Estimates Of Annual Incidence Research Articles

Responding to social and emotional vulnerability: Child welfare investigations involving older adolescents

AbstractIn 2018, the child welfare system in Ontario, Canada, expanded the age of protection to include 16 and 17 year olds for the purpose of mitigating risk of harm for older adolescents. To date, there is little information regarding investigations of older adolescents, particularly in Ontario; this study will address this gap. Data used for this analysis were drawn from the Ontario Incidence Study of Reported Child Abuse and Neglect‐2018. The Ontario Incidence Study of Reported Child Abuse and Neglect‐2018 sample data were weighted to derive an annual incidence estimate of 155 649 maltreatment‐related investigations conducted in Ontario in 2018. Child, caregiver, household, and investigation characteristics were compared across three age groups: children (0–10), younger adolescents (11–15), and older adolescents (16–17). Characteristics and differences in the likelihood of a service response (referral to nonchild welfare services, transfer to ongoing child welfare services, or placement in out‐of‐home care during the investigation) were examined descriptively and using chi‐square automatic interaction detection. Half of investigations involving older adolescents received a service response, and they were more likely to receive a service response when there were concerns about future risk of harm, where there were concerns about the relationship between the adolescent and their caregivers, where internalizing or externalizing symptoms were noted, where caregivers had few social supports, and where the household experienced economic hardship. These findings suggest that older adolescents are being triaged for circumstances that reflect concerns about their vulnerability, including mental health needs, attachment concerns, and caregiver isolation.

64-OR: Trends in Racial, Ethnic, and Socioeconomic Inequalities in Diagnosed Diabetes Prevalence and Incidence among U.S. Adults, 2008–2021

We examined national trends in racial, ethnic, and socioeconomic status (SES) inequalities for diagnosed diabetes prevalence and incidence. Self-reported data were from adults aged ≥18 years in the National Health Interview Survey 2008-2021. Annual prevalence and incidence estimates were age-standardized to the 2010 U.S. Census population. Absolute measures of inequality in diagnosed diabetes prevalence and incidence included between-group variance (BGV) for race and ethnicity (nominal categories) and the slope index of inequality (SII) for SES (educational attainment and family poverty-to-income ratio (PIR) ordinal categories). We calculated BGV and SII for each year along with the average annual percent change (AAPC) to assess trends in inequalities over time. PIR inequalities in diabetes prevalence increased (AAPC for SII: -1.7%, p=.010) while racial and ethnic (AAPC for BGV: -10.9%, p=.010) and education (AAPC for SII: 5.8%, p=.001) inequalities in diabetes incidence decreased over time (Figure). From 2008-2021, racial, ethnic, and education inequalities in diagnosed diabetes incidence improved but persisted. Income-related inequalities in diagnosed diabetes prevalence worsened over time. To close these gaps, future research could focus on identifying factors driving these trends including the contribution of morbidity and mortality. Disclosure R.Saelee: None. I.A.Hora: None. M.E.Pavkov: None. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. K.M.Bullard: None.

Epidemiology of Dog Walking-Related Injuries among Adults Presenting to US Emergency Departments, 2001-2020.

Dog walking is a popular daily activity, yet information regarding its injury burden is limited. This study describes the epidemiology of injuries related to leash-dependent dog walking among adults presenting to US emergency departments from 2001 to 2020. A retrospective analysis was performed using the National Electronic Injury Surveillance System database to identify adults (≥18 yr) presenting to US emergency departments with leash-dependent dog walking-related injuries between 2001 and 2020. Outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for sustaining a fracture or traumatic brain injury (TBI). Weighted estimates and 95% confidence intervals (CI) were generated using National Electronic Injury Surveillance System sample weights. Between 2001 and 2020, an estimated 422,659 adults presented to US emergency departments with injuries related to leash-dependent dog walking. The annual incidence increased more than fourfold during this period ( n = 7282 vs n = 32,306, P < 0.001). Most patients were women (75%) and adults age 40 to 64 yr (47%), with a mean age of 53 ± 0.5 yr. Patients commonly injured their upper extremity (51%) and were injured while falling when pulled or tripped by the leash (55%). The three most common injuries were finger fracture (6.9%), TBI (5.6%), and shoulder sprain/strain (5.1%). On multivariate analysis, fracture risk among dog walkers was higher in adults age ≥65 yr (odds ratio [OR], 2.1; 95% CI, 1.8-2.5) and women (OR, 1.5; 95% CI, 1.3-1.7). Risk of TBI was also elevated among older dog walkers (OR, 1.6; 95% CI, 1.3-2.0). Dog walking is associated with a considerable and rising injury burden. Dog owners should be informed of this injury potential and advised on risk-reduction strategies.

