Decline In Incidence Rates Research Articles

Millions of excess cases and thousands of excess deaths of malaria occurred globally in 2020 during the COVID-19 pandemic

The COVID-19 pandemic disrupted malaria-related health care services, leading to an excess burden of malaria. However, there is a lack of research on the indirect global impact of the COVID-19 pandemic on malaria. We aimed to assess the excess burden of malaria due to the COVID-19 pandemic in malaria-endemic countries in 2020. Based on data from the World Health Organization Global Observatory, we used estimated annual percentage changes (EAPCs) from 2000 to 2019 (model A) and from 2015 to 2019 (model B) to predict the malaria burden in 2020. We calculated the ratios between reported and predicted malaria incidence (incidence rate ratio (IRR)) and mortality rates (mortality rate ratio (MRR)). In 2020, African countries suffered the most from malaria, with the largest number of malaria cases (64.7 million) and deaths (151 thousand) observed in Nigeria. Most countries showed a decrease in malaria incidence and mortality rates from 2000 to 2019, with the strongest decline in incidence rates in Bhutan (EAPC = -35.7%, 95% CI = -38.7 to -32.5%) and mortality rates Ecuador (EAPC = -40.6%, 95% confidence interval (CI) = -46.6 to -33.8%). During the COVID-19 pandemic in 2020, there was a total of 18 million excess malaria cases and 83 291 excess deaths per model A, and 7.4 million excess cases and 33 528 excess deaths per model B globally. Malaria incidence rates increased excessively in over 50% of the malaria-endemic countries, with the greatest increase in Costa Rica (IRR = 35.6) per model A and Bhutan (IRR = 15.6) per model B. Mortality rates had increased excessively in around 70% of the malaria-endemic countries, with the greatest increase in Ecuador in both model A (MRR = 580) and model B (MRR = 58). The emergence of the COVID-19 pandemic indirectly caused an increase in the prevalence of malaria and thwarted progress in malaria control. Global efforts to control the pandemic's impact should be balanced with malaria control to ensure that the goal for global malaria elimination is achieved on time.

Use of ADHD Medication Among Danish Children and Adolescents from 2010-2020 - A Nationwide Study

IntroductionTo ensure rational drug use, there is a need to continuously monitor the use of ADHD medication among children and adolescents.ObjectivesTo describe the use of ADHD medication among Danish children and adolescents from 2010-2020.Methods Using the Danish national healthcare registries, we extracted data on filled prescriptions of ADHD medication (including methylphenidate, atomoxetine, guanfacine, dexamphetamine, and lisdexamphetamine) among children (age 6-12 years) and adolescents (age 13-17 years) between 2010-2020. We examined the annual incidence rate and prevalence proportion of ADHD drug use, and the proportion of children and adolescents having an ADHD diagnosis when initiating ADHD medication.Results From 2010-2020, the incidence followed a u-shaped trend with an incidence rate of 4.9/1,000 children and 4.4/1,000 adolescents in 2010, decreasing to 3.2/1,000 children and 3.0/1,000 adolescents in 2013, and rising to 4.9/1,000 children and 4.8/1,000 adolescents in 2020. The prevalence for children showed a similar trend, shifting from 17/1,000 in 2010, to 15/1,000 in 2016, and peaking at 19/1,000 children in 2020. However, among adolescents the prevalence increased steadily from 19/1,000 in 2010 to 29/1,000 in 2020. 67% of children and 53% of adolescents initiating ADHD medication had an ADHD diagnosis.Conclusions After an initial decline in incidence rates of ADHD medication use among Danish children and adolescents, there has been a rise in use the last five years. The same trend applied for the prevalence among children, whereas the prevalence among adolescents increased steadily over the entire period. More than half of children and adolescents initiating ADHD medication were diagnosed with ADHD.DisclosureNo significant relationships.

An Exploratory Analysis of Fifteen Years Suicide Trends Using Population-Level Data From Croatian Committed Suicides Registry.

