (NHA); and Hispanic. Age-specific incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were generated in SEER-STAT (v8.3.6). Results: Data on cases with LCH ages 0-14 (nchildren=894), 15-39 (nAYAs=246), and 40+ (nadults=341) were abstracted. Compared to NHW children, Hispanic children experienced significantly elevated IRRs (IRRHispanic_children=1.28, 95% CI: 1.10-1.48). However, this trend was not observed among AYAs (IRRHispanic_AYAs=0.57, 95% CI: 0.40-0.80) or adults (IRRHispanic_adults=0.47, 95% CI: 0.29-0.73) where lower IRRs compared to NHWs were evident. While not statistically significant across all age groups, this trend was also suggested among NHAs. Compared to NHW children, IRRs for NHAs were slightly elevated (IRRNHA_children=1.19; 95% CI: 0.93-1.51), whereas among AYAs a trend toward lower incidence was evident (IRRNHA_AYAs=0.57, 95% CI: 0.32-0.94) and became stronger among NHA adults (IRRNHA_adults=0.52, 95% CI: 0.31-0.84). NHBs experienced lower IRRs compared to NHWs in all age groups that reached a level of statistical significance: (IRRNHB_children=0.43, 95% CI: 0.31-0.57; IRRNHB_AYAs=0.48, 95% CI: 0.28-0.77; and IRRNHB_adults=0.50, 95% CI: 0.30-0.79). These estimates remained similar after adjusting for sex and SEER registry using Poisson regression. Conclusion: This study demonstrates that the incidence of LCH by racial/ethnic group varies substantially across the age spectrum. Specifically, Hispanic pediatric LCH cases experience a unique increase in incidence compared to NHWs that is not observed among Hispanic AYAs or adults, or among other racial/ethnic groups. These results align with previous studies that indicate Hispanic children in the lowest age groups experience the highest risk of LCH compared to NHWs. Additionally, NHBs in all age groups experienced a decreased incidence of LCH compared to NHWs; an observation historically noted in the literature. Overall, these contrasts in incidence by race/ethnicity may suggest differences in underlying LCH etiology across the age spectrum, and particularly in children. While limitations of registry data exist, future studies characterizing molecular components in adults compared to children is warranted. Citation Format: Erin Christine Peckham-Gregory, Kenneth McClain, Carl Allen, Philip Lupo, Michael Scheurer. Racial and ethnic disparities in incidence of Langerhans Cell Histiocytosis differ across age groups [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1182.

Broadening risk profile in familial colorectal cancer type X; increased risk for five cancer types in the national Danish cohort

BackgroundFamilial colorectal cancer type X (FCCTX) is a phenotypically defined subset of hereditary colorectal cancer with unknown and potentially heterogeneous genetic aetiology. FCCTX has been characterized as a colorectal cancer-specific syndrome, which we herein challenge by estimating the risk for extra-colorectal cancer in the Danish FCCTX cohort.MethodsThrough the national hereditary non-polyposis colorectal cancer (HNPCC) register, 213 families fulfilling the Amsterdam I criteria and showing retained mismatch repair (MMR) function were identified. In here, sex and age-specific incidence rate ratios (IRR) were calculated for 30 extra-colorectal cancer types in comparison with the general Danish population.ResultsIn total, 494 extra-colorectal cancers developed with significantly increased risks for cancers of the urinary tract, breast, stomach, pancreas, and eye tumours. The age groups at increased risks were 30–49 years for gastric cancer, 30–69 years for female breast cancer, 50–69 years for ocular melanoma and above age 70 for pancreatic cancer and urothelial cancer.ConclusionsDanish FCCTX families show an increased risk of several extra-colorectal cancer types. This observation may indicate unidentified disease-predisposing genetic variants in this phenotypically defined subset of hereditary colorectal cancer and calls for awareness during genetic counselling and follow-up.

