Contemporary Incidence Research Articles

Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals

Guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in hepatitis C individuals with cirrhosis if the HCC incidence rate is above 1.5 per 100 person-years (PY). However, the incidence threshold for surveillance in individuals who achieve a virologic cure is unknown. We estimated the HCC incidence rate above which routine HCC surveillance is cost-effective in this growing population of virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis. We developed a Markov-based microsimulation model of the natural history of HCC in individuals with hepatitis C who achieved virologic cure with oral direct-acting antivirals. We used published data on the natural history of hepatitis C, competing risk post virologic cure, HCC tumor progression, real-world HCC surveillance adherence, contemporary HCC treatment options and associated costs, and utilities of different health states. We estimated the HCC incidence above which biannual HCC surveillance using ultrasound and alpha-fetoprotein would be cost-effective. In virologically cured hepatitis C individuals with cirrhosis or advanced fibrosis, HCC surveillance is cost-effective if HCC incidence exceeds 0.7 per 100 PY using $100,000 per quality-adjusted life year willingness-to-pay. At this HCC incidence, routine HCC surveillance would result in 2650 and 5700 additional life years per 100,000 cirrhosis and advanced fibrosis persons, respectively, compared with no surveillance. At $150,000 willingness-to-pay, surveillance is cost-effective if HCC incidence exceeds 0.4 per 100 PY. Sensitivity analysis showed that the threshold mostly remained below 1.5 per 100 PY. The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC.

A population-based study on autoimmune disease

The increasing prevalence of autoimmune diseases has become one of the leading concerns in public health. 1 Wang L Wang FS Gershwin ME Human autoimmune diseases: a comprehensive update. J Intern Med. 2015; 278: 369-395 Crossref PubMed Scopus (505) Google Scholar , 2 Greiner W Patel K Crossman-Barnes CJ Rye-Andersen TV Hvid C Vandebrouck T High-expenditure disease in the EU-28: does drug spend correspond to clinical and economic burden in oncology, autoimmune disease and diabetes?. PharmacoEconom Open. 2021; 5: 385-396 Crossref PubMed Scopus (8) Google Scholar Autoimmune diseases occur when the immune system mistakenly attacks healthy cells and tissues in the body, leading to chronic inflammation, tissue damage, and organ dysfunction. 1 Wang L Wang FS Gershwin ME Human autoimmune diseases: a comprehensive update. J Intern Med. 2015; 278: 369-395 Crossref PubMed Scopus (505) Google Scholar As more people are diagnosed with autoimmune disease, the burden on health-care systems, families, and communities grows. 2 Greiner W Patel K Crossman-Barnes CJ Rye-Andersen TV Hvid C Vandebrouck T High-expenditure disease in the EU-28: does drug spend correspond to clinical and economic burden in oncology, autoimmune disease and diabetes?. PharmacoEconom Open. 2021; 5: 385-396 Crossref PubMed Scopus (8) Google Scholar Adequate public health and service delivery planning requires reliable information about contemporary population-level disease incidence; however, there is a poor understanding about the estimates of autoimmune diseases and their temporal trends in many countries. 3 Scherlinger M Mertz P Sagez F et al. Worldwide trends in all-cause mortality of auto-immune systemic diseases between 2001 and 2014. Autoimmun Rev. 2020; 19102531 Crossref PubMed Scopus (53) Google Scholar Little is known about the similarities and differences between these diseases concerning the incidence, prevalence, and co-occurrence. 4 Głowińska-Olszewska B Szabłowski M Panas P et al. Increasing co-occurrence of additional autoimmune disorders at diabetes type 1 onset among children and adolescents diagnosed in years 2010-2018-single-center study. Front Endocrinol (Lausanne). 2020; 11: 476 Crossref PubMed Scopus (9) Google Scholar Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UKAutoimmune diseases affect approximately one in ten individuals, and their burden continues to increase over time at varying rates across individual diseases. The socioeconomic, seasonal, and regional disparities observed among several autoimmune disorders in our study suggest environmental factors in disease pathogenesis. The inter-relations between autoimmune diseases are commensurate with shared pathogenetic mechanisms or predisposing factors, particularly among connective tissue diseases and among endocrine diseases. Full-Text PDF

Aortic Dissection During Pregnancy and Puerperium: Contemporary Incidence and Outcomes in the United States.

