Annual Trends Research Articles

Clostridioides difficile Infections and Antibiotherapy: Results of Four Years of Observation in a Romanian Tertiary Hospital

Clostridioides difficile infection (CDI) is one of the main causes of morbidity associated with antibiotic use, producing both healthcare-associated infections and community infections. This study aims to describe the epidemiological characteristics, the clinical outcomes, previous antibiotic exposure, and other risk factors of hospitalized patients with CDI in a tertiary infectious disease hospital in Bucharest, Romania. We performed a descriptive analysis based on four-year surveillance data, collected in a tertiary infectious disease hospital in Bucharest, Romania. The annual incidence of CDIs varied from 65.1 cases per 10,000 discharges in 2020 to 211.7 cases per 10,000 discharges in 2023, with a continuously ascending trend. Most of the cases were hospital-acquired cases. There was a high share of antibiotic consumption three months before admission (61.3%). Third-generation cephalosporins, β-lactams with inhibitor combination, and carbapenems were the most used antibiotics, with shares of 46.0%, 25.2%, and 18.6%, respectively. Hospitalization in the previous 12 months and contact with a confirmed CDI case were other frequent factors in the study group, the occurrences of which were recorded as 66.2% and 2.4%, respectively. The surveillance data identified that the annual trend in CDIs is very variable, suggesting the need for continuous and multiannual analysis.

Unravelling nitrate transformation mechanisms in karst catchments through the coupling of high-frequency sensor data and machine learning

Nitrate dynamics within a catchment are critical to the earth's system process, yet the intricate details of its transport and transformation at high resolutions remain elusive. Hydrological effects on nitrate dynamics in particular have not been thoroughly assessed previously and this knowledge gap hampers our understanding and effective management of nitrogen cycling in watersheds. Here, machine learning (ML) models were employed to reconstruct the annual variation trend in nitrate dynamics and isotopes within a typical karst catchment. Random forest model demonstrates promising potential in predicting nitrate concentration and its isotopes, surpassing other ML models (including Long Short-term Memory, Convolutional Neural Network, and Support Vector Machine) in performance. The ML-modeled NO3−-N concentrations, δ15N-NO3−, and δ18O-NO3− values were in close agreement with field data (NSE values of 0.95, 0.80, and 0.53, respectively), which are notably challenging to achieve for process models. During the transition from dry to wet period, approximately 23.0% of the annual precipitation (∼269.1 mm) was identified as the threshold for triggering a rapid response in the wet period. The modeled nitrate isotope values were significantly supported by the field data, suggesting seasonal variations of nitrogen sources, with precipitation as the primary driving force for fertilizer sources. Mixing of multiple sources appeared to be the main control of the transport and transformation of nitrate during the rising limb in the wet period, whereas process control (denitrification) took precedence during the falling limb, and the fate of nitrate was controlled by biogeochemical processes during the dry period.

Long-term (2000–2020) global 0.05° continuous atmospheric carbon dioxide mapping combining OCO-2 observations and model simulations

We reconstructed a global continuous 8-day XCO2 (column-averaged CO2 dry air mole fraction) product (GCXCO2) at a spatial resolution of 0.05° from 2000 to 2020, combining terrestrial/marine remote sensing data and model simulations based on developed and tested stacking machine learning method. The GCXCO2 product has the similar spatial pattern with OCO-2 satellite observations but with global seamless coverage, showing a higher spatial resolution and accuracy than CarbonTracker and CAMS model simulation data. A novel dynamic normalization strategy was developed to handle the great temporal variation issue and ensure the temporal expansion of the prediction model. The sampled based 10-fold cross-validation shows an overall satisfactory result at a global scale, with R2 = 0.974 and root-mean-square error (RMSE) = 0.551 ppm (parts per million). Further spatial extension and temporal prediction experiments also proved that dependable results could be obtained in the regions and time periods without valid OCO-2 satellite observations (R2 = 0.958 and R2 = 0.886, respectively). Compared with Total Carbon Column Observing Network (TCCON) ground station observations, the GCXCO2 demonstrates a better accuracy and a higher spatial resolution than the model simulation data. Based on the GCXCO2 product, an upward annual trend of approximately 2.105 ppm/year can be found for global XCO2 between 2000 and 2020, with greater seasonal fluctuations in the Northern Hemisphere than in the Southern Hemisphere. This product is one of some remote sensing-based global high-precision long-term XCO2 datasets and an important tool to help advance the understanding of climate change and carbon balance, but also to detect CO2 concentration anomalies. The dataset can be obtained publicly at doi:https://doi.org/10.5281/zenodo.10083102 (Guan and Sun, 2023).