ObjectivesThe provide a descriptive analysis of the available population-level aggregated data on committed suicides in the Republic of Croatia, in the 2004–2018 period, showing emerging trends in suicide incidence focusing on sex/age/geographical distribution of suicides and the primary and secondary causes of suicide mortality, as well as making comparisons with similar neighboring neighboring countries.MethodsThe aggregated suicide data were obtained from the Croatian Committed Suicides Registry, a national registry maintained by the public health authority. The raw data extract was organized into tables according to several variables (age, sex, place of birth, place of residence, and cause of death). Simple descriptive statistics were performed on the structured data.ResultsDespite being among the highest in the world and EU, the number of committed suicides in Croatia is in decline since 2004. A higher number of suicides by males was observed when compared to females. Most of the suicides occur during spring and summer. The wealthier, northern continental region of the country had the highest average rate of committed suicides per 1,00,000 population, contrary to some of the findings in the published literature associating economic instability with suicide. The most common way to commit suicide for both sexes in all age groups is self-harm by hanging, strangulation and suffocation. Suicide by firearm and explosive devices discharge remains higher than the global average.ConclusionsDespite its steadily declining incidence rates in the past 20 years, suicides remain a major public health challenge in Croatia. Results may bolster the Ugro-Finnish suicide hypothesis, linking higher suicide rates to regions with populations of Hungarian descent.

A nationwide registry study on heart failure in Norway from 2008 to 2018: variations in lookback period affect incidence estimates

BackgroundThe incidence of heart failure (HF) has declined in Europe during the past two decades. However, incidence estimates from registry-based studies may vary, partly because they depend on retrospective searches to exclude previous events. The aim of this study was to assess to what extent different lookback periods (LPs) affect temporal trends in incidence, and to identify the minimal acceptable LP. Further, we wanted to estimate temporal trends in incidence and prevalence of HF in a nationwide population, using the minimal acceptable LP.MethodsWe identified all in- and out-patient contacts for HF in Norway during 2008 to 2018 from the Norwegian Patient Registry. To calculate the influence of varying LP on incident cases, we defined 2018 with 10 years of LP as a reference and calculated the relative difference by using one through 9 years of lookback. Temporal trends in incidence rates were estimated with sensitivity analyses applying varying LPs and different case definitions. Standardised incidence rates and prevalence were calculated by applying direct age- and sex-standardization to the 2013 European Standard Population.ResultsThe overestimation of incident cases declined with increasing number of years included in the LP. Compared to a 10-year LP, application of 4, 6, and 8 years resulted in an overestimation of incident cases by 13.5%, 6.2% and 2.3%, respectively. Temporal trends in incidence were affected by the number of years in the LP and whether the LP was fixed or varied. Including all available data mislead to conclusions of declining incidence rates over time due to increasing LPs.ConclusionsWhen taking the number of years with available data and HF mortality and morbidity into consideration, we propose that 6 years of fixed lookback is sufficient for identification of incident HF cases. HF incidence rates and prevalence increased from 2014 to 2018.Trial registrationRetrospectively registered.

АНАЛИЗ ЗАБОЛЕВАЕМОСТИ ВЗРОСЛОГО НАСЕЛЕНИЯ, ПРОЖИВАЮЩЕГО В ЗОНЕ ДЕЙСТВИЯ ПРЕДПРИЯТИЯ АТОМНОЙ ИНДУСТРИИ

Significance. Implementation of the federal projects “Fight against cardiovascular diseases” and “Fight against cancer” requires assessment of incidence of socially significant diseases in population (malignant neoplasms, diabetes mellitus, mental and behavioral disorders, diseases characterized by elevated blood pressure). One of the categories of citizens requiring such assessment is population of single-industry towns accounting for about 12.5 % of the Russian population. Purpose. To analyze incidence of socially significant diseases in the adult population of a single-industry town located in the area of operation of a nuclear industry enterprise in 1990-2020. The material of the study was information on disease incidence among adult population of the closed administrative-territorial entity – the city of Seversk, residing in the operation area of the Siberian Chemical Plant in 1990-2020. Results. During the study period there was an increase in the incidence of malignant neoplasms, diseases of the endocrine system (including diabetes mellitus), as well as diseases of the circulatory system (in particular, diseases characterized by elevated blood pressure). At the same time, in 2018-2020, there was a decrease in the incidence of diseases under study, as well as a decrease in the incidence rates with temporary disability. The incidence of mental and behavioral disorders associated with the use of psychoactive substances has been steadily decreasing throughout the study period. Conclusion. Increase in incidence of socially significant diseases is most likely due to population aging and increase in the share of people aged 60 and older in population. However, the 2018-2020, decline in incidence rates requires a further analysis of availability of primary health care, volumes of emergency care, hospital mortality and mortality of population of the area under study. Decreased incidence of mental and behavioral disorders associated with the use of psychoactive substances suggests that the socio-economic situation in the Russian Federation has significantly improved during the study period.

