Average Percentage Research Articles

Spatial Epidemiology and Temporal Trend of Brucellosis in Iran Using Geographic Information System (GIS) and Join Point Regression Analysis: An Ecological 10-Year Study

Background: Brucellosis is one of the common diseases between humans and animals. We aimed to assess the annual incidence rate, the geographical distribution of Malta fever using GIS and its time trend. Methods: This was an ecology study carried out in exploratory mixed design. The study population was the individuals with brucellosis in Iran during the years 2009-2018. Data analysis has been done using Joinpoint regression analysis and GIS at a significant level of α = 0.05. Results: The average annual incidence rate of the disease rate was 19.91 per one hundred thousand people. The trend of the changes in the incidence between 2009 and 2018 has increased and the Annual Average Percent Change increased by 4.6%. However, a joinpoint was observed in 2014 and the incidence has changed significantly at this point in time, so that the annual incidence of the disease has increased more strongly between 2009 and 2014 (APC=17.1%) and then from 2014 to 2018, the incidence of the disease has decrease (APC=-9.2%). The spatial distribution showed that the western and northwestern provinces have high incidence rate, but the northern and southern provinces have low incidence rate. Conclusion: The incidence of brucellosis in Iran is higher than in developed countries and similar to developing countries. Ten-year trend of disease incidence increased slightly, but it has decreased in recent years. It is necessary to improve the surveillance system and increase facilities for prevention and treatment in the high-risk areas including the west and northwest of Iran.

Avoidable Mortality in Korea 1997-2001: Temporal Trend and its Contribution to All-cause Mortality.

This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies.

Determination of surface density of nonporous membranes with ultrasonic immersion measurements

ABSTRACT The surface density of nonporous membranes is estimated with a conventional ultrasonic immersion measurement system without need for a priori information about the membrane such as wave speed, density, thickness or impedance under most testing conditions. The derivation, theoretical limitations and practical restrictions of the technique are discussed. The broadband nature of the measurement allows the surface density values to be estimated at multiple discrete frequencies within the useful bandwidth of the transducer. In experimentation, the technique was used to measure surface densities in a range of 0.044–0.328 kg/m2. All calculated surface densities are within 5% or less of their nominal values with an average percent difference of 1.7%.

Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020.

The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.

Impacts of Deicer Salt on Water Quality Performance of Stormwater Bioretention Systems with Varied Vegetation and Hydrology.

Sodium chloride (NaCl) deicers contaminate bioretention and influence effluent water quality, the effects of which are not yet fully understood. We tested this by constructing 48 mesocosms in a greenhouse, each having Panicum virgatum, Eutrochium purpureum, or no vegetation; having an internal water storage (IWS) zone or not; and being exposed to high or low NaCl doses in the late winters of 2022 and 2023. Synthetic stormwater was applied and effluent was monitored through May 2023 with an end-of-experiment analysis of soil and plant biomass for nitrogen, phosphorus, copper, zinc, and total suspended solids (TSS). Average effluent loads increased in spring, after NaCl application, for total phosphorus (+61%), copper (+61%), zinc (+88%), and TSS (+66%). These four analytes recovered by summer, with average annual percent removals >85%. Vegetation and IWS reduced annual phosphorus (by -33 and -70%, respectively) and copper (by -24 and -40%) loads, while higher NaCl concentrations increased annual phosphorus (+107%), copper (+22%), and TSS (+51%) loads. Nitrogen removal was not linked with NaCl but was dependent upon the presence of IWS or vegetation. Post-NaCl effluent spikes pose seasonal risks to aquatic ecosystems, emphasizing the need for active maintenance, redundant removal mechanisms, and minimized exposure to NaCl.

Thyroid cancer trends in China and its comparative analysis with G20 countries: Projections for 2020-2040.