Information provision and financial incentives in Catalonia's public primary care (2010–2019): an interrupted time series analysis

The relative efficacy of information provision versus financial incentives in improving primary care quality remains a critical, unresolved question. We investigated these two strategies in Catalonia's public primary care system from 2010 to 2019: an innovative online platform providing real-time quality indicator information and targeted economic incentives for achieving indicator goals. We conducted a comprehensive interrupted time series regression analysis on data from 272 primary care practices (5,628,080 patients). This analysis used linear regression models with Newey-West standard errors, and a sensitivity analysis including logit transformations to address ceiling effects. We evaluated 1) immediate post-intervention changes (step changes) in indicator results and inter-practice variability (coefficient of variation, CV), and 2) shifts in pre-intervention trends (slopes). We scrutinized 39 indicators after rigorous quality control: 23 novel (12 informed, 11 incentivized) and 16 derived from existing incentivized indicators. Robustness checks included 14 consistently incentivized and 10 non-intervened indicators. Overall, we assessed 63 indicators: 18 control, 13 follow-up, 9 quaternary prevention, 7 treatment, 7 diagnosis, 6 screening and 3 vaccination indicators. Informed indicators showed positive impacts in 75% (9/12) of cases, and incentivized indicators in 64% (7/11) of cases. Incentivized indicators displayed improvements in annual trends ranging from 6.66 to 1.25 percentage points, with step changes up to 8.87 percentage points. Information led to step changes ranging from 19.67 to 1.07 percentage points, along with trend improvements between 1.09 and 0.34 percentage points annually. Both interventions were associated with step reductions in variability (up to-0.18 CV reduction) and significant trend improvements. Derived indicators showed limited improvements in results or variability (31%, 5/16), with minor step increases up to 2.22 percentage points. Our findings reveal that information provision alone can match or even surpass the impact of financial incentives in improving care quality and reducing practice variability. This challenges conventional wisdom and offers a cost-effective, scalable approach to primary care quality enhancement, with far-reaching implications for global health policy. European Union, Horizon Europe.

Surgical Trends in Chronic Pancreatitis from 2014 Through 2021.

We analyzed annual surgical trends for benign chronic pancreatitis (CP), studying specifically mortality, morbidity, and pancreatic fistula rates. We also aimed to identify predictors of pancreatic fistula formation. For this analysis, we used data from the American College of Surgeons National Surgical Quality Improvement Program from 2014 through 2021. The study included patients who underwent surgery for benign CP. Data collected included patient demographics, preoperative variables, and postoperative outcomes. Data were analyzed with univariate and multivariate analyses, with significance defined as P ≤ .05. Over the study period, the number of pancreatic surgical procedures increased 49.3%, although surgery specifically for CP declined by 31.7%. The rate of pancreatic fistula formation decreased 44.9%, and mortality decreased 31.9%. Significant predictors of a pancreatic fistula included no diabetes, preoperative sepsis, soft texture of the pancreatic gland, and greater patient weight. Surgery for benign CP decreased substantially despite the established efficacy of surgical intervention for long-term pain management. The concurrent decline in mortality and rates of pancreatic fistula formation suggest advances over the study years in surgical and postoperative care.