Abstract PR-06: Examining disparities in incidence of colorectal cancer by race, ethnicity, sex, and site

Abstract Over the past 21 years, while the incidence of colorectal cancer in the US has decreased, disparities in race and ethnicity have increased but no recent evaluation exists of differences in race and ethnicity by location of primary tumors within the colon and rectum among all age groups. Recent literature has shown that there are differences in the rates of colorectal cancer between multiple minority groups; however, many of these studies only compare CRC among White and Black groups. We examined the trends of colorectal cancer incidence by racial/ethnic group and location of the primary tumors within the colon and rectum to describe disparities. This study used SEER*Stat v 8.3.9 Incidence – SEER Research Data, 18 Registries, Nov 2020 Sub (2000-2018) to analyze age-adjusted rates in incidence by race, ethnicity, sex, and site. We examined the sites within the proximal, transverse, and distal colon, as well as the rectum, and further examined localized, regional, and distant diagnosis stages. As others have reported, we observed declining incidence in colorectal cancer, but found that some racial and ethnic groups experienced higher incidence rates compared to other groups by diagnosis site and the stage of diagnosis. For example, when singling out the proximal colon, Black males had a rate of 12.7/100,000 people at the local stage in 2000. Comparing this localized proximal rate to male Whites (11.7), American Indian/Alaskan Natives (7.2), Asians/Pacific Islanders (6.9), and Hispanics (7.9), we can see that Blacks have already experienced a higher diagnosis rate than other races and ethnicities. Examining annual percent changes, incidence rates for Blacks decreased just as those for other racial and ethnic groups did. However, they do not experience the largest annual percent decrease. From this portion of the data, we see that some racial and ethnic groups had decreases in incidence trends. However, when examining each rate individually by subsite and diagnosis stage, some groups are seeing a trend where the rate is not as favorable. Despite declining incidence rates of colorectal cancer in the United States overall, comparisons by race and ethnicity reveal important disparities, particularly by site of primary tumors within the colon and rectum, which may have critical implications for treatment and long-term survival. Citation Format: Andrea Joyce M Malabay, Kristin Primm, Taylor Curry, Shine Chang. Examining disparities in incidence of colorectal cancer by race, ethnicity, sex, and site [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-06.

Clinical and Social Findings of Childhood Epilepsy

Background: Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. Seizure is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Epilepsy is the most frequent chronic neurologic condition in children. Studies have suggested declining incidence rates of childhood epilepsy in high-income countries during the last decades. Objective: To describe the clinical features and social findings of epilepsy in children, and to evaluate some risk factors associated with control of epilepsy. Patients and Methods: This cross-sectional study was conducted in the pediatric department of Albatool teaching hospital in Diyala province, Iraq. A total of 100 children were included in the study from February 2020 to May 2020. All children diagnosed with epilepsy in this study. Results: One hundred children with epilepsy, their mean age was 5.96± 3.33 years (range 1-14 years). Of the 48(48%) children were male and 52(52%). Of the total patients, 79% were free from seizure on AED, 21% of them were refractory to treatment.Patients without developmental delay (88.7%, p=0.012) can be controlled by AED. Patients who had idiopathic seizures (87.5%, p=0.04) can be controlled by AED. Patients who had seizure attacks can be controlled by AED more than patients who had weekly or monthly seizure attacks (97.4%) (p<0.001). Patients who had been treated by monotherapy (94.7%, p=0.012) can be controlled more than patients who were treated by multidrug therapy. Affected social interaction and need more supervision were factors that detected more in patients with refractory epilepsy, p=0.04, 0.01 respectively. While there was no association between frightened other people and epilepsy control. Conclusion: Most of the patients are characterized by: treatment approach monotherapy, less affected by social interaction and need less supervision. Patients with refractory epilepsy had opposite factors. Keywords: Epilepsy, Albatool teaching hospital.