Burden of Serious Fungal Infections in India.

Fungal disease is frequent in India, but its incidence and prevalence are unclear. This review aims at defining the frequency or burden of various fungal infections in India. A systematic review of the literature on the PubMed, Embase, and Web of Science (WOS) databases was conducted using appropriate search strings. Deterministic modeling determined annual incidence and prevalence estimates for multiple life- and sight-threatening infections with significant morbidity. Literature searches yielded >2900 papers; 434 papers with incidence/prevalence/proportion data were analyzed. An estimated 57 251 328 of the 1 393 400 000 people in India (4.1%) suffer from a serious fungal disease. The prevalence (in millions) of recurrent vulvovaginal candidiasis is 24.3, allergic bronchopulmonary aspergillosis is 2.0, tinea capitis in school-age children is 25, severe asthma with fungal sensitization is 1.36, chronic pulmonary aspergillosis is 1.74, and chronic fungal rhinosinusitis is 1.52. The annual incidence rates of Pneumocystis pneumonia (58 400), invasive aspergillosis (250 900), mucormycosis (195 000), esophageal candidiasis in HIV (266 600), candidemia (188 000), fungal keratitis (1 017 100), and cryptococcal meningitis (11 500) were also determined. Histoplasmosis, talaromycosis, mycetoma, and chromoblastomycosis were less frequent. India's fungal burden is high and underappreciated in clinical practice.

S1.5a Epidemiology of myotic keratitis in developing countries

S1.5 Mycotic keratitis, September 21, 2022, 11:00 AM - 12:30 PM Mycotic keratitis (corneal infection due to a fungal etiology) is a well-recognized ophthalmological emergency warranting rapid initiation of specific antifungal therapy. However, the magnitude of the problem of mycotic keratitis in the community, especially in the Indian subcontinent and the developing world, is, perhaps, less apparent. A minimal annual incidence estimate of 1051, 787 cases (23.6/100 000 population [popln]) globally has recently been reported, with the highest rates being in Asia (33.9/100 000 popln, an absolute number of 939 895) and Africa (13.5/100 000; 75 196); if all culture-negative cases are assumed to be fungal, especially where the incidence of mycotic keratitis is known to be high, then the annual incidence would be about 1480 916 cases. A fungal etiology has been found to account for a very high proportion (> 45%) of microbial keratitis cases in countries in the Indian subcontinent. Countries where a fungal etiology accounts for >25% of microbial keratitis mostly tend to abut the equator. Interestingly, the proportion of microbial keratitis patients with a proven fungal etiology shows a significant negative correlation with the gross domestic product per capita. Although it is clear that the most common fungal species are Fusarium, Aspergillus, and Candida species, marked regional variations in fungal etiology have been noted. It is important to realize that sensitivity of the culture of ocular fungal pathogens can vary, depending on the pathogen, as well as the competence of the testing laboratory. For some countries, multiple reports over time have been noted, with there being some evidence of an increasing trend in the proportion of all microbial keratitis cases being diagnosed as mycotic keratitis. Even in a single geographical location, cases of mycotic keratitis may be higher than the yearly average at certain times of the year, such as during the harvest or windy seasons, or when there is increased relative humidity. A disturbing statistic to note is that, in 8%-11% of patients with mycotic keratitis, the affected eye needs to be removed, representing an irreversible annual loss of 84 143-115 697 eyes. It is recognized that many people suffering from mycotic keratitis in rural distant communities never present to health care workers due to financial and other constraints. Hence, the actual number of people afflicted by mycotic keratitis, man-days lost due to the disease and during therapy, and reduced quality of life due to persistent disability (corneal scarring) in the Indian subcontinent and developing countries requires further study.