Long-Term Spatiotemporal Analysis of Precipitation Trends with Implications of ENSO-Driven Variability in the Department of Magdalena, Colombia

The Magdalena department, influenced by southern trade winds and ocean currents from the Atlantic and Pacific, is a climatically vulnerable region. This study assesses the Magdalena Department’s precipitation trends and stationary patterns by analyzing multi-year monthly records from 55 monitoring stations from 1990 to 2022. To achieve this, the following methods were used: (i) homogeneous regions were established by an unsupervised clustering approach, (ii) temporal trends were quantified using non-parametric tests, (iii) stationarity was identified through Morlet wavelet decomposition, and (iv) Sea Surface Temperature (SST) in four Niño regions was correlated with stationarity cycles. Silhouette’s results yielded five homogeneous regions, consistent with the National Meteorological Institute (IDEAM) proposal. The Department displayed decreasing annual trends (−32–−100 mm/decade) but exhibited increasing monthly trends (>20 mm/decade) during the wettest season. The wavelet decomposition analysis revealed quasi-bimodal stationarity, with significant semiannual cycles (~4.1 to 5.6 months) observed only in the eastern region. Other regions showed mixed behavior: non-stationary in the year’s first half and stationary in the latter half. Correlation analysis showed a significant relationship between SST in the El Niño 3 region (which accounted for 50.5% of the coefficients), indicating that strong phases of El Niño anticipated precipitation responses for up to six months. This confirms distinct rainfall patterns and precipitation trends influenced by the El Niño–Southern Oscillation (ENSO), highlighting the need for further hydrometeorological research in the area.

Spatio-temporal variability and trends of air pollutants in the Metropolitan Area of Curitiba

Monitoring air pollutants over time is essential for identifying and addressing trends, which may help improve air quality management and safeguard public health. This study investigates the spatio-temporal variability of air quality in the Metropolitan Area of Curitiba (MAC), Brazil, focusing on six pollutants (SO2, NO2, NOx, O3, CO, and PM10) measured at eight monitoring stations from 2003 to 2017. We conducted statistical analyses, including diurnal cycles, seasonal variability, spatio-temporal correlations, conditional bivariate probability functions, Theil-Sen trend analysis, and comparison with national quality standards (NAQS) and World Health Organization (WHO) guidelines. The analyses revealed large variations in pollutant concentrations across the study area. For instance, stations strongly impacted by industrial emissions presented the highest mean annual SO2 (20–28 μg/m3) and PM10 (32–34 μg/m3) concentrations, while those mostly impacted by traffic showed elevated NO2 (31–39 μg/m3), NOx (63–86 μg/m3) and CO (0.6–0.8 mg/m3) concentrations. The two residential stations recorded the highest O3 concentrations (annual mean of 30–32 μg/m3). Seasonal and diurnal patterns varied by pollutant, with winter experiencing higher concentrations and O3 peaking in spring. SO2 concentrations presented no clear seasonal or diurnal cycle patterns, and showed the highest spatial variability. Significant decreasing annual trends were observed for SO2 (−5.9%), NO2 (−2.6%), NOx (−2.6%), CO (−5.4%), and PM10 (−3.7%), which suggests the success of emission reduction programs implemented in the road transportation and industrial sectors. However, O3 concentrations increased at most stations (+3.3%/yr), likely due to reduced NOx emissions, increased emissions of volatile organic compounds from on-road transport biofuels, and regional O3 transport. Although exceedances of NAQS decreased over time, concentrations of most pollutants remained above WHO guidelines, except for CO. These results highlight the importance of targeted emission control strategies for both industrial and vehicular sources to improve local air quality and inform future policy decisions.