Background Aortic dissection (AD) during pregnancy and puerperium is a rare catastrophe with devastating consequences for both parent and fetus. Population-level incidence trends and outcomes remain relatively undetermined. Methods and Results We queried a US population-based health care database, the National Inpatient Sample, and identified all patients with a pregnancy-related AD hospitalizationfrom 2002 to 2017. In total, 472 pregnancy-related AD hospitalizations (mean age, 30.9±0.6 years) were identified from 68 514 000 pregnancy-related hospitalizations (0.69 per 100 000 pregnancy-related hospitalizations), with 107 (22.7%) being type A and 365 (77.3%) being type B. The incidence of AD appeared to increase over the 16-year study period but was not statistically significant (P for trend >0.05). Marfan syndrome, primary hypertension, and preeclampsia/eclampsia were found in 21.9%, 14.4%, and 11.5%, respectively. On multivariable logistic regression analysis, Marfan syndrome was associated with the highest risk of developing AD during pregnancy and puerperium (adjusted odds ratio, 3469.36 [95% CI, 1767.84-6831.75]; P<0.001). The in-hospital mortalities of AD, type A AD, and type B AD were 7.3%, 4.3%, and 8.1%, respectively. Length of hospital stay for the AD, type A AD, and type B AD groups were 7.7±0.8, 10.4±1.9, and 6.9±0.9 days, respectively. Conclusions We quantified population-level incidence and in-hospital mortality in the United States and observed an increase in the incidence of pregnancy-related AD. In contrast, its in-hospital mortality appears lower than that of non-pregnancy-related AD.

Primary mediastinal/thymic diffuse large B-cell lymphoma: a population-based study on incidence and survival.

Primary mediastinal large B-cell lymphoma is a rare subtype of lymphoma. The contemporary incidence of primary mediastinal large B-cell lymphoma remains unknown, and a large population-based study has not been reported. It is essential to provide guidance for further strategies in reducing the disease burden via population-based preventive initiatives. This study aims to explore the epidemiology and effect of therapeutic advances on the survival of patients with primary mediastinal large B-cell lymphoma. This population-based study was conducted using the Surveillance, Epidemiology, and End Results Program (SEER), covering the period from 1975 to 2018. A total of 774 patients in the SEER 9 and 1654 patients in the SEER 18 were analyzed. The age-adjusted incidence rate of primary mediastinal large B-cell lymphoma increased from 0.05/1,000,000 in 1975 to 2.38/1,000,000 in 2018. A significant positive linear increase in the incidence trend was found in primary mediastinal large B-cell lymphoma, with an annual percent change of 8.47% (95% confidence interval 7.7-9.2%, P < 0.001, z test). The survival in primary mediastinal large B-cell lymphoma was significantly superior to nodal diffuse large B-cell lymphoma. The incidence of PMBCL increases over the year. The survival of patients with primary mediastinal large B-cell lymphoma has improved over time.

Assessing the Influence of Climate on the Spatial Pattern of West Nile Virus Incidence in the United States.

West Nile virus (WNV) is the leading cause of mosquito-borne disease in humans in the United States. Since the introduction of the disease in 1999, incidence levels have stabilized in many regions, allowing for analysis of climate conditions that shape the spatial structure of disease incidence. Our goal was to identify the seasonal climate variables that influence the spatial extent and magnitude of WNV incidence in humans. We developed a predictive model of contemporary mean annual WNV incidence using U.S. county-level case reports from 2005 to 2019 and seasonally averaged climate variables. We used a random forest model that had an out-of-sample model performance of . Our model accurately captured the V-shaped area of higher WNV incidence that extends from states on the Canadian border south through the middle of the Great Plains. It also captured a region of moderate WNV incidence in the southern Mississippi Valley. The highest levels of WNV incidence were in regions with dry and cold winters and wet and mild summers. The random forest model classified counties with average winter precipitation levels as having incidence levels over 11 times greater than those of counties that are wetter. Among the climate predictors, winter precipitation, fall precipitation, and winter temperature were the three most important predictive variables. We consider which aspects of the WNV transmission cycle climate conditions may benefit the most and argued that dry and cold winters are climate conditions optimal for the mosquito species key to amplifying WNV transmission. Our statistical model may be useful in projecting shifts in WNV risk in response to climate change. https://doi.org/10.1289/EHP10986.