A nationwide registry study on heart failure in Norway from 2008–2018: variations in lookback period affect incidence estimates

Abstract Background/Introduction Incidence estimations of heart failure from registry-based studies may vary because they depend on a retrospective search in the database to exclude previous events (prevalent cases), termed the lookback period. Purpose The aim of this study was to assess to what extent different lookback periods affect temporal trends in heart failure incidence utilizing national registry data. Methods We identified all heart failure hospital contacts (ICD-10 codes I11.0, I13.0, I13.2, I42.x and I50.x) in adult Norwegian individuals in the Norwegian Patient Registry (NPR) during 2008–2018. To calculate the influence of varying lookback period on incident cases, we defined 2018 with 10 years of lookback as a reference and calculated the relative difference by using one through nine years of lookback. Temporal trends in age-adjusted incidence rates were estimated with sensitivity analyses using fixed and varying lookback periods (including all available data). Results Using a lookback period of 10 years, we identified 14 862 incident patients in 2018 (6 842 women, 8 020 men) with a diagnosis of heart failure. Compared to a 10-year lookback period, application of four, six, and eight years resulted in an overestimation of incident cases by 13.5%, 6.2% and 2.3%, respectively. This corresponds to incidence rates of 5.40, 5.04 and 4.85 per 1000 person-years, respectively. Figure 1 shows that the overestimation of incident cases declined with increasing number of years included in the lookback period. The overestimation was largest in the beginning of the observational period. When assessing temporal trends in incidence rate using a fixed lookback period, the incidence rates were lower with additional years in the lookback period. However, incidence rates increased regardless of whether four, six or eight years were applied. In contrast, incidence rates were lower and declined during the period when including all available data and thereby increasing the lookback period with time. Fig. 2 shows that a relatively shorter lookback period provided higher incidence rate estimates and that the direction of the curves were similar when using a fixed lookback period. Moreover, it shows that including all available data instead of using a fixed lookback period resulted in the misleading conclusion of declining incidence rates. Conclusions The length of the lookback period affects incidence estimates when calculating incidence rates from longitudinal health registry data. Our results suggest that one to five years of lookback is too short since incident cases are overestimated by 64% - 9%. A fixed lookback period of six year or more seems beneficial with less overestimation (≤6%). Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by the Research Council of Norway and Novartis Norway AS. KMO is a PhD-student at the University of Oslo and an employee of Novartis Norway AS. Overestimation of incident cases in 2018Incidence rates

Ecological Analysis of the Decline in Incidence Rates of COVID-19 Among Nursing Home Residents Associated with Vaccination, United States, December 2020-January 2021

ObjectiveTo evaluate if facility-level vaccination after an initial vaccination clinic was independently associated with COVID-19 incidence adjusted for other factors in January 2021 among nursing home residents. DesignEcological analysis of data from the CDC's National Healthcare Safety Network (NHSN) and from the CDC's Pharmacy Partnership for Long-Term Care Program. Setting and ParticipantsCMS-certified nursing homes participating in both NHSN and the Pharmacy Partnership for Long-Term Care Program. MethodsA multivariable, random intercepts, negative binomial model was applied to contrast COVID-19 incidence rates among residents living in facilities with an initial vaccination clinic during the week ending January 3, 2021 (n = 2843), vs those living in facilities with no vaccination clinic reported up to and including the week ending January 10, 2021 (n = 3216). Model covariates included bed size, resident SARS-CoV-2 testing, staff with COVID-19, cumulative COVID-19 among residents, residents admitted with COVID-19, community county incidence, and county social vulnerability index (SVI). ResultsIn December 2020 and January 2021, incidence of COVID-19 among nursing home residents declined to the lowest point since reporting began in May, diverged from the pattern in community cases, and began dropping before vaccination occurred. Comparing week 3 following an initial vaccination clinic vs week 2, the adjusted reduction in COVID-19 rate in vaccinated facilities was 27% greater than the reduction in facilities where vaccination clinics had not yet occurred (95% confidence interval: 14%-38%, P < .05). Conclusions and ImplicationsVaccination of residents contributed to the decline in COVID-19 incidence in nursing homes; however, other factors also contributed. The decline in COVID-19 was evident prior to widespread vaccination, highlighting the benefit of a multifaced approach to prevention including continued use of recommended screening, testing, and infection prevention practices as well as vaccination to keep residents in nursing homes safe.