Human brucellosis: Widespread information deficiency hinders an understanding of global disease frequency.

BackgroundFor decades, human brucellosis has been recognized worldwide as a significant cause of morbidity, yet the annual incidence of this disease remains unknown. We analyzed this frequency, using international reports (2005–2019), identifying information gaps, and distinguishing a possible path forward.Methodology/Principal findingsA novel approach to estimating the incidence of this disease was explored. We utilized annual health data extracted from the World Organization for Animal Health (OIE)–World Animal Health Information System (WAHIS) database, assessing the dataset completeness and representativeness of the data for the world population. Additionally, we assessed the reported country level human brucellosis case counts and the factors that influenced the observed changes over time. Our analysis revealed incomplete and unrepresentative information, preventing the estimation of annual human brucellosis case incidence at the global level. In the OIE-WAHIS database, only 48.4% of the required reports have been submitted as of 2019, with approximately 47.3% of the world population represented. Additionally, geographic regions were disproportionate in completeness, representativeness, and actual reported case counts. Africa and Asia constituted the majority of reported cases, while simultaneously submitting the lowest percentage of reports as well as covering the lowest percentage of their populations within those reports, when compared to the rest of the world.Conclusions/SignificanceThe global annual frequency of human brucellosis cases remains elusive. Furthermore, there exists great heterogeneity in diagnostic, surveillance, and reporting systems worldwide, calling into question the validity of available information. This study reveals that the Neglected Zoonotic Disease priority status for brucellosis should be restored.

Global incidence and mortality of hepatitis B and hepatitis C acute infections, cirrhosis and hepatocellular carcinoma from 2010 to 2019.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) contribute to significant healthcare burden globally. We aim to provide an updated and comprehensive analysis of global trends in the incidence and mortality of HBV and HCV related acute infections, cirrhosis and hepatocellular carcinoma (HCC). Estimates of annual cause-specific disease incidence and mortality for HBV and HCV were analysed using the 2010-2019 Global Burden of Diseases, Injuries and Risk Factors Study database. Three distinct disease states were evaluated: acute infections, cirrhosis and HCC. Age-standardized disease incidence and mortality were presented per 100,000 population and stratified by age, sex, year and 21 world regions. From 2010 to 2019, overall incidence of acute HBV declined by 19.3% (95% CI 4.1-32.0, p<.05) and HBV cirrhosis declined by 15.0% (95% CI 9.8-20.7, p<.05). Incidence of HCV cirrhosis increased by 5.6% (95% CI 0.3-10.2, p<.05) and HCV HCC remained stable. Incidence of acute HCV declined until 2015, after which it began increasing. From 2010 to 2019, overall mortality for HBV cirrhosis and HCV cirrhosis declined, whereas mortality for acute infections and HCC remained stable. Major differences in HBV and HCV incidence and mortality trends were observed when stratified by world regions. In conclusion, while our analyses of global trends in HBV and HCV incidence and mortality demonstrate encouraging trends, disparities in disease epidemiology were observed across world regions. These observations will identify regions and populations where greater focus and resources are needed to continue progressing towards viral hepatitis elimination.

Trends in the Annual Consultation Incidence and Prevalence of Low Back Pain and Osteoarthritis in England from 2000 to 2019: Comparative Estimates from Two Clinical Practice Databases.