Under recognition and treatment of lymphedema in head and neck cancer survivors – a database study

PurposeHead and neck cancer (HNC) will be diagnosed in approximately 54,000 Americans in 2022 with more than 11,000 dying as a result. The treatment of HNC often involves aggressive multimodal therapy including surgery, radiotherapy, and systemic therapy. HNC and its treatments are associated with multiple painful and function-limiting neuromusculoskeletal and visceral long-term and late effects. Among these is head and neck lymphedema (HNL), the abnormal accumulation of protein rich fluid, in as many as 90% of survivors. Though HNL is common and potentially contributory to other function-limiting issues in this population, it is notoriously understudied, underrecognized, underdiagnosed, and undertreated. This study seeks to determine the incidence of HNC-related lymphedema diagnosis and treatment in a large US healthcare claims repository database.MethodsA retrospective observational cohort design and data from an integrated US healthcare claims repository—the IBM MarketScan Commercial Claims and Encounters (CCAE) and Medicare Supplemental and Coordination of Benefits (MDCR) Databases spanning the period April 1, 2012 through March 31, 2020.ResultsOf the 16,654 HNC patients eligible for evaluation, 1,082 (6.5%) with a diagnosis of lymphedema were identified based on eligibility criteria. Of the 521 HNC patients evaluated for lymphedema treatment, 417 (80.0%) patients received 1.5 courses of MLD, 71 (13.6%) patients were prescribed compression garments, and 45 (8.6%) patients received an advanced pneumatic compression device.ConclusionHNL in this population of HNC survivors was underdiagnosed and treated compared with contemporary assessments HNL incidence.

Trends in incidence, treatments, and clinical outcomes of cholangiocarcinoma diagnosed in British Columbia, Canada, from 2005 through 2019.

522 Background: While only accounting for 3% of gastrointestinal malignancies, cholangiocarcinoma (CC) has poor prognosis. New targeted therapies are on the horizon and understanding the potential size of the population eligible for such therapies is of importance. Contemporary incidence and outcomes in Canada have not been studied. Methods: Patients diagnosed with CC between 2005-2019 in British Columbia were identified using the BC Cancer Registry. Patient characteristics, treatments received and outcomes were collected and analyzed. Results: A total of 1520 patients were identified. Median age at diagnosis was 69 (interquartile 61-76) and 52% were female, 594 patients presented with localized disease (39%) of whom 416 had disease recurrence. The proportion of intrahepatic CC (ICC) rose from 17% in 2005-2009 to 44% in 2015-2019 while the incidence of extrahepatic (ECC) and gallbladder (GB) cancers followed populational trends. More patients with ICC had stage IV cancer at the time of diagnosis (64% vs 43% for ECC and 45% for GB, p&lt;0.01). Treatments received are shown in the table. Among 1086 patients with recurrent or metastatic disease, 54% and 14% respectively received first- and second-line chemotherapy. Overall survival (OS) was 13.7 months [HR 0.43 (95% CI 0.37-0.49)] with 1 line of treatment and 21.3 months with 2 lines [HR 0.30 (95% CI 0.24-0.37)], compared to 4.8 months with best supportive care. On multivariate analysis, ECOG, first and second-line treatment and liver-directed therapy remained associated with improved outcomes while tumor site or time period did not. Conclusions: The incidence of CC is rising and most patients present with advanced disease. Treatment attrition is high and few patients receive second line therapies. The outcomes of patients receiving first line, second line and liver-directed therapies are significantly better than those receiving supportive care only. Understanding contemporary trends in presentation and treatment patterns is essential as we consider strategies to improve implementation and access of emerging novel therapies in this setting. [Table: see text]

Promoting Conservation Agriculture in Rural Nigeria: Relevance of Environmental Literacy Education

Agricultural practice in Nigeria includes farming, fishing and herdskeeping. However, in the rural areas, farming tends to dominate the practice; hence, the term agriculture is generally used interchangeably with farming. Farmers in rural Nigeria generally adopt the traditional method of farming which involves environmentally unfriendly processes known to result in low productivity and income, occasioning the ultimate impoverishment of the farmers. Conservation/ Non-Tillage Agriculture is being advocated globally as a veritable alternative towards the solution of the adverse effect of both the traditional farming method and the contemporary incidence of climate change. Although global statistics indicate that Africa experienced relative increase in her land area under CA between 2007/2008 and 2012, nonetheless, Nigeria was conspicuously not among countries with up to 340 hectares (ha) of land area under CA in Sub-Saharan Africa. With the several known benefits of the CA system, there is a need to promote the adoption of the system by farmers in rural Nigeria. However, the constraints limiting the adoption of the CA system, as well as the notable hiatus in the spurring elements of the farmers’ demographic/ educational profile call for salient approaches (including education) towards promotion of CA among the farmers. The purpose of this paper is to expound the latent benefits and challenges of the CA system, the necessary strategies for the promotion of the system and the pertinence of Environmental Literacy Education to the promotion and adoption of CA in Rural Nigeria.