Abstract LB082: Prostate cancer incidence and mortality in the United States, 2000-2016

Abstract Background/Purpose Prostate cancer (PC) is the second most common and deadly cancer among men in the United States. In general, incidence rate of prostate cancer has declined while mortality rate has increased over the past 15 years. The purpose of this study is to assess the incidence and mortality rates of this cancer according to race/ethnicity from 2000-2016. Methods We obtained data from the Surveillance, Epidemiology and End Results (SEER) 18 program to calculate incidence and mortality rates by race/ethnicity from 2000 to 2016. The Annual Percent Change (APC) was also obtained for incidence and mortality rates by race/ethnicity. Results From 2000-2016, the overall incidence rate has decreased significantly from 77.4 to 49.1 per 100,000 (APC = -3.1). Asian and Pacific Islander had the highest decline in incidence rate from 44.4 to 23.4 per 100,000 whereas African-American had the lowest decline from 113.3 to 72.4 per 100,000 (APC -4.4 vs -2.9 respectively). Conversely, the death rate has increased substantially, particularly among White and Black (APC = 8.6 vs 6.6). However, African-Americans still have a disproportionate mortality rate compared to White (46.5 vs 28.8 per 100,000). Conclusion African-Americans are still suffering disproportionately from the PC. There is a need to implement public health interventions to improve PC screening among African-Americans, and examine additional factors that may contribute to the burden of this cancer among African-Americans. Citation Format: Michael Rutalira Koko, Rasaki Aranmolate, Raza Z. Shah, Glodi Mutamba. Prostate cancer incidence and mortality in the United States, 2000-2016 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB082.

Incidence of HIV in Sub-Saharan Africa, 2000\u20132015: The Interplay Between Social Determinants and Behavioral Risk Factors

HIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.

Renal Replacement Therapy in People With and Without Diabetes in Germany, 2010-2016: An Analysis of More Than 25 Million Inhabitants.

OBJECTIVEEpidemiological studies have shown contradictory results regarding the time trend of end-stage renal disease (ESRD) in people with diabetes. This study aims to analyze the incidence of ESRD, defined as chronic renal replacement therapy (RRT), to investigate time trends among people with and without diabetes in Germany and to examine whether these patterns differ by age and sex.RESEARCH DESIGN AND METHODSThe data were sourced from nationwide data pooled from two German branches of statutory health insurances covering ∼25 million inhabitants. We estimated age- and sex-standardized incidence rates (IRs) for chronic RRT among people with and without diabetes in 2010–2016 and the corresponding relative risks. Time trends were analyzed using Poisson regression.RESULTSWe identified 73,638 people with a first chronic RRT (male 60.0%, diabetes 60.6%, mean age 71.3 years). The IR of chronic RRT among people with diabetes (114.1 per 100,000 person-years [95% CI 110.0–117.2]) was almost six times higher than among people without diabetes (19.6 [19.4–19.8]). A consistent decline in IR was observed among people with diabetes (3% annual reduction, P < 0.0001) for both sexes and all age classes. In contrast, no consistent change of IR was identified in people without diabetes. Only among women aged <40 years (P = 0.0003) and people aged ≥80 years (P < 0.0001) did this IR decrease significantly.CONCLUSIONSIncidence of chronic RRT remained significantly higher among people with diabetes. The IR decreased significantly in people with diabetes independent of age and sex. Time trends were inconsistent in people without diabetes.

Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era.

The development of artificial intelligence (AI) algorithms has permeated the medical field with great success. The widespread use of AI technology in diagnosing and treating several types of cancer, especially colorectal cancer (CRC), is now attracting substantial attention. CRC, which represents the third most commonly diagnosed malignancy in both men and women, is considered a leading cause of cancer-related deaths globally. Our review herein aims to provide in-depth knowledge and analysis of the AI applications in CRC screening, diagnosis, and treatment based on current literature. We also explore the role of recent advances in AI systems regarding medical diagnosis and therapy, with several promising results. CRC is a highly preventable disease, and AI-assisted techniques in routine screening represent a pivotal step in declining incidence rates of this malignancy. So far, computer-aided detection and characterization systems have been developed to increase the detection rate of adenomas. Furthermore, CRC treatment enters a new era with robotic surgery and novel computer-assisted drug delivery techniques. At the same time, healthcare is rapidly moving toward precision or personalized medicine. Machine learning models have the potential to contribute to individual-based cancer care and transform the future of medicine.