PurposeTo compare estimates of annual person-consulting incidence and prevalence of low back pain (LBP) and osteoarthritis for two national English electronic health record databases (Clinical Practice Research Datalink (CPRD) Aurum and CPRD GOLD).Patients and MethodsRetrospective, population-based, longitudinal cohort study. LBP and osteoarthritis cases were defined using established codelists in people aged ≥15 and ≥45 years, respectively. Incident cases were new recorded cases in a given calendar year with no relevant consultation in the previous 3 years (denominator = exact person-time in the same calendar year for the at-risk population). Prevalent cases were individuals with ≥1 consultation for the condition of interest recorded in a given calendar year, irrespective of prior consultations for the same condition (denominator = all patients with complete registration history in the previous 3 years). We estimated age-sex standardised incidence and annual (12-month period) prevalence for both conditions in 2000–2019, overall, and by sex, age group, and region.ResultsStandardised incidence and prevalence of LBP from Aurum were lower than those from GOLD until 2014, after which estimates were similar. Both databases showed recent declines in incidence and prevalence of LBP: declines began earlier in GOLD (after 2012–2014) than Aurum (after 2014–2015). Standardised incidence (after 2011) and prevalence of osteoarthritis (after 2003) were higher in Aurum than GOLD and showed different trends: incidence and prevalence were stable or increasing in Aurum, decreasing in GOLD. Stratified estimates in CPRD Aurum suggested consistently higher occurrence among women, older age groups, and those living in the north of England.ConclusionComparative analyses of two English databases produced conflicting estimates and trends for two common musculoskeletal conditions. Aurum estimates appeared more consistent with external sources and may be useful for monitoring population musculoskeletal health and healthcare demand, but they remain sensitive to analytic decisions and data quality.

Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014.

ABSTRACT.Q fever and spotted fever group rickettsioses (SFGR) are common causes of severe febrile illness in northern Tanzania. Incidence estimates are needed to characterize the disease burden. Using hybrid surveillance—coupling case-finding at two referral hospitals and healthcare utilization data—we estimated the incidences of acute Q fever and SFGR in Moshi, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Cases were defined as fever and a four-fold or greater increase in antibody titers of acute and convalescent paired sera according to the indirect immunofluorescence assay of Coxiella burnetii phase II antigen for acute Q fever and Rickettsia conorii (2007–2008) or Rickettsia africae (2012–2014) antigens for SFGR. Healthcare utilization data were used to adjust for underascertainment of cases by sentinel surveillance. For 2007 to 2008, among 589 febrile participants, 16 (4.7%) of 344 and 27 (8.8%) of 307 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 80 (uncertainty range, 20–454) and 147 (uncertainty range, 52–645) per 100,000 persons, respectively. For 2012 to 2014, among 1,114 febrile participants, 52 (8.1%) and 57 (8.9%) of 641 participants with paired serology had Q fever and SFGR, respectively. Adjusted annual incidence estimates of Q fever and SFGR were 56 (uncertainty range, 24–163) and 75 (uncertainty range, 34–176) per 100,000 persons, respectively. We found substantial incidences of acute Q fever and SFGR in northern Tanzania during both study periods. To our knowledge, these are the first incidence estimates of either disease in sub-Saharan Africa. Our findings suggest that control measures for these infections warrant consideration.

The disease burden of ocular toxoplasmosis in Denmark in 2019: Estimates based on laboratory testing of ocular samples and on publicly available register data