Trends and Risk Factors for Venous Thromboembolism Among Hospitalized Medical Patients

While hospital-associated venous thromboembolism (HA-VTE) is a known complication of hospitalization, contemporary incidence and outcomes data are scarce and methodologically contested. To define and validate an automated electronic health record (EHR)-based algorithm for retrospective detection of HA-VTE and examine contemporary HA-VTE incidence, previously reported risk factors, and outcomes. This cohort study was conducted using hospital admissions between January 1, 2013, and June 30, 2021, with follow-up until December 31, 2021. All medical (non-intensive care unit) admissions at an integrated health care delivery system with 21 hospitals in Northern California during the study period were included. Data were analyzed from January to June 2022. Previously reported risk factors associated with HA-VTE and administration of pharmacological prophylaxis were evaluated as factors associated with HA-VTE. Yearly incidence rates and timing of HA-VTE events overall and by subtype (deep vein thrombosis, pulmonary embolism, both, or unknown), as well as readmissions and mortality rates. Among 1 112 014 hospitalizations involving 529 492 patients (268 797 [50.8%] women; 75 238 Asian [14.2%], 52 697 Black [10.0%], 79 398 Hispanic [15.0%], and 307 439 non-Hispanic White [58.1%]; median [IQR] age, 67.0 [54.0-79.0] years), there were 13 843 HA-VTE events (1.2% of admissions) occurring in 10 410 patients (2.0%). HA-VTE events increased from 307 of 29 095 hospitalizations (1.1%) in the first quarter of 2013 to 551 of 33 729 hospitalizations (1.6%) in the first quarter of 2021. Among all HA-VTE events, 10 746 events (77.6%) were first noted after discharge. In multivariable analyses, several factors were associated with increased odds of HA-VTE, including active cancer (adjusted odds ratio [aOR], 1.96; 95% CI, 1.85-2.08), prior VTE (aOR, 1.71; 95% CI, 1.63-1.79), and reduced mobility (aOR, 1.63; 95% CI, 1.50-1.77). Factors associated with decreased likelihood of HA-VTE included Asian race (vs non-Hispanic White: aOR, 0.65; 95% CI, 0.61-0.69), current admission for suspected stroke (aOR, 0.73; 95% CI, 0.65-0.81), and Hispanic ethnicity (vs non-Hispanic White: aOR, 0.81; 95% CI, 0.77-0.86). HA-VTE events were associated with increased risk of readmission (hazard ratio [HR], 3.33; 95% CI, 3.25-3.41) and mortality (HR, 1.63; 95% CI, 1.57-1.70). This study found that HA-VTE events occurred in 1.2% of medical admissions, increased over time, and were associated with increased adverse outcomes. These findings suggest that approaches designed to mitigate occurrence and outcomes associated with HA-VTE may remain needed.

Contemporary cystic fibrosis incidence rates in Canada and the United States

BackgroundThe availability of new diagnostic algorithms for cystic fibrosis (CF), changing population demographics and programs that impact family planning decisions can influence incidence rates. Thus, previously reported incidence rates in Canada and the United States (US) may be outdated. The objectives of this study were to estimate contemporary CF incidence rates in Canada and the US and to determine if the incidence rate has changed over time. MethodThis population-based cohort study utilized data between 1995-2019 from the Canadian CF Registry (CCFR), Statistics Canada, US CF Foundation Patient Registry (CFFPR) data, and US Center for Disease Control (CDC) National Vital Statistics System. Incidence was estimated using the number of live CF births by year, sex, and geographic region using Poisson regression, with the number of live births used as the denominator. To account for delayed diagnoses, we imputed the proportion of diagnoses expected given historical trends, and varying rates of newborn screening (NBS) implementation by region. ResultsAfter accounting for implementation of NBS and delayed diagnoses, the estimated incidence rate for CF in 2019 was 1:3848 (95% CI: 1:3574, 1:4143) live births in Canada compared to 1:5130 (95% CI:1:4996, 1:5267) in the US. There was substantial regional variation in incidence rates within both Canada and the US. Since 1995, incidence rates have decreased at a rate of 1.6% per year in both countries (p<0.001). ConclusionContemporary CF incidence rates suggest CF incidence is lower than previously reported and varies widely within North America. This information is important for resource planning and for tracking how programs (e.g., genetic counselling, modulator availability etc.) may impact the incidence of CF moving forward.