Incidence of cancers of unknown primary origin in India and their trends during 1986-2014: A joinpoint regression analysis.

Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are in the body but the site of cancer where it began is unknown. Detailed incidence and time trends of these cancers, specific to various regions in India is needed. This paper aims to summarize and report the incidence of other and unknown (O&U) cancers across India in 27 population-based cancer registries (PBCRs) and to study the trends among these cancers using joinpoint regression analysis. Data on the incidence of CUP were obtained from the published reports on 27 PBCRs of the National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR). A joinpoint regression model was used to analyze the long-term trends of incidence related to CUP based on published data from PBCRs between 1986 and 2014. Annual Percent Change (APC) in incidence rate was estimated for various registries. The northeast region had the highest age-adjusted rate (AAR) for both men (1.76-29.7) and women (1.99-14.68). Age-specific rate (ASR) for both men (39.8-855.7) and women (48.2-470.4) was highest in the northeast region. There is an increase in the incidence rate for all six major registries over the past decade with an exception of women in the Delhi Cancer Registry. There is a decline in incidence rate by 0.14 during 1990-2012 in the female population of the Delhi registry. The increasing incidence trends of CUP is a matter of concern for the healthcare professionals and researchers. There is a need for research and advanced and improved diagnostic tools for the improvement of the status of O&U cancers.

Epidemiological profile of tuberculosis in Iraq during 2011–2018

BackgroundTuberculosis (TB) is one of the most progressive infectious diseases caused by Mycobacterium tuberculosis. The pathogen is the first cause of mortality linked to a single pathogen worldwide, especially in poor and developing countries. MethodsA cross-sectional descriptive study was conducted to estimate incidence rate (IR) of TB in Iraq during a period of eight years (2011–2018). TB data were extracted from the computer system of the National Specialized Center for Chest and Respiratory Diseases in Baghdad. ResultsDuring 2011–2018, 65,102 confirmed TB cases were reported in Iraq; 39,640 pulmonary TB (PTB) and 25,462 extra-pulmonary TB (EPTB). The average IR (case/100,000 inhabitants) of TB was 23.4 (14.2 for PTB and 9.1 for EPTB). Annual rate of TB cases showed a gradual decline over years (from 29.2 in 2011 to 18.6 in 2018). The decline in IR was more pronounced in PTB than EPTB. However PTB/EPTB ratio showed a gradual decreasing over years (from 2.04 in 2011 to 1.56 in 2018). GIS-mapping revealed that PTB and EPTB IRs show variations between the 18 governorates of Iraq. Most of the recorded PTB cases were new (average: 90.5%), followed by relapse cases (average: 7.9%). Among the reported PTB cases, percentage of males was greater than females (average: 52.1 vs. 47.9%), whereas an opposite trend was observed in EPTB (42.9 vs. 57.1%). The frequency distribution of PTB and EPTB varied between age groups, and lowest average frequency was recorded in age groups 1–4 and 5–14 year. ConclusionsTB is still a public health threat, and although a declining trend in incidence was depicted over the years 2011–2018, the disease is still out of control in Iraq, and more investments of resource are necessitated to eliminate the disease. In this context, EPTB and PTB relapse need a recognized attention.

Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry

Aim This study examines epidemiological trends of acute myocardial infarction (AMI) in Germany from 2004–2015 across different age groups, using data of the population-based KORA myocardial infarction registry. Methods Annual age-standardised, age-group- and sex-specific mortality and event rates (incident and recurrent) per 100,000 population as well as 28-day case fatality were calculated from all registered cases of AMI and coronary heart disease deaths in 25–74-year-olds from 2004–2015 and 75–84-year-olds from 2009–2015. Average annual percentage changes (AAPC) were calculated by joinpoint regression. Results Mortality rates declined considerably among the elderly (75–84 years), in men by –6.0% annually, due to declines of case fatality by –3.0% and incidence rate by 3.4% and in women by –10.0%, driven by declines in incidence (–9.1%) and recurrence rate (–4.9%). Significant mortality declines also occurred in males, 65–74 years of age (AAPC –3.8%). Among the age groups 25–54 years and 55–64 years, there was no substantial decline in mortality, event rates or case fatality except for a decline of incidence rate in 55–64-year-old men (AAPC –1.8%). Conclusion Inhomogeneous AMI trends across age-groups indicate progress in prevention and treatment for the population >64 years, while among <55-year-olds, we found no significant trend in AMI morbidity and mortality. KEY MESSAGES Age standardised AMI mortality continued to decline from 2009 to 2015 in the study region. Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality. AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75–84 years of age).