BackgroundToxoplasma gondii is an important zoonotic protozoan parasite with worldwide distribution. Information on the contribution of ocular toxoplasmosis to the disease burden caused by this parasite is limited or lacking from many countries. MethodsWe estimated the minimum occurrence of ocular toxoplasmosis in Denmark using results from direct detection of T. gondii DNA with qPCR and determination of the Goldmann-Witmer coefficient on ocular samples submitted by ophthalmological clinics and departments to the national reference laboratory in 2003–2019. In addition, we inferred incidence estimates using retrospective data that are publicly available in the National Patient Register, and we used unstructured expert elicitation as the basis for sensitivity analyses. We estimated the disease burden of ocular toxoplasmosis in 2019 in disability-adjusted life years (DALYs). FindingsOcular samples from 263 individuals (median age 57 years, range 2–88) had been tested with at least one of the methods during 2003–2019, and 42 (16%) tested positive (median age 65 years, range 14–85). In 2019, five (16%) of 31 tested individuals were positive, giving a minimum annual incidence estimate of 0.09 per 100.000 population. From this, we calculated a disease burden of at least 4 DALYs (95% confidence interval, 3–5). The age range suggested that this figure represented postnatally acquired ocular toxoplasmosis. The disease burden of ocular toxoplasmosis due to congenital toxoplasmosis has been previously estimated to be at least 12 DALYs, resulting in an estimated minimum total disease burden due to ocular toxoplasmosis of 16 DALYs. In 2005–2018, the mean annual number of diagnoses of ocular toxoplasmosis reported to the National Patient Register was 186, and the corresponding disease burden estimate was 134 DALYs (95% confidence interval, 113–158). Sensitivity analyses focusing on incidence and severity resulted in disease burden estimates in the range of 9–523 DALYs. InterpretationBecause most diagnoses of ocular toxoplasmosis are based on clinical observations, ophthalmoscopy, and serology without confirmatory testing, the disease burden caused by ocular toxoplasmosis is likely substantially higher than our minimum estimates. Our results indicate that ocular toxoplasmosis contributes to the disease burden caused by T. gondii in Denmark, but uncertainty about the incidence and severity precludes reliable estimation of its importance.

Current and Future Projections of Amyotrophic Lateral Sclerosis in the United States Using Administrative Claims Data

Background: Various methodologies have been reported to assess the real-world epidemiology of amyotrophic lateral sclerosis (ALS) in the United States. The aim of this study was to estimate the prevalence, incidence, and geographical distribution of ALS using administrative claims data and to model future trends in ALS epidemiology. Methods: We performed a retrospective analysis of deidentified administrative claims data for >100 million patients, using 2 separate databases (IBM MarketScan Research Databases and Symphony Health Integrated DataVerse [IDV]), to identify patients with ALS. We evaluated disease prevalence, annual incidence, age- and population-controlled geographical distribution, and expected future trends. Results: From 2013 to 2017, we identified 7,316 and 35,208 ALS patients from the MarketScan databases and IDV, respectively. Average annual incidence estimates were 1.48 and 1.37 per 100,000 and point prevalence estimates were 6.85 and 5.16 per 100,000 and in the United States for the MarketScan databases and IDV, respectively. Predictive modeling estimates are reported out to the year 2060 and demonstrate an increasing trend in both incident and prevalent cases. Conclusions: This study provides incidence and prevalence estimates as well as geographical distribution for what the authors believe to be the largest ALS population studied to date. By using 2 separate administrative claims data sets, confidence in our estimates is increased. Future projections based on either database demonstrate an increase in ALS cases, which has also been seen in other large-scale ALS studies. These results can be used to help improve the allocation of healthcare resources in the future.

328-OR: County-Level Diabetes Incidence among U.S. Adults in 2019: Timely Small-Area Estimates from a New Model

Incident cases of diabetes among survey participants are defined as those diagnosed within the proceeding12 months. Because few cases may be observed each year, annual county-level estimates of incidence have required multiple years of data, delaying their release. We developed a new model, Bayesian weighted Binomial Zero-inflated (BBZ), to deliver timely estimates based on the most recent year of data while incorporating sampling weights and prior-year data and accounting for counties with “excess” zero cases. BBZ models were validated with American Community Survey county-level 1-year reports. We used 2019 Behavioral Risk Factor Surveillance System and US Census projections to estimate county-level incidence of diagnosed diabetes among US adults ≥20 years in 2019. In 2019, age-adjusted diabetes incidence ranged from 2.7 (95% CI: 2.6-2.8) per 1000 persons to 15.8 (95% CI: 15.7-1.60) per 1000 persons among 3121 counties (Figure). The national rate, calculated by aggregating county-level estimates, was 6.8 (95% CI: 6.5-7.0) per 1000 persons. National incidence among adults ≥65 years was over 4.5 times higher than those aged 20 to 44; there was no statistical difference by sex. The new BBZ modeling approach facilitates timely release of annual county-level estimates and prompt evaluation of disparities in the incidence of diagnosed diabetes. Disclosure H. Xie: None. D. B. Rolka: None. S. R. Benoit: None. K. M. Bullard: None.