Differences in cancer incidence by age at diagnosis between Aboriginal and non-Aboriginal people for cancer types included in Australian national screening programs

BackgroundThis study examined age distributions and age-specific incidence of screened cancers by Aboriginal status in New South Wales (NSW) to consider the appropriateness of screening target age ranges. MethodsThe NSW Cancer Registry identified invasive (female) breast, cervical and bowel cancers in people diagnosed in 2001–2014. ResultsAboriginal people were younger at diagnosis with higher proportions of breast and bowel cancers diagnosed before the screening target age range (<50 years) compared with non-Aboriginal people (30.6% vs. 22.8%, and 17.3% vs. 7.3%, respectively). Age-specific incidence rate ratios (IRRs) were lower/similar for breast and bowel cancers in younger and higher in older Aboriginal than non-Aboriginal people. All age-specific cervical cancer IRRs were higher for Aboriginal compared with non-Aboriginal people. ConclusionAlthough higher proportions of breast and colorectal cancers were diagnosed before screening commencement age in Aboriginal people, this does not necessarily indicate a need for earlier screening commencement. Other aspects needing consideration include benefits, harms and cost-effectiveness.

Breast cancer in Portugal: Temporal trends and age-specific incidence by geographic regions

BackgroundFemale breast cancer incidence rates have been increasing in Portugal for years. We, therefore, conducted the first nationwide breast cancer study to assess regional differences. MethodsCases were obtained from population-based cancer registries covering the country’s Mainland (South, North, Centre), as well as the two Autonomous Regions (Azores and Madeira), for the time-period 1998 through 2011. Analyses were restricted to ages 30–84 years and stratified by region. We used the age-period-cohort (APC) framework to complement standard descriptive techniques and to forecast future trends. Estimable APC parameters included net drift, longitudinal age-specific incidence rate curves, and fitted age-specific incidence rate ratios. ResultsThere were 71 545 breast cancer cases diagnosed in Portugal at ages 30–84 years from 1998 to 2011. The South presented the highest age-standardized rate (155.8/100 000), while the North presented the fastest rate of increase (3.6%/year). Age-specific statistical interactions were observed between regions. Younger women in the North revealed a decreased risk of developing breast cancer compared to women from the same age group in the South and Centre, while that risk was reversed in older women (p < 0.05). We estimate that from 2014 onwards, the North might rank first among all regions. ConclusionThe variant patterns observed could be due to a combination of different screening practices and/or exposure to risk factors across regions. Disease heterogeneity among younger and older women may also explain part of the differences in age-specific rates. These results justify continued monitoring of breast cancer incidence by region.

The Impact of Pneumococcal Vaccination on Bacterial and Viral Pneumonia in Western Australian Children: Record Linkage Cohort Study of 469589 Births, 1996-2012.

Pneumococcal conjugate vaccine (PCV) was included in Australia's National Immunisation Program for all children from 2005. We assessed the impact of PCV on all-cause and pathogen-specific pneumonia hospitalizations in Western Australian (WA) children aged ≤16 years. All hospitalizations with pneumonia-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes occurring in WA-born children (1996-2012) were linked to pathology records. Age-specific incidence rate ratios and temporal trends for all-cause and pathogen-specific pneumonia hospitalizations were calculated before and after PCV introduction. Among 469589 births, there were 15175 pneumonia-related hospitalizations. Hospitalization rates were 6.7 (95% confidence interval, 6.4-6.9) times higher in Aboriginal than in non-Aboriginal children. Following PCV introduction, all-cause pneumonia hospitalizations showed significant declines across all age groups. A pathogen was identified in 2785 of 6693 (41.6%) pneumonia hospitalizations that linked to a pathology record. Respiratory syncytial virus (RSV) was most frequently identified, with RSV-associated pneumonia hospitalization rates of 89.6/100000 child-years in Aboriginal and 26.6/100000 child-years in non-Aboriginal children. The most common bacterial pathogen was Streptococcus pneumoniae in Aboriginal children (32.9/100000 child-years) and Mycoplasma pneumoniae in non-Aboriginal children (8.4/100000 child-years). Viral pneumonia rates declined in all children following PCV introduction, with the greatest declines seen in non-Aboriginal children; declines in bacterial pneumonia were observed in non-Aboriginal children. Based on our ecological analyses, PCV seems to have had an impact on hospitalizations for pneumonia, suggesting that the pneumococcus is likely to play a role in both bacterial and viral pneumonia. Respiratory viruses remain an important pathogen in childhood pneumonia. Vaccines targeting respiratory viruses are needed to combat the residual burden of childhood pneumonia.