Contemporary Incidence and Burden of Cerebral Venous Sinus Thrombosis in Children of the United States.

The incidence of cerebral venous thrombosis (CVT) in children of the United States is unknown, and it is uncertain how the burden of CVT hospitalizations in children changed over the last decade. We conducted a retrospective cohort study using the State Inpatient Database and Kid's inpatient database. All new CVT cases in children (0-19 years) in the New York 2006 to 2018 State Inpatient Database (n=705), and all cases of CVT in the entire US contained in the 2006 to 2019 Kid's inpatient database (weighted n=6115) were identified using validated International Classification of Diseases (ICDs) codes. Incident counts were combined with census data to compute incidence. Between-group differences in incidence were tested using 2-proportions Z-test, and Joinpoint regression was used to trend incidence over time. Across the study period, 48.2% of all incident CVT cases and 44.6% of all CVT admissions nationally were in girls. Of all incident cases, 27.2% were infants and 65.8% of these infants were neonates. Average incidence across the study period was (1.1/100 000/year, SE:0.04) but incidence in infants (6.4/100 000/year) was at least 5 times the incidence in other age groups (1-4 years: 0.7/100 000/year, 15-19 years: 1.2/100 000/year). Incidence and national burden of CVT admissions was higher in girls in adolescents 15 to 19 years, but overall burden was higher in boys in other age groups. Age- and sex-standardized CVT incidence increased by 3.8% annually (95% CI, 0.2%-7.6%), while the overall burden of admissions increased by 4.9% annually (95% CI, 3.6%-6.2%). CVT incidence in New York and national burden of CVT increased significantly over the last decade.

Estimating individual lifetime risk of incident cardiovascular events in adults with Type 2 diabetes: an update and geographical calibration of the DIAbetes Lifetime perspective model (DIAL2).

The 2021 European Society of Cardiology cardiovascular disease (CVD) prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding intensified preventive treatment options in adults with Type 2 diabetes, e.g. the DIAbetes Lifetime perspective model (DIAL model). The aim of this study was to update the DIAL model using contemporary and representative registry data (DIAL2) and to systematically calibrate the model for use in other European countries. The DIAL2 model was derived in 467 856 people with Type 2 diabetes without a history of CVD from the Swedish National Diabetes Register, with a median follow-up of 7.3 years (interquartile range: 4.0-10.6 years) and comprising 63 824 CVD (including fatal CVD, non-fatal stroke and non-fatal myocardial infarction) events and 66 048 non-CVD mortality events. The model was systematically recalibrated to Europe's low- and moderate-risk regions using contemporary incidence data and mean risk factor distributions. The recalibrated DIAL2 model was externally validated in 218 267 individuals with Type 2 diabetes from the Scottish Care Information-Diabetes (SCID) and Clinical Practice Research Datalink (CPRD). In these individuals, 43 074 CVD events and 27 115 non-CVD fatal events were observed. The DIAL2 model discriminated well, with C-indices of 0.732 [95% confidence interval (CI) 0.726-0.739] in CPRD and 0.700 (95% CI 0.691-0.709) in SCID. The recalibrated DIAL2 model provides a useful tool for the prediction of CVD-free life expectancy and lifetime CVD risk for people with Type 2 diabetes without previous CVD in the European low- and moderate-risk regions. These long-term individualized measures of CVD risk are well suited for shared decision-making in clinical practice as recommended by the 2021 CVD ESC prevention guidelines.