Major findings from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018

BackgroundThe Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is the only source of province-wide statistics on families investigated by child welfare. ObjectiveThis paper presents key findings from the 2018 cycle of the OIS (OIS-2018) and highlights select policy and practice implications of these findings. Participants and SettingsThe OIS-2018 captured information directly from investigating child protection workers about children and families who were the subject of a child protection investigation sampled for inclusion in the study. MethodsThe OIS-2018 sample was drawn in three stages: first, a representative sample of child welfare agencies in Ontario was selected, then cases were sampled over a three-month period within selected agencies, and, finally, investigations that met the study criteria were identified from the sampled cases. The data collected for the OIS-2018 were weighted in order to derive provincial, annual incidence estimates. ResultsAn estimated 158,476 child maltreatment-related investigations were conducted in Ontario in 2018. In the majority of investigations, there was no documented physical or emotional harm to the child. The overall incidence of investigations remains unchanged between 2008 and 2018. The only statistically significant difference during this time period is an increase in risk investigations between 2013 and 2018. ConclusionsData from the OIS gives Ontario child welfare policymakers and practitioners an empirical basis for making evidence-informed decisions. Findings are compared to the United States and Australia.

National and Subnational Trends of Incidence and Mortality of Female Genital Cancers in Iran; 1990-2016.

The present study aims to assess the incidence and mortality rates of gynecological cancers and their changes from 1990 to 2016 at national and subnational levels in Iran. Annual estimates of incidence and mortality for gynecological cancers from 1990 to 2016 at national and subnational levels were generated as part of a larger project entitled National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD). After the precise processing of data extracted from the Iran Cancer Registry, annual age-standardized incidence and mortality rates were calculated for each cancer, province, year and age group during the period of the study. In 2016, gynecological cancers constituted 8.0% of new cancer cases among women of all ages compared to 3.7% of new cases of cancer among women in 1990. The incidence rate of gynecological cancers has increased from 2.5 (0.9-5.6) per 100000 women in 1990 to 12.3 (9.3-15.7) per 100000 women in 2016, and the most common gynecological cancer has changed from cervical cancer in 1990 to corpus uteri cancer in 2016. Age-standardized incidence rates of ovarian, corpus uteri and vulvovaginal cancers increased from 1.3 (0.5-2.4), 1.7 (0.6-3.0), and 0.3 (0.0-0.7) in 1990 to 4.4 (3.6-5.2), 9.9 (6.8-13.4), and 0.6 (0.2-1.0) in 2016, respectively, showing a 3.3, 5.8 and 1.7-fold increase during this period. Age-standardized incidence rate of cervical cancer was 2.4 (1.7-3.3) cases per 100000 women in 2016 and did not differ significantly from the beginning of the study. An overall reduction was seen in national mortality to incidence ratios (MIR) from 2000 to 2015. The incidence rates of all gynecological cancers in different provinces have shown a converging trend that could indicate that attempts toward health equality have been effective. The declining trend of MIR could be interpreted as advancements in detection of cancer in its early stages and also improvements in treatments, in turn reflecting improvements in access to and quality of care.

Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995-2014: a population-based study using linked administrative data.

Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.