Thyroid cancer, a leading type of endocrine cancer, accounts for 3-4% of all cancer diagnoses. This study aims to analyse and compare thyroid cancer patterns in China and the Group twenty (G20) countries, and predict these trend for the upcoming two decades. This observational longitudinal study utilised data from the Global Burden of Disease (GBD) study 2019. We used metrics including incidence, mortality, mortality-incidence ratio (MIR), age-standardised rate (ASR) and average annual percent change (AAPC) to examine thyroid cancer trends. Joinpoint regression analysis was used to identify periods manifesting notable changes. The association between sociodemographic index (SDI) and AAPC were investigated. The autoregressive integrated moving average (ARIMA) model was used to predict thyroid cancer trends from 2020 to 2040. From 1990 to 2019, thyroid cancer incidence cases in China increased by 289.6%, with a higher AAPC of age-standardised incidence rate (ASIR) in men. Contrastingly, the G20 demonstrated a smaller increase, particularly among women over 50. Despite the overall age-standardised mortality rate (ASMR) was higher in the G20, the increase in mortality was less pronounced than in China. Age-standardised incidence rate increased across all age groups and genders, with a notable rise among men aged 15-49. ASMR decreased in specific age groups and genders, especially among women. Conversely, the ASMR significantly increased in group aged over 70. The MIR exhibited a declining trend, but this decrease was less noticeable in men and the group aged over 70. Joinpoint analysis pinpointed significant shifts in overall ASIR and ASMR, with the most pronounced increase in ASIR during 2003-2011 in China and 2003-2010 in the G20. Predictions suggested a continual ASIR uptrend, especially in the 50-69 age group, coupled with a predicted ASMR downturn among the elderly by 2040. Moreover, the proportion of thyroid cancer deaths attributable to high body mass index (BMI) escalated, with significant increase in Saudi Arabia and a rise to 7.4% in China in 2019. Thyroid cancer cases in incidence and mortality are escalating in both China and the G20. The increasing trend may be attributed to factors beyond overdiagnosis, including environmental and genetic factors. These findings emphasise the necessity for augmenting prevention, control, and treatment strategies. They also highlight the significance of international collaboration in addressing the global challenge posed by thyroid cancer.

Predicting Survival in Mucinous Adenocarcinoma of the Appendix: Demographics, Disease Presentation, and Treatment Methodology

BackgroundMucinous adenocarcinoma of the appendix (MACA) follows a complex disease course with variable survival. Large-scale predictive modeling may determine subtle yet important prognostic factors otherwise unseen in smaller cohort analyses.MethodsPatients with MACA were identified from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database (2005–2019). Primary, secondary, and tertiary outcomes were disease-specific survival (DSS), overall survival (OS), and average annual percent change (AAPC) in incidence.ResultsAmong 4,258 included patients, MACA was most frequently diagnosed at 50 to 69 years (52.0%), with female preponderance (55.9%). MACA incidence AAPC was 3.8 (95% confidence interval [CI] 1.9–5.9). For patients with exclusive, first-diagnosis MACA included in survival analysis (3,222 patients), median DSS and OS were 118 and 88 months, respectively. In DSS-based multivariable analysis, worse prognosis was associated with non-Hispanic Black background (HR 1.36, 95% CI 1.02–1.82; p = 0.036), high grade (grade 3 HR 3.10, 95% CI 2.44–3.92; p < 0.001), lymphatic spread (HR 2.73, 95% CI 2.26–3.30; p < 0.001), and distant metastasis (HR 5.84, 95% CI 3.86–8.83; p < 0.001). In subcohort analysis of patients with rationale for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC, 2,387 patients), CRS-HIPEC was associated with survival benefit compared with surgery alone but only for moderate-grade tumors (median DSS/OS 138/138 vs. 116/87 months; p < 0.001).ConclusionsMucinous adenocarcinoma of the appendix incidence is increasing in the United States. Survival rates are affected by both demographics and classical risk factors, and CRS-HIPEC-associated survival benefit predominantly occurs in moderate-grade tumors. Further exploration of biologic and clinicopathologic features may enhance risk stratification for this disease.

Mortality trends in idiopathic pulmonary fibrosis in Europe between 2013 and 2018.