Emissions of methane from coal fields, thermal power plants, and wetlands and their implications for atmospheric methane across the south Asian region

Abstract. Atmospheric methane (CH4) is a potent climate change agent responsible for a fraction of global warming. The present study investigated the spatiotemporal variability of atmospheric-column-averaged CH4 (XCH4) concentrations using data from the Greenhouse gases Observing SATellite (GOSAT) and the TROPOspheric Monitoring Instrument on board the Sentinel-5 Precursor (S5P/TROPOMI) from 2009 to 2022 over the south Asian region. During the study period, the long-term trends in XCH4 increased from 1700 to 1950 ppb, with an annual growth rate of 8.76 ppb yr−1. Among all natural and anthropogenic sources of CH4, the rate of increase in XCH4 was higher over the coal site at about 10.15 ± 0.55 ppb yr−1 (Paschim Bardhaman) followed by Mundra Ultra Mega Power Project at about 9.72 ± 0.41 ppb yr−1. Most of the wetlands exhibit an annual trend of XCH4 of more than 9.50 ppb yr−1, with a minimum rate of 8.72 ± 0.3 ppb yr−1 over Wular Lake. The WetCHARTs-based emissions of CH4 from the wetlands were minimal during the winter and pre-monsoon seasons. Maximum CH4 emissions were reported during the monsoon, with a maximum value of 23.62 ± 3.66 mg m−2 per month over the Sundarbans Wetland. For the 15 Indian agroclimatic zones, significant high emissions of CH4 were observed over the Middle Gangetic Plain, Trans-Gangetic Plain, Upper Gangetic Plain, Eastern Coastal Plains, Lower Gangetic Plain, and East Gangetic Plain. Further, the bottom-up anthropogenic CH4 emissions data are mapped against the XCH4 concentrations, and a high correlation was found in the Indo-Gangetic Plain region, indicating the hotspots of anthropogenic CH4.

Seasonal and annual trends in reference evapotranspiration and prediction using machine learning models across seven climatic zones of Bangladesh

ABSTRACT The primary aim of this investigation is to examine the historical (1989–2020) and future trends and magnitude of Reference Evapotranspiration (ET0) in terms of spatiotemporal measures, considering its significance as a hydro-meteorological parameter influenced by changing climate. The FAO-56 Penman-Monteith method is employed to analyze ET0, while the Modified Mann Kendall test is utilized to assess trends and Sen’s Slope Estimator is used for magnitude analysis. The future prediction is conducted using Support Vector Machine (SVM), Artificial Neural Network (ANN), and Random Forest (RF) models. Results show an increasing ET0 trend annually in the southeastern and northeastern zones, while decreased values are observed in other regions, particularly in the northwest (0.83 mm). Sen’s slope estimator reveals distinct fluctuations in ET0, with notable disparities in the Southeastern, Northeastern, Southwestern, and South-Central zones. Notably, Chattogram and Sitakunda experience an ET0 magnitude of 0.02 mm/Year, while other zones show a magnitude of 0.01 mm/Year. SVM outperformed other models, predicting rising ET0 in various seasons. These findings offer insights for optimizing irrigation systems and sustainable water management under changing climatic conditions.

Evaluating Temporal Price Behaviour of Rice in Bangladesh

Aims: The agriculture sector in Bangladesh is predominantly centered on rice production and it is the staple food. High prices of rice can affect the consumers adversely. This study aimed to analyze the annual price dynamics of rice in Bangladesh. Study Design: The study was based on secondary time series data of prices of different category of rice at wholesale and retail level. Both nominal and deflated prices were sued to analyze for achieving the objectives of the study. Place and Duration of Study: Secondary time series data of price for different category of rice from country as a whole from 1991 to 2021 were used to assess its annual price behavior. Methodology: Descriptive statistics were employed to assess the annual price fluctuations, while linear regression analysis was used to evaluate the annual price trends. Results: The analysis revealed significant variations in the annual wholesale and retail prices of rice (both fine and coarse). Notably, coarse rice exhibited greater price fluctuations compared to fine rice in both wholesale and retail markets. Price fluctuation at retail level for fine rice is greater than the wholesale level but in case of coarse rice, price fluctuation at retail level is lower than wholesale level. The study further found that the wholesale price trend for fine rice increased more sharply than that of coarse rice, a pattern that was also reflected in retail prices. Conclusion: The study indicates that over the study period, the price of fine rice experienced a more pronounced fluctuate and increase compared to coarse rice.