Infection and infective endocarditis according to type of diabetes mellitus after cardiac implantable electronic device implantation: a contemporary nationwide cohort study

Abstract Background Patients with diabetes mellitus (DM) are at increased risk of infection. However, there are controversial reports about type 1 or 2 DM and their associations with infection and infective endocarditis (IE) following implantation of cardiac implantable electronic device (CIED). We evaluated the contemporary incidence of infections and infective endocarditis (IE) following implantation of a first-time, permanent CIED in DM patients compared to controls. Methods This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults hospitalized in French hospitals from 2010 to 2019, who underwent a de novo permanent pacemaker (PM) or implantable cardioverter defibrillator (ICD) implantation were identified together with the occurrence of post-implantation infection and IE-events during follow-up. Results In total 688,007 CIED patients were identified (pacemakers 87.3%, ICDs 12.7%). History of diabetes was present in 162,490 patients: 8,041 (1.2%) with type 1 DM and 154,449 (22.5%) with type 2 DM. Patients with no DM were slightly older and had less prevalent associated comorbidities than those with DM. Patients with type 1 DM had less prevalent associated comorbidities than those with type 2 DM. Follow-up was 2.6±2.6 years (median 1.9, IQR 0.2–4.3 years). There were 9,804 patients with CIED-related infection during follow-up (incidence rate 5.48 per 1000 patient.year) among whom 2,658 had IE (incidence rate 1.49 per 1000 patient year). The incidence rate (per 1000 PYs) of CIED-related infection and IE in the different subgroups of patients with no DM, type 1 DM and type 2 DM are in Table 1. Incidence rates were higher in patients with DM than in those with no DM, and numerically higher in those with type 2 DM than in those with type 1 DM. In multivariable analysis (adjustment on baseline characteristics including age, cardiovascular and non-cardiovascular comorbidities and type of CIED), type 1 DM and type 2 DM were independent risk factors for CIED-related infection vs no DM. Type 1 DM was not associated with a statistically different risk of CIED-related infection than type 2 DM. When analysing the risk of IE during FU, type 2 DM was an independent risk factors for IE vs no DM, whilst there was a non-statistical trend for type 1 DM vs no DM. Type 1 DM was however not associated with a statistically different risk of IE than type 2 DM. Results were similar when one considered separately the periods 2010–2014 and 2015–2019 Conclusion The risk of CIED-related infection was significantly higher in patients with type 1 and type 2 DM than in those with no DM. Although there were differences in the profile and clinical history of patients with type 1 and type 2 DM, there was no statistical difference in the risk of CIED-related infection and IE in patients with type 1 and type 2 DM in this contemporary analysis at a nationwide level. Funding Acknowledgement Type of funding sources: None.

Incidence and predictors of radial artery occlusion following transradial coronary angiography: the proRadial trial

ObjectivesThis study investigated the contemporary incidence and predictors of radial artery occlusion as well as the effectiveness of antithrombotic treatment for radial artery occlusion following transradial coronary angiography.BackgroundThe radial artery is the standard access for coronary angiography and even complex interventions. Postprocedural radial artery occlusion is still a common and significant complication.MethodsThis prospective study enrolled 2004 patients following transradial coronary angiography. After sheath removal, hemostasis was obtained in a standardized fashion. Radial artery patency was evaluated by duplex ultrasonography in all patients. In case of occlusion, oral anticoagulation was recommended and patients were scheduled for a 30-day follow-up including Doppler ultrasonography.ResultsA new-diagnosed radial occlusion was found in 4.6% of patients. The strongest independent predictors of radial occlusion were female sex and active smoking status. In the subgroup of patients with percutaneous coronary interventions, female sex followed by sheath size > 6 French were the strongest predictors of radial occlusion. 76 of 93 patients with radial occlusion received an oral anticoagulation for 30 days. However, reperfusion at 30 days was found in 32% of patients on oral anticoagulation.ConclusionThe incidence of radial artery occlusion following coronary angiography in contemporary practice appears with 4.6% to be lower as compared to previous cohorts. Female sex and smoking status are the strongest independent predictors of radial occlusion followed by procedural variables. The limited effectiveness of oral anticoagulation for treatment of radial artery occlusion suggests a primarily traumatic than thrombotic mechanism of this complication.Graphical abstract

Roadmap to incorporating group A Streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease.

Roadmap to incorporating group A Streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease.