Previous research has suggested that the incidence of idiopathic pulmonary fibrosis (IPF) is increasing in the UK and elsewhere. The aim of this study is to provide contemporary estimates of IPF mortality rates across 24 European Union (EU) countries from 2013 to 2018, using death certificate data from the European Statistics Institution (EUROSTAT) database. We extracted country data for IPF (International Classification of Diseases, 10th Revision: code J84.1) mortality from the EUROSTAT dataset. We calculated country-, age- and sex-specific death registration rates between 2013 and 2018. We used direct standardisation to compare rates between countries. We calculated annual trends in mortality rate ratios using a segmented regression model. The overall standardised mortality rate in 24 EU countries during this period was 3.90 (95% CI 3.80-3.90) per 100 000 person-years, with the rate rising from 3.70 in 2013 to 4.00 in 2018 (average annual percent change 1.74%, 95% CI 0.91-2.59%). We observed substantial inter-country differences, with the highest rates detected in Ireland, the UK and Finland, the lowest rate in Bulgaria, and middle rates in Germany, Greece, Italy, the Netherlands, Portugal and Slovenia. The IPF mortality rate is increasing across Europe. There are currently more than 17 000 deaths recorded from IPF each year in Europe but the marked geographical differences we observed suggest that this figure may underestimate the true rate considerably.

Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

Effect of Enzyme Supplementation on Nutrient Utilization and Production Performance in Lactating Murrah Buffaloes

Background: Enzyme stimulates metabolic and digestive processes leading to increased feed intake and improved nutrient availability in animals. This study was conducted to investigate the effect of enzyme supplementation on nutrient utilization and production performance in lactating Murrah Buffaloes during winter season. Methods: Twenty four lactating Murrah buffaloes were selected for the study from Livestock Research Centre, Sardar Vallabhbhai Patel University of Agriculture and Technology, Modipuram, Meerut (UP). All the selected animals were randomly allocated into four treatment groups having six animals in each group on the basis of body weight, lactation length and milk yield. The daily nutrient requirements of lactating Murrah buffaloes in term of DM, DCP and TDN were provided as per the feeding standards of Indian Council of Agricultural Research, New Delhi (2013). Total Mixed Ration for buffaloes was prepared by mixing of roughage and concentrates in the ratio of 60:40 after grinding/chaffing. Roughage part was consisting of available winter season green fodder e.g. oat and wheat straw available at research centre. Feeding trial was planned into four treatment groups viz. T1 (Basal diet without enzyme supplementation), T2 (Basal diet with supplementation of Xylanase @ 800000 IU), T3 (Basal diet with supplementation of Cellulase @ 240000 IU) and T4 (Basal diet with supplementation of Xylanase @ 800000 IU and Cellulase @ 240000 IU). Result: From the present study, it was observed that the average milk yield (5.34 litre/day) was higher in T4 as compared to other treatment groups, but the difference was non-significant. The average milk fat percent was recorded as 7.52, 7.58. 7.60 and 7.65 in T1, T2, T3 and T4 treatment groups, respectively. Although the results of T4 group animals were comparatively higher in all major milk constituents the differences were found to be statistically non-significant. The average DM intake (kg/d, kg/100 kg BW and g/kg W0.75) and CP intake (g/d, g/100 kg BW) were almost similar in all treatment groups. The TDN intake (kg/d, kg/100 kg BW and g/kg W0.75) was significantly (P less than 0.05) higher in enzyme supplemented groups. The digestibility coefficient of CP, CF, NDF and ADF were higher (P less than 0.05) in buffaloes of T4 over control (T1) group. So, it was concluded from the above study that the milk production and milk composition could be improved with the combine use of Xylanase and Cellulase enzyme in murrah buffaloes due to improved CP and fibre digestibility.

Trends and age-period-cohort effect on incidence of hepatitis B from 2008 to 2022 in Guangzhou, China

Hepatitis B virus (HBV) infection is highly prevalent in Guangzhou, China. This study aimed to examine the long-term trend of HB incidence from 2008 to 2022 and the independent impacts of age, period, and cohort on the trends. HBV data were collected from the China Information System for Disease Control and Prevention. Joinpoint regression was utilized to examine temporal trends, and an age-period-cohort model was employed to estimate the effects of age, period, and cohort. A total of 327,585 HBV cases were included in this study. The incidence of chronic and acute HB showed a decreasing trend in Guangzhou over the past 15 years, with an average annual percent change of − 4.31% and − 16.87%, respectively. Age, period, and cohort all exerted significant effects. The incidence of HB was higher in males than in females and non-central areas compared to central areas. Age groups of 0–4 years and 15–24 years were identified as high-risk groups. The period relative risks for chronic HB incidence decreased initially and then stabilized. Cohorts born later had lower risks. Chronic HB incidences remain high in Guangzhou, especially among males, younger individuals, and residents of non-central areas. More efforts are still needed to achieve hepatitis elimination targets.