Spatial Distribution of Public Lower Secondary School and its Impact on Students’ Enrolment in Ogun Central Senatorial District Ogun State, Nigeria

Given the quest for universal basic education, the large enrolments in the Nigerian secondary educational institutions has resulted in the problem of over-crowded classes, shortage of teachers and shortages of classroom, which portend enormous challenges to the development of the educational sector in Ogun state. Using Ogun Central as a case study, the study identified the spatial pattern of the schools; analyzing students’ enrolment trends in the area, and identifying the factors associated with the observed pattern. Spatial analysis tool in ArcGIS was used to analyze both the spatial accessibility index and the students’ annual enrolment trend of the lower secondary school in the area. The result of the nearest neighbor analysis for the spatial pattern of lower secondary schools in the study revealed a random pattern. This pattern implies that the lower secondary schools are located far from one another, which indicates, that for students to attend the schools, most of them need to cover long distances. The spatial distribution of junior secondary school is influenced by socioeconomic status, environmental factors, demographic characteristics, transportation infrastructure, and geographic accessibility, which are key determinants of educational equity. Linear regression analysis was employed to identify trends and predict future enrollments of students. Further, the results of the trend analysis of enrolments of students in the zone from 2020 – 2023 reveal a negative trend. This implies a decrease in students’ enrolment as the year increases. The four years (2020 – 2023) annual trend of enrolments in the zone is represented by the negative trend y = -3180.3x + 99400. This result suggests that the students’ enrolments in the zone would gradually keep decreasing as time goes on if quick remedial actions are not taken. However, factors such as shortage of teachers, shortage of classrooms, COVID-19, insufficient infrastructural facilities and fuel subsidy removal could be responsible for the negative enrolment trend

BN SO37 - Upper GI surgical training in the UK: Are there enough training opportunities? 10-year trends in Benign Upper GI index procedures and the impact of COVID-19

Abstract Background Surgical training was adversely impacted during the COVID pandemic, with reports of reduced logbook numbers and challenges in meeting training competencies. Despite a national elective care recovery plan, and interventions aimed at maintaining training opportunities, waiting list expansion has continued and has particularly impacted benign procedures. Upper GI trainees are all required to achieve “Level 4” (independent) competence in Cholecystectomy and Antireflux surgery, however there are anecdotally. fewer opportunities in the post-COVID era to train in these procedures. This study aimed to evaluate trends in these index procedures and to compare the pre- and post- COVID eras. Method The annual Admitted Patient Care (APC) publications draw on Hospital Episode Statistics and summarise activity for each financial year by OPCS4 codes. Codes pertaining to cholecystectomy and antireflux surgery (the “Benign Upper GI” competences on the Joint Committee of Surgical Training New Curriculum Checklist) were screened for inclusion. Data were extracted from APC publications between 2013 and 2023. These data were summarised in a Microsoft Excel Spreadsheet, categorised by index procedure and divided into pre-covid (2013-2019) and post-covid (2019-2023). Trends were evaluated using a Mann-Kendal Non-Seasonal Trend Test. Comparisons were undertaken using a two tailed unpaired t-test. Results Between 2013 and 2023 there was a statistically significant negative annual trend in the number of cholecystectomies from 75934 to 68182 (p=0.02), with a minimum of 47803 in the 2020-2021 financial year and a non-significant positive trend in the subsequent years. There were significantly fewer cholecystectomies in the 4 years following COVID (mean 77357 vs 63882, p=0.015). Antireflux procedures also underwent a significant negative trend from 5467 to 4745 (p=0.02), with a minimum of 2565 in the 2020-2021 financial year and a non-significant positive trend in subsequent years. Mean post-COVID antireflux procedures were also significantly lower (5548 vs 4256, p=0.03). Conclusion The procedures required for training in Benign Upper GI surgery in the UK are occurring with lower frequency than before the COVID pandemic. Whilst this may reflect ongoing operational pressures, or changes in clinical practice, this evidence suggests that training opportunities are now less frequent. This highlights the importance of focussed training and an awareness of training needs amongst both trainees and their mentors.

Spatio-temporal evaluation of MODIS temperature vegetation dryness index in the Middle East

Drought, a recurring meteorological event, can potentially cause devastating consequences for human populations, and its attributes vary significantly across diverse geographic areas. Therefore, recognizing drought events is paramount for strategically planning and managing water resource systems. In this study, the Temperature Vegetation Dryness Index (TVDI), derived using Moderate-Resolution Imaging Spectroradiometer (MODIS) data spanning from 2003 to 2022 in the Middle East, was used as the foundation for both trend and spectral analyses. To assess TVDI trends, the Mann-Kendall test and Sen's slope estimator were utilized, and harmonic analysis was conducted for spectral analyses. These methods were applied to a dataset comprising 258,087 pixels within the specified region, covering various time scales, including monthly and seasonal analyses. The monthly analyses indicated significant growth in March and April, with September showing the least significant increase, suggesting stability or decline. Geographically, upward trends were predominant in the northern Middle East, including Turkey, Syria, Iraq, western Iran, and eastern Jordan. Significant downward trends were observed in the southern Middle East during the warmer months. Seasonal assessments showed no significant TVDI trends in winter, but upward trends in the south, west, and northwest were identified during spring. The annual trend map indicates a long-term declining trend in TVDI for most regions within specific latitudes, particularly those below 34 degrees. The results of harmonic analysis revealed the presence of multiple cycles at a 95 % confidence level. Notably, there was a heightened prevalence of significant sinusoidal cycles, especially the 2–3-year cycles. This cycle was widespread in countries such as Iran, Oman, Yemen, and Turkey, as well as in the southern regions of Saudi Arabia and Egypt.

Abstract 4134396: Trends and Disparities in Ischaemic Heart Disease Mortality in the United States: An Analysis of CDC WONDER Database, 1999-2020

Backgrounds: Ischemic heart disease (IHD) remains a leading cause of mortality globally and has a high prevalence in the United States, necessitating an understanding of long-term trends to inform interventions. This study examines IHD-related mortality trends among US adults from 1999 to 2020, considering demographic and geographic disparities. Aim: This study aimed to evaluate patterns and geographical variations in mortality associated with IHD among adults in the United States. Methods: Death certificates from the CDC WONDER database spanning from 1999 to 2020 were analyzed to investigate mortality related to IHD among adults aged 35 years and above. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated, stratified by year, sex, race/ethnicity, and geographic region. Results: Ischemic Heart Disease (IHD) caused 12,756,359 deaths among U.S. adults aged 35 and above from 1999 to 2020. Annual trends in age-adjusted mortality rates (AAMRs) showed a decline from 48.7 in 1999 to 28.9 in 2020, with notable fluctuations. Men consistently had higher AAMRs than women. NH Black or African American individuals exhibited the highest AAMRs. Geographically, significant disparities existed among states and regions, with the Northeast having the highest mortality. Nonmetropolitan areas consistently had higher AAMRs compared to metropolitan areas, showing varying trends over the study period. Conclusion: Fluctuations in mortality trends among IHD patients were observed over the study duration, revealing significant disparities across demographic and geographic parameters. Targeted interventions are imperative to alleviate the burden of IHD and mitigate mortality rates in the United States.

Abstract 4116981: Sex- and Racial/Ethnic Mortality Trends Across Separate Time Periods Following Hospitalization for Acute Myocardial Infarction

Intro: Mortality for patients hospitalized with acute myocardial infarction (AMI) has improved over time, but sex- and racial/ethnic disparities remain. Whether disparities have changed over specific time periods following hospitalization is poorly understood. Aim: To assess mortality trends across separate time periods following incident AMI hospitalization by sex and race. Methods: Using Medicare fee-for-service data covering all patients with incident AMI hospitalizations from 2008 to 2018, we examined unadjusted mortality rates by sex and race/ethnicity for the following time periods: acute (in-hospital), post-acute (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), and long term (1-3 years after discharge). Each period was considered separately (i.e., patients who died during one period were not counted in later periods). Results: We identified 768,084 patients hospitalized with incident AMI (mean age 81 years, 48% male, 87% White) between 2008-2018. Figures 1 and 2 show annual mortality rates and trends. From 2008-2018, men and women had similar in-hospital and post-acute mortality, but women had persistently higher short- and long-term mortality compared to men. In 2008, Black patients had higher mortality rates compared to White patients for every period studied. In-hospital mortality rates were similar by 2018 but remained higher for Black patients for every other time period. Conclusions: For incident AMI patients, mortality rates have improved across subgroups through 3 years after discharge. However, women have had persistently higher mortality rates 1-3 years following hospitalization compared to men, while Black patients have had persistently higher mortality rates 30 days – 3 years following hospitalization compared to White patients. These results suggest that opportunities to reduce sex- and race-based AMI disparities might be particularly effective in longitudinal outpatient care following hospital discharge.

Abstract 4135444: Sex Disparities in Enrollment of Cardiovascular Trials: A Meta-Analysis of ClinicalTrials.gov Listings

Background: Despite increasing recognition of sex differences in the burden of cardiovascular (CV) diseases, women have historically been underrepresented in clinical trials. Aims: The study aimed to systematically quantify the extent of sex disparity in the enrollment of CV trials and explore the annual enrollment trends of women in CV trials. Methods: The analysis included studies that: (1) were registered in ClinicalTrials.gov up to February 2024; (2) were randomized trials involving ≥1 intervention; (3) investigated ≥1 CV condition, as determined by Medical Subject Heading descriptors. The exclusion criteria were: (1) studies without available enrollment information; (2) studies exclusively enrolling men or women; and (3) studies with ≤100 participants. We computed enrollment disparity difference (EDD), defined as the difference between the proportion of women in trial participants and the proportion of women with CV diseases in the general population, based on the Global Burden of Disease estimates matched by country/geographic region and enrollment period. Random-effects meta-analysis was performed to summarize the overall enrollment disparity. Subgroup analysis by trial characteristics was conducted. Meta-regression was used to assess the association of enrollment disparity with the start year of the trials. Results: A total of 1,687 CV trials were identified from 484,781 studies. Among 2,198,317 trial participants for whom sex was reported, 819,570 (37.3%) were women. EDD in CV trials was -0.105 (95% CI, -0.113 to -0.097), indicating that women were under-enrolled by 10.5% (Figure 1). Except for valvular heart disease trials, disparities were evident across other CV disease trials, with the most remarkable under-enrollment of women in peripheral artery disease trials (-0.302 [95% CI, -0.324 to -0.279]). Disparities were more prominent in trials with larger sample sizes, longer study durations, device or procedural interventions, and data monitoring committee oversight (p<0.001 for subgroup differences; Figure 2). There was a significant yet modest improvement in the representation of women over time (increase of 0.0028 [95% CI, 0.0011 to 0.0045] in EDD per start year of trials; p=0.001; Figure 3). Conclusion: Women remain substantially underrepresented in CV trials, particularly in peripheral artery disease trials. The findings underscore the imperative for interventions to mitigate sex inequity in the enrollment of CV trials.

Abstract 4119868: Statin and PCSK9 Inhibitor Utilization and Spending in Medicaid between 2018 to 2022: A National Analysis