P237 Annual incidence and prevalence of ulcerative colitis and Crohn’s disease from 2010 to 2017 in four Nordic countries: Results from the TRINordic study

Abstract Background Incidence and prevalence of inflammatory bowel diseases (IBD) have been increasing for the past decades in the western world, however with an emerging trend of incidence stabilisation in recent years. There is an indication of higher IBD incidence and prevalence in northern Europe, especially in the Nordic region, compared with southern Europe. Methods This retrospective observational study collected data from the National Patient Registries and National Prescription Registries (Sweden [SWE], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate the annual incidence and prevalence of ulcerative colitis (UC) and Crohn’s disease (CD). Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later and no K51 or K50 codes prior to 2010 were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Incidence proportions highlight results through 2016, as 2017 patients had less than 1-year follow-up. Results In total, 69,876 patients were included (SWE n = 27,902, NOR n = 20,761, FIN n = 2,118, DEN n = 19,095), of which 44 367 patients were diagnosed with UC and 25,509 with CD. In 2016, the annual incidence of UC was 28 patients per 100,000 persons in NOR, 32 patients per 100,000 persons in DEN, 25 patients per 100,000 persons in SWE, and 44 patients per 100,000 in FIN. The corresponding results for the annual incidence of CD per 100,000 persons were 22 in NOR, 16 in DEN, 16 in SWE, and 21 in FIN. The prevalence per 100,000 persons of both UC and CD was the highest in DEN, followed by SWE and NOR, and lowest in FIN. Prevalence estimates increased in all four Nordic countries during 2010–2017: for UC, from 409 to 488 patients in SWE, from 256 to 428 in NOR, from 129 to 375 in FIN, and from 577 to 798 in DEN. For CD, it increased from 261 to 313 patients in SWE, from 164 to 258 in NOR, from 54 to 164 in FIN, and from 280 to 400 in DEN. Conclusion This retrospective observational study showed that during 2016, the annual incidence of UC ranged from 25–44 patients per 100,000 persons across the evaluated Nordic countries, whereas the annual incidence of CD was 16–22 patients per 100,000 persons. Prevalence of both UC and CD increased during 2010–2017 in all four countries. Estimates of UC and CD incidence and prevalence in this analysis are greater than reported in the published literature. Additional analyses are underway to further explore the impact of methodological decisions on the estimates of UC and CD annual incidence and prevalence.

Estimating HIV-1 incidence in Japan from the proportion of recent infections.

The first step of the UNAIDS/WHO 90-90-90 targets to encourage early diagnosis with treatment for the control of HIV-1 epidemic is to achieve 90% HIV-1 diagnosis in infected individuals. In Japan, approximately 30% of newly reported cases have been annually identified by AIDS onset, implying that substantial numbers of HIV-1-infected individuals remain undiagnosed. However, the proportion of undiagnosed cases has not yet been determined. In the present study, the proportion of recent HIV-1 infections to newly-diagnosed cases was determined from 2006 to 2015 using a recent infection assay for three metropolitan areas in Japan: Tokyo, Osaka, and Fukuoka. Estimated median periods between infection and diagnosis were 1.0, 1.8, and 2.9 years for Tokyo, Osaka, and Fukuoka, respectively. Estimation of annual HIV-1 incidence by a back-calculation method using these data as well as HIV/AIDS national surveillance data indicated proportions of undiagnosed to new HIV-1 infections from 2006 to 2015 to be 18% in Tokyo, 22% in Osaka, 38% in Fukuoka, and 28% in Japan. This is the first report estimating HIV-1 incidence in Japan using a serological biomarker in combination with national HIV/AIDS surveillance data.

Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

AimsThis article describes the methods, results and limitations of the International Diabetes Federation (IDF) Diabetes Atlas 9th edition estimates of worldwide numbers of cases of type 1 diabetes in children and adolescents. MethodsMost information in the published literature is in the form of incidence rates derived from registers of newly-diagnosed cases. After systematic review of the published literature and recent conference abstracts, identified studies were quality graded. If no study was available, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Estimates of incident cases were obtained by applying incidence rates to United Nations 2019 population estimates. Estimates of prevalent cases were derived from incidence rates after making allowance for higher mortality rates in less-developed countries. ResultsIncidence rates were available for 45% of countries (ranging from 6% in the sub-Saharan Africa region to 77% in the European region). Worldwide annual incidence estimates were 98,200 (128,900) new cases in the under 15 year (under 20 year) age-groups. Corresponding prevalence estimates were 600,900 (1,110,100) existing cases. Compared with estimates in earlier Atlas editions, numbers have increased in most IDF regions, reflecting incidence rate increases, but prevalence estimates have decreased in sub-Saharan Africa because allowance has been made for increased mortality in those with diabetes. ConclusionsWorldwide estimates of numbers of children and adolescents with type 1 diabetes continue to increase.