WS08.02 Contemporary incidence of cystic fibrosis in Canada and the United States

WS08.02 Contemporary incidence of cystic fibrosis in Canada and the United States

Infection and infective endocarditis after cardiac implantable electronic device implantation: a contemporary nationwide cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Aims To determine the contemporary incidence and risk factors of infection and infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED). Methods This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals from January 1, 2010 to December 31, 2019, who underwent a de novo permanent pacemaker (PM) or implantable cardioverter defibrillator (ICD) implantation were identified together with the occurrence of post-implantation infection and IE-events during follow-up. Results In total 688,007 CIED patients with de novo implants were identified (single-chamber pacemaker 18.8%, dual-chamber pacemaker 64.9%, cardiac resynchronization therapy [CRT]pacemaker 3.2%, single-chamber ICD 4.3%, dual-chamber ICD 3.4%, CRT ICD 5.5%). Follow-up was 2.6±2.6 years (median 1.9, IQR 0.2-4.3 years) and total follow-up time was 1,788,166person-years (PYs). There were 9,804 patients with CIED-related infection during follow-up (incidence rate 5.48 per 1000 patient.year) among whom 2,658 had IE (incidence rate 1.49 per 1000 patient.year). The incidence rate (per 1000 PYs) of CIED-related infection and IE in the different subgroups of patients with pacemakers and ICD (single-chamber, dual-chamber, CRT) are in table 1. Incidence rates were higher in patients with an ICD than in those with a pacemaker, and higher in those with CRT. Incidence rates of CIED-related infection and IE were not different in single-chamber vs dual-chamber CIEDs(table 1). In multivariable analysis, ICD (vs pacemaker, HR: 1.59; 95% CI 1.40-1.80) and CRT (vs no CRT, HR: 1.21; 95% CI: 1.07-1.37) were independent risk factors for CIED-related infection. Dual-chamber pacemakers were not associated with a higher risk of CIED-related infection than single-chamber pacemakers. Similarly, dual-chamber ICDs were not associated with a higher risk of CIED-related infection than single-chamber ICDs (table). There were similar findings when analysing the risk of IE during FU. ICD (vs pacemaker, HR: 1.31; 95% CI 1.23-1.40) and CRT (vs no CRT, HR: 1.24; 95% CI: 1.16-1.32) were independent risk factors for IE. Dual-chamber pacemakers were not associated with a higher risk of IE than single-chamber pacemakers and dual-chamber ICDs were not associated with a higher risk of IE than single-chamber ICDs (table). Results were similar when one considered separately the periods 2010-2014 and 2015-2019 Conclusion The risk of CIED-related infection and IE was significantly higher in patients with ICDs than in those with pacemakers and significantly higher with CRT than with no CRT. By contrast, there was no statistical difference in the risk of CIED-related infection and IE in patients with single-chamber or dual-chamber CIEDs in this contemporary analysis at a nationwide level.

Contemporary incidence, outcomes, and survival associated with endovascular aortic aneurysm repair conversion to open repair among Medicare beneficiaries

ObjectiveThe widespread application of endovascular abdominal aortic aneurysm repair (EVAR) has ushered in an era of requisite postoperative surveillance and the potential need for reintervention. The national prevalence and results of EVAR conversion to open repair, however, remain poorly defined. The purpose of this analysis was to define the incidence of open conversion and its associated outcomes. MethodsThe SVS Vascular Quality Initiative EVAR registry linked to Medicare claims via Vascular Implants Surveillance and Interventional Outcomes Network was queried for open conversions after initial EVAR procedures from 2003 to 2016. Cumulative conversion incidence within up to 5 years after EVAR and outcomes after open intervention were determined. Multivariable logistic regressions were used to identify independent predictors of conversion and mortality. ResultsAmong 15,937 EVAR patients, 309 (1.9%) underwent an open conversion: 43% (n = 132) early (<30 days) and 57% (n = 177) late (>30 days). The longitudinally observed rate of conversion was constant over time, as well as by geographic region. Independent predictors of conversion included female sex (hazard ratio [HR], 1.49; P < .001), aneurysm diameter or more than 6.0 cm at the time of index EVAR (HR, 1.74; P < .001), nonelective repair (compared with elective presentation: HR, 1.72; P < .001), and aortouni-iliac repairs (HR, 2.19; P < .001). In contrast, adjunctive operative procedures such as endo-anchors or cuff extensions (HR, 0.62; P = .06) were protective against long-term conversion. Both early (HR, 1.6; P < .001) and late (HR, 1.26; P = .07) open conversions were associated with significant 30-day (total cohort, 15%) and 1-year mortality (total cohort, 25%). Patients undergoing open conversion experienced high rates of 30-day readmission (42%) and cardiac (45%), renal (32%), and pulmonary (30%) complications. ConclusionsThis large, registry-based analysis is among the first to document the incidence and outcomes for open conversion after EVAR in a national cohort with long-term follow-up. Importantly, women, patients with large aneurysms, and complex anatomy, as well as urgent or emergent EVARs are at an increased risk for open conversion. It seems that more conversions are performed in the early postoperative period, despite perceptions that conversion is a delayed phenomenon. In all instances, conversion is associated with significant morbidity and mortality and highlights the importance of appropriate patient selection at the time of index EVAR.