Introduction: Low-income working-aged adults in the Medicaid program have a high burden of cardiovascular risk factors and disease, but often face barriers accessing necessary therapies. Little is known about contemporary patterns of utilization and spending on lipid-lowering therapies in Medicaid programs. Goal: To evaluate national trends in utilization and spending on statins and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in Medicaid. Methods: We performed a serial cross-sectional study using the Medicaid Spending by Drug Database, which contains national-level Medicaid spending data for medications partially or fully reimbursed by Medicaid for the approximately 84 million beneficiaries. We evaluated annual trends in utilization (prescription fills) and total spending for statins and PCSK9i from 2018 to 2022, both overall and by individual drug formulation. Spending was adjusted for inflation and reported in 2022 US dollars. Results: Medicaid beneficiaries filled 20.4 million statin prescriptions in 2018 compared to 20.3 million in 2022, representing a 0.4% decrease. However, Medicaid spending on statins decreased by 7.1%, from $246.2 million to $226.8 million over the same period. Prescription fills for generic Rosuvastatin increased the most (0.79 million to 2.6 million, +224.2%), while fills for brand-name Crestor decreased the most (0.065 million to 0.003 million, -95.2%). Medicaid beneficiaries filled 121,737 prescriptions for PCSK9 inhibitors in 2022 compared to 7,617 in 2018 (+1498%), coinciding with a 640% increase in total spending ($8.9 million to $65.7 million). Repatha Sureclick was the most filled PCSK9i in Medicaid with 80,503 fills in 2022, representing $43.9 million in total Medicaid spending. Conclusions: Despite almost no change in statin utilization between 2018 and 2022, Medicaid spending on statins fell by approximately $20 million, driven by a shift from brand-name to generic formulations. In contrast, spending on PCSK9 inhibitors increased by $57 million as these medications became more widely used. Understanding these trends is critical as Medicaid programs work to ensure access to effective cardiovascular therapies while also identifying opportunities for cost efficiencies nationwide.

Abstract 4127417: Trends in Atherosclerotic Cardiovascular Disease Related Mortality Among Older Adults in the United States From 1999-2021

Background: Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established. Aims: This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7). Figure 1. Conclusion: Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Abstract 4128261: Heart Failure-Associated Sudden Cardiac Death: Trends and Demographic Differences in the United States Adults, 1999 to 2020

Background: The US population has seen a dramatic increase in the burden of heart failure (HF) and sudden cardiac death (SCD) mortality. SCD is one of the prominent causes of mortality in HF patients. However, HF-associated SCD-related mortality trends have not been established yet. Aims: This study aims to highlight the annual trends and demographic differences in HF-associated SCD mortality among adults in the U.S from 1999-2020. Methods: The CDC WONDER multiple-cause of death database was examined from 1999 to 2020 for HF-associated SCD mortality in adults over the age of 25. Age-adjusted mortality rates (AAMRs) per 1,000,000 persons was calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race/ethnicity, urbanization status, and census region. Results: Between 1999 and 2020, 39,660 HF-associated SCD-related deaths occurred among US populations. Following a reduction from 10.9 in 1999 to 6.8 in 2018 (APC, -2.5 [-2.8 to -2.3]), AAMR increased to 8.2 in 2020 (APC, 10.3 [3.6 to 13.7]) in the overall population. Men had consistently higher AAMRs than women from 1999 (AAMR men: 15.1 vs women: 7.9) to 2020 (AAMR men: 11.3 vs women: 5.6). Non-Hispanic (NH) Black or African Americans had the highest AAMR (14.0), followed by NH Whites (8.3), and Hispanics or Latinos (3.4). Southern region had the highest AAMR (10.4), followed by Midwest (9.6), West (5.8), and Northeast (5.8). Moreover, rural areas had consistently higher AAMR (14.6) than urban areas (6.9). Conclusion: Following a steady decline until 2018, HF-associated SCD mortality in adults increased between 2018 and 2020. The highest AAMRs were observed among Black or African American adults and men, and patients living in the Southern and non-metropolitan areas. Tailored strategies focusing specifically on arrhythmic events and related mortality in HF patients are needed to address the recent surge in mortality rates among these demographics.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data.

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact. Mortality data were obtained from CDC repository between 1999 and 2020 among patients ≥15 years old, using ICD-10 codes hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to project 2020 AAMR, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483,155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMR rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause while hypertension had the highest mortality increase (AAPC +10.23%). Mortality rates were higher in males (AAMR 104.87), non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35-75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups. Hyperlipidemia-related CVD mortality has risen over the past two decades, further heightened by the COVID-19 pandemic, with higher impact on males, Black Americans, the elderly, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.