Autochthonous leprosy in Spain: Has the transmission of Mycobacteriumleprae stopped?

BackgroundThe aim of this study is to explore whether transmission of M. leprae has ceased in Spain, based upon the patterns and trends of notified cases.MethodologyData on new cases reported to the National Leprosy Registry between the years 2003–2018 were extracted. In absence of detailed travel history, cases were considered “autochthonous” or “imported” based on whether they were born within or outside of Spain. These data were analyzed by age, sex, clinical type, country of origin, and location of residence at time of notification.Principal findingsData were available on 61 autochthonous and 199 imported cases since 2003. There were clear declines in incidence in both groups, and more imported than autochthonous cases every year since 2006. Autochthonous cases were more frequently multibacillary and had older age at diagnosis compared to imported cases. All the autochthonous cases had been born before 1985 and were more than 25 years old at diagnosis. Male-to-female ratio increased with time for autochthonous cases (except for the last time period). The imported cases originated from 25 countries, half of them from Brasil and Paraguay. Autochthonous cases were mainly distributed in the traditionally endemic regions, especially Andalucía and the eastern Mediterranean coast.ConclusionsAutochthonous and imported cases have different epidemiologic patterns in Spain. There was a clear decline in incidence rates of autochthonous disease, and patterns consistent with those reported from other regions where transmission has ceased. Autochthonous transmission of M. leprae is likely to have now effectively stopped in Spain.

General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus.

Nontuberculous mycobacteria (NTM) are emerging human pathogens, causing a wide range of clinical diseases affecting individuals who are immunocompromised and who have underlying health conditions. NTM are ubiquitous in the environment, with certain species causing opportunistic infection in humans, including Mycobacterium avium and Mycobacterium abscessus. The incidence and prevalence of NTM infections are rising globally, especially in developed countries with declining incidence rates of M. tuberculosis infection. Mycobacterium avium, a slow-growing mycobacterium, is associated with Mycobacterium avium complex (MAC) infections that can cause chronic pulmonary disease, disseminated disease, as well as lymphadenitis. M. abscessus infections are considered one of the most antibiotic-resistant mycobacteria and are associated with pulmonary disease, especially cystic fibrosis, as well as contaminated traumatic skin wounds, postsurgical soft tissue infections, and healthcare-associated infections (HAI). Clinical manifestations of diseases depend on the interaction of the host’s immune response and the specific mycobacterial species. This review will give a general overview of the general characteristics, vulnerable populations most at risk, pathogenesis, treatment, and prevention for infections caused by Mycobacterium avium, in the context of MAC, and M. abscessus.

Epidemiology of Skin Cancer: Update 2019.

Melanoma and keratinocyte skin cancer (KSC) are the most common types of cancer in White-skinned populations. Both tumor entities showed increasing incidence rates worldwide but stable or decreasing mortality rates. Rising incidence rates of cutaneous melanoma (CM) and KSC are largely attributed to increasing exposure to ultraviolet (UV) radiation, the main causal risk factor for skin cancer.Incidence rates of KSC, comprising of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are much higher than that of melanoma. BCC development is mainly the cause of an intensive UV exposure in childhood and adolescence, while SCC development is related to chronic, cumulative UV exposure over decades. Although mortality is relatively low, KSC is an increasing problem for health care services causing significant morbidity.Cutaneous melanoma is rapidly increasing in White populations, with an estimated annual increase of around 3-7% over the past decades. In contrast to SCC, melanoma risk is associated with intermittent and chronic exposure to sunlight. The frequency of its occurrence is closely associated with the constitutive color of the skin and the geographical zone. Changes in outdoor activities and exposure to sunlight during the past 70years are an important factor for the increasing incidence of melanoma. Mortality rates of melanoma show stabilization in the USA, Australia, and in European countries. In the USA even dropping numbers of death cases were recently reported, probably reflecting efficacy of the new systemic treatments.Among