Trends in injury-related mortality among residents of Jiangsu Province from 2012 to 2021: an age-period-cohort analysis.

We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention. This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk. ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all p < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, p < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% CI: 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% CI: 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group. The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.

Ion Mobility Separations Using Cocentric Architecture.

Ion mobility separations, especially using drift tube ion mobility spectrometers, are usually performed in linear channels, which can have a large footprint when extended to achieve higher resolving powers. In this work, we explored the performance of an ion mobility device with a curved architecture, which can have a more compact form. The cocentric ion mobility spectrometer (CoCIMS) manipulates ions between two cocentric surfaces containing a serpentine track. The mobility separation inside the CoCIMS is achieved using traveling waveforms (TWs). We initially evaluated the device using ion trajectory simulations using SIMION, which indicated that when ions traveled circularly inside the CoCIMS they resulted in similar resolving powers and transmitted m/z range as traveling in a straight path. We then performed experimental validation of the CoCIMS in conjunction with a TOF MS. The CoCIMS was made of two flexible printed circuit board materials folded into cocentric cylinders separated by a gap of 2.8 mm. The device was about 50 mm diameter ×152 mm long and provided 1.846 m of serpentine path length. Three sets of mixtures (Agilent tune mixture, tetraalkylammonium salts, and an eight-peptide mixture) and four traveling waveform profiles (square, sine, triangle, and sawtooth) were used. The sawtooth TW profile produced a slightly higher resolving power for the Agilent tuning mixture and tetraalkylammonium ions. The average resolving power for Agilent tune mixture ions ranged from 37 (using sawtooth TW) to 27 (using square TW). The average resolving powers ranged from 45 (sawtooth TW) to 31 (square TW) for tetraalkylammonium ions. The resolving power of the peptide mixture ions was similar among the four TW profiles and ranged from 51 to 56. The average percent error in TWCCS for the peptide mixture ions was about 0.4%. The new device showed promising results, but improvements are needed to further increase the resolving power.

VERIFIKASI KUALITAS ANALISIS MANGAN MENGGUNAKAN TEKNIK ICP-OES DALAM SAMPEL AIR MINUM

Drinking water quality, including the levels of dissolved metals, is an important public health consideration. Manganese (Mn) is a naturally occurring metal that can be present in drinking water sources, and excessive intake of Mn can have adverse health effects. The objective of this study was to verify the performance of the analytical method for the determination of manganese (Mn) concentration in drinking water samples using Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES) techniques at the PT XYZ Laboratory. The method verification included tests for analyte identity confirmation, linearity, precision, accuracy, as well as the determination of the Method Detection Limit (MDL) and Limit of Quantification (LOQ). The verification results showed that the ICP-OES method met the established performance requirements. The linearity test yielded a correlation coefficient (r) of 0.9998, fulfilling the criteria of r ≥ 0.995. The percent relative standard deviation (% RSD) value in the precision test was 1.41%, meeting the requirement of % RSD ≤ 2/3 % CV Horwitz. The accuracy test provided an average percent recovery of 98.66%, which is within the acceptable range of 85-120%. The determined MDL was 0.0006 mg/L, while the LOQ was 0.002 mg/L, both meeting the criteria of MDL &lt; spiked concentration &lt; 10 MDL and LOQ &lt; environmental quality standard. In conclusion, the method for the determination of Mn concentration in drinking water using ICP-OES has been verified and can be used for routine analysis at the PT. XYZ Laboratory, supporting the monitoring and control of Mn levels in drinking water to ensure public health protection.

Association of Chemotherapy-Induced Peripheral Neuropathy with Diet Quality Among Post-Treatment Cancer Survivors

Nutrition is essential for peripheral nerve function, yet dietary factors associated with chronic chemotherapy-induced peripheral neuropathy (CIPN) remain poorly characterized. The purpose of this cross-sectional study was to determine differences in diet quality and macronutrients for cancer survivors with and without CIPN. Cancer survivors (e.g., ≥3 months post platinum and/or taxane-based neurotoxic chemotherapy) with (i.e., ≥1/4 PRO-CTACE™ Numbness and Tingling Severity) and without CIPN completed the VioScreen Research Graphical Food Frequency Questionnaire. The association among diet (Healthy Eating Index [HEI]), macronutrient intake (average percent caloric intake), and CIPN severity were analyzed using generalized linear regression models, adjusting for caloric intake, body mass index, age, and sex. Results revealed that for each one-point increase in diet quality, PRO-CTCAE severity decreased by −0.06 (95% CI: −0.10, −0.02, P < 0.01). Participants without CIPN reported higher diet quality than those with CIPN (HEI mean: 70.11 vs 68.45) (OR = 0.94, P = 0.03, 95% CI: 0.89, 0.99). Participants with CIPN had significantly higher carbohydrate consumption than participants without CIPN (OR = 1.11, P = 0.04, 95% CI: 1.01, 1.22). There were no significant differences in consumption of proteins or fats between groups. Further research should be pursued to discover the potential benefits of dietary interventions for CIPN management among cancers survivors.

Incidence and prevalence of primary biliary cholangitis in the Netherlands – A nationwide cohort study

Background & AimsAlthough primary biliary cholangitis (PBC) is considered a rare disorder, accurate determination of its incidence and prevalence remains challenging due to limited comprehensive population-based registries. We aimed to assess the incidence and prevalence of PBC in the Netherlands over time through the nation-wide Dutch PBC Cohort Study (DPCS). MethodsDPCS included retrospectively every identifiable patient with PBC in the Netherlands from 1990 onwards in all 71 Dutch hospitals. Incidence and prevalence were assessed between 2008-2018 by Poisson regression between sex and age groups over time. ResultsOn January 1st 2008, there were 1458 patients with PBC in the Netherlands. Between 2008-2018, 2187 individuals were newly diagnosed, 46 were transplanted and 468 died. The yearly incidence of PBC in 2008 was 1.38, and increased to 1.74 per 100.000 persons in 2018. When compared to those aged <45 years, females aged 45-64 years (adjusted Incidence Rate Ratio [aIRR] 4.21, 95%CI 3.76-4.71, p<0.001) and males ≥65 years (aIRR 14.41, 95%CI 9.62-21.60, p<0.001) had the highest risk to be diagnosed with PBC. The male-to-female ratio of patients newly diagnosed with PBC during the study period was 1:14 in those <45 years, 1:10 in patients aged 45-64 years, and 1:4 in those ≥65 years. Point prevalence increased from 11.9 in 2008 to 21.5 per 100.000 persons in 2018. Average annual percent change (AAPC) in this time period was 5.94% (95%CI 5.77-6.15, p<0.05), and was the highest among the population ≥65 years (5.69%, 95%CI 5.32-6.36, p<0.001). ConclusionsIn this nationwide cohort study, we observed an increase in both incidence and prevalence of PBC in the Netherlands over the past decade, with marked age and sex differences. Impact And ImplicationsThis nationwide Dutch PBC cohort study, including all hospitals in the Netherlands, showed that the PBC incidence and prevalence has increased over the last decade. The age-dependent PBC incidence rate differed for males (highest risk ≥65 years) and females (highest risk between 45 and 65 years), which may be related to a difference in the timing of exposure to environmental triggers of PBC. The largest increase in PBC prevalence over time was observed in the population ≥65 years, which may have implications for the use of second line therapies. These results therefore indicate that further studies are needed to elaborate on the advantages and disadvantages of add-on therapies in the elderly population.

National Trends in Emergency Department Visits for Suicide Attempts and Intentional Self-Harm.

This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020. Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated. The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional. A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.

Demographic Disparities in Lung Cancer Mortality and Trends in the United States From 1999 Through 2020: A Population-Based CDC Database Analysis.

Lung cancer is the leading cause of cancer-related mortality in the United States and is projected to account for 127,070 deaths in 2023. Although the lung cancer mortality rate has been decreasing over the last decade, demographic disparities in mortality still exist. We sought to determine the impact of demographic factors on lung cancer mortality and trends in the United States. We queried the Centers for Disease Control and Prevention (CDC) database for mortality statistics with an underlying cause of death of lung and bronchus cancer from 1999 through 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 people. We assessed the AAMR by demographic variables, including race, geographic density, sex, age, and US census region. Temporal trends were evaluated using Joinpoint regression software, and average annual percent change (APC) was calculated. From 1999 through 2020, lung cancer led to 3,380,830 deaths. The AAMR decreased by 55.1 to 31.8, with an associated average APC of -2.6%. In 1999, men had an AAMR almost twice as high as women, but these differences became less pronounced over time. Rural populations experienced the highest AAMR and the slowest rate of decrease compared with urban populations, who experienced the lowest AAMR and fastest decrease. Non-Hispanic Black individuals experienced the highest AAMR, with an annual decrease of -3.0%. The West experienced the fastest decrease at -3.1% annually, whereas the Midwest experienced the slowest decrease at -2.0% annually. Although the mortality rate of lung cancer has been decreasing since 1999, not all demographic groups have experienced the same rates of decrease, and disparities in outcomes are still prevalent. Vulnerable subgroups need targeted interventions, such as the incorporation of patient navigators, improved screening chest CT scan access and follow-up, and telehealth expansion, which will improve the likelihood of earlier-stage diagnoses and the potential for curative treatments.

North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy.

In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy). The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios. In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions. In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open.

Rural-urban disparities in colorectal cancer-related mortality changes in the United States.

e13714 Background: Colorectal cancer is the second leading cause of cancer-related death in the world. The incidence of colorectal cancer rates is higher in rural areas compared to urban populations which is attributed to obesity, and lower adherence to screening. It is hence vital to identify large population-based data on rural and urban disparities in colorectal cancer-related mortality. We, therefore, sought to analyze the outcome variances between urban and rural populations. Methods: We retrieved the mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database (years:1999-2020) for patients aged 15 years and above, with malignant neoplasm of colorectum (ICD-10: C18.9, C19, C20) listed as underlying cause of death. We analyzed age-adjusted mortality rates (AAMRs) per 100,000 population and assessed temporal trends in the average percent change (APC) of AAMRs by applying the simplest model with a maximum of 3 joinpoints (using the Joinpoint regression program 5.0.2). We conducted nonparallel pairwise comparisons to assess differences in trends between large metropolitan, small/medium metropolitan, and rural areas (per National Center for Health Statistics Urban- Rural Classification Scheme, 2016) using average annual percentage change difference (AAPCD). Results: A total of 810,577 colorectal cancer-related deaths were retrieved, amongst which 418,744 (51.6%), were in the large metropolitan, 249,933 (30.8%) were in the small/medium metropolitan, and 141,900 (17.5%) were in the rural regions. We noted a decline in the AAMR overall and across large metropolitan, small/medium metropolitan, and rural areas. However, the decline in AAMR was significantly higher among large metropolitan areas as compared to rural areas (AAPCD: -1.0043, 95% CI -1.64, -0.35, p=0.0022). There was no statistically significant difference in decline in AAMR when large metropolitan areas were compared to small/medium metropolitan (AAPCD: -0.4517, 95% CI -0.90, -0.002, p=0.051) and when small/medium metropolitan were compared to rural areas (AAPCD: -0.5526, 95% CI -1.16, -0.05, p=0.07). Conclusions: We identified discrepancies in the decline in colorectal cancer AAMR between urban and rural areas. A substantially lower decline in AAMR is eminent in the rural regions, as compared to the large metropolitan counterparts. This raises the concern for poor access to cancer care in this population group. Our results emphasize the imperative of prioritizing and designing strategies to ensure healthcare equity in rural areas. [Table: see text]