Epidemiology of systemic sclerosis and systemic sclerosis-associated interstitial lung disease.

Background: Interstitial lung disease (ILD) is one of the leading causes of mortality in patients with systemic sclerosis (SSc). To further understand this patient population, we present the first systematic review on the epidemiology of SSc and SSc-associated ILD (SSc-ILD).Methods: Bibliographic databases and web sources were searched for studies including patients with SSc and SSc-ILD in Europe and North America (United States and Canada). The systematic review was limited to publications in English, German, French, Spanish, Italian, and Portuguese, published between January 1, 2000 and February 29, 2016. For all publications included in the review, the methodologic quality was assessed. For each dimension and region, data availability in terms of quantity and consistency of reported findings was evaluated.Results: Fifty publications reporting epidemiologic data (prevalence, incidence, demographic profile, and survival and mortality) were included; 39 included patients with SSc and 16 included patients with SSc-ILD. The reported prevalence of SSc was 7.2–33.9 and 13.5–44.3 per 100,000 individuals in Europe and North America, respectively. Annual incidence estimates were 0.6–2.3 and 1.4–5.6 per 100,000 individuals in Europe and North America, respectively. Associated ILD was present in ~35% of the patients in Europe and ~52% of the patients in North America. In Europe, a study estimated the prevalence and annual incidence of SSc-ILD at 1.7–4.2 and 0.1–0.4 per 100,000 individuals, respectively. In both Europe and North America, SSc-ILD was diagnosed at a slightly older age than SSc, with both presentations of the disease affecting 2–3 times more women than men. Ten-year survival in patients with SSc was reported at 65–73% in Europe and 54–82% in North America, with cardiorespiratory manifestations (including ILD) associated with poor prognosis.Conclusion: This systematic review confirms that SSc and SSc-ILD are rare, with geographic variation in prevalence and incidence.

Changing epidemiology of motor neurone disease in Scotland.

Scotland benefits from an integrated national healthcare team for motor neurone disease (MND) and a tradition of rich clinical data capture using the Scottish MND Register (launched in 1989; one of the first national registers). The Scottish register was re-launched in 2015 as Clinical Audit Research and Evaluation of MND (CARE-MND), an electronic platform for prospective, population-based research. We aimed to determine if incidence of MND is changing over time. Capture-recapture methods determined the incidence of MND in 2015-2016. Incidence rates for 2015-2016 and 1989-1998 were direct age and sex standardised to allow time-period comparison. Phenotypic characteristics and socioeconomic status of the cohort are described. Coverage of the CARE-MND platform was 99%. Crude incidence in the 2015-2017 period was 3.83/100,000 person-years (95% CI 3.53-4.14). Direct age-standardised incidence in 2015 was 3.42/100,000 (95% CI 2.99-3.91); in 2016, it was 2.89/100,000 (95% CI 2.50-3.34). The 1989-1998 direct standardised annual incidence estimate was 2.32/100,000 (95% CI 2.26-2.37). 2015-2016 standardised incidence was 66.9% higher than Northern European estimates. Socioeconomic status was not associated with MND. Our data show a changing landscape of MND in Scotland, with a rise in incidence by 36.0% over a 25-year period. This is likely attributable to ascertainment in the context of improved neurological services in Scotland. Our data suggest that CARE-MND is a reliable national resource and findings can be extrapolated to the other Northern European populations.