Towards gene- and gender-based risk estimates in Lynch syndrome; age-specific incidences for 13 extra-colorectal cancer types

Background:In Lynch syndrome, inherited mismatch repair (MMR) defects predispose to colorectal cancer and to a wide spectrum of extra-colorectal tumours. Utilising a cohort study design, we aimed to determine the risk of extra-colorectal cancer and to identify yet unrecognised tumour types.Methods:Data from 1624 Lynch syndrome mutation carriers in the Danish hereditary non-polyposis colorectal cancer register were used to estimate the sex- and age-specific incidence rate ratios (IRRs) for 30 extra-colorectal malignancies with comparison to the general population.Results:Significantly increased IRRs were identified for 13 cancer types with differences related to gender, age and disease-predisposing gene. The different cancer types showed variable peak age incidence rates (IRs) with the highest IRs for ovarian cancer at age 30–49 years, for endometrial cancer, breast cancer, renal cell cancer and brain tumours at age 50–69 years, and for urothelial cancer, small bowel cancer, gastric cancer, pancreatic cancer and skin tumours after age 70.Conclusions:The broad spectrum of tumour types that develop at an increased incidence defines Lynch syndrome as a multi-tumour syndrome. The variable incidences in relation to age, gender and gene suggest a need for individualised surveillance.

Epidemiology of serogroup C and Y invasive meningococcal disease (IMD) in Ontario, 2000–2013: Vaccine program impact assessment

ObjectivesA publicly-funded meningococcal serogroup C conjugate vaccine (MCCV) program was introduced in Ontario, in 2004/2005 for 1-year-old children as well as adolescents (approximately 12 years old). In 2009, quadrivalent meningococcal conjugate vaccine (MCV4) replaced MCCV for grade seven students. Our objective was to determine meningococcal vaccine program impact on reported cases of serogroup C and Y invasive meningococcal disease (IMD) at the population level in Ontario, Canada. MethodsData were obtained from the Ontario reportable diseases system, the integrated Public Health Information System (iPHIS), and Public Health Ontario Laboratories (PHOL) for 2000–2013. Descriptive epidemiologic analyses, including age-specific rates for age groups based on program eligibility, were conducted. Changes over the 14-year observation period and comparison of pre- and post-program periods for MCCV and MCV4 were assessed. Analyses were conducted using SAS 9.3. ResultsThere were 161 serogroup C IMD cases and its annual incidence decreased significantly over time (17.2% reduction per year [95% CI: 13.4 to 20.7]). The incidence of serogroup C IMD decreased significantly in children aged 1–17 years in the post-program period, based on age-specific incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Adolescents 12–16 years had the lowest serogroup C IRR (0.07 [95% CI: 0.01 to 0.55]); the rate decreased more than 14-fold between the pre- and post-periods. There were 187 serogroup Y IMD cases and there was a non-significant 1.6% reduction per year [95% CI: −1.9 to 5.1]) over the surveillance period. Likewise, there was a non-significant decrease in serogroup Y IMD among persons 12–16 years (MCV4 eligible) in the post-program period. ConclusionsReductions in serogroup C IMD among program eligible and ineligible age groups suggest both direct and indirect MCCV vaccine program impact. Continued surveillance of IMD in Ontario is important to further assess MCV4 program impact.

Graduated driver licensing and motor vehicle crashes involving teenage drivers: an exploratory age-stratified meta-analysis

ObjectiveGraduated Driver Licensing (GDL) has been implemented in Australia, Canada, New Zealand, USA and Israel. We conducted an exploratory summary of available data to estimate whether GDL effects varied with...