Breast Cancer Incidence, Hormone Receptor Status, Historical Redlining, and Current Neighborhood Characteristics in Massachusetts, 2005-2015.

BackgroundScant research has analyzed contemporary US cancer incidence rates in relation to historical redlining (ie, 1930s US federally imposed residential segregation), implemented via the color-coded federal Home Owners’ Loan Corporation (HOLC) maps.MethodsWe analyzed Massachusetts Cancer Registry data for all patients with primary invasive breast cancer (BC) diagnosed in 2005-2015 among women in the 28 Massachusetts municipalities with digitized 1930s HOLC maps. Multilevel Poisson regression estimated BC incidence rate ratios (IRR), overall and by tumor estrogen receptor (ER-positive, ER-negative) and progesterone receptor (PR-positive, PR-negative) status, in relation to HOLC grade and contemporary census tract (CT) social characteristics.ResultsNet of age and racialized group, the extremes of BC incidence were detected by combinations of HOLC grade and contemporary CT racialized economic segregation. Compared with CTs with the best HOLC grade (A + B) and most privileged contemporary characteristics (T1), for all, ER-positive and PR-positive BC, incidence was highest in T1 and mixed HOLC grade CTs (eg, IRRER+; Mixed-T1 = 1.10, 95% confidence interval [CI] = 1.01 to 1.21) and lowest in CTs with most concentrated racialized economic deprivation (T3) and no HOLC grade (eg, IRRER+; No Grade-T3 = 0.85, 95% CI = 0.75 to 0.95). For ER-negative and PR-negative BC, incidence was highest in CTs with the most contemporary deprivation, but the best HOLC grade (eg, IRRER-; A+B-T3 = 1.27, 95% CI = 0.93 to 1.75) and lowest in T1 and worst HOLC-graded CTs (eg, IRRER-; D-T1 = 0.84, 95% CI = 0.56 to 1.25).ConclusionBreast cancer risk may be shaped by combined histories of redlining and present-day CT characteristics.

Trends in Positive Surgical Margins in cT1-T2 Oral Cavity Squamous Cell Carcinoma.

To evaluate trends in contemporary positive surgical margin incidence in cT1-T2 oral cavity squamous cell carcinoma and to evaluate factors associated with surgical margin status. Retrospective analysis of large dataset. Retrospective analysis of the National Cancer Database. Between 2004 and 2016, 39,818 patients with cT1 or cT2 oral cavity squamous cell carcinoma received primary curative-intent surgery. Positive surgical margins were present in 7.95% of patients, and univariable adjusted probability of positive surgical margins over the study period declined by 1% per year (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-1.0; P= .049). Multivariable regression revealed the annual rate of positive surgical margins declined significantly (OR, 0.95 per year; 95% CI, 0.92-0.97; P< .001). Factors associated with increased odds of positive surgical margins included cT2 disease, subsite, understaged disease, lymphovascular invasion, tumor grade, and positive lymph nodes. Race and socioeconomic status were not associated with surgical margin status. Treatment at an academic center was associated with increased time to definitive surgery (median 35 days IQR 22-50 vs. median 27 days IQR 14-42; P< .001) and a 20% reduction in positive surgical margin rate (OR, 0.80; 95% CI, 0.71-0.90; P< .001). Treatment at high-volume centers was less likely to be associated with positive surgical margins (OR, 0.85; 95% CI, 0.74-0.98; P= .02). Surgical subsite, clinical T and N category, presence of lymphovascular invasion, and histologic grade were independent predictors of positive surgical margins. Patients are increasingly being treated at high-volume and academic centers. Overall, the rate of positive surgical margins in cT1-T2 oral cavity squamous cell carcinoma is decreasing. 4 Laryngoscope, 132:1962-1970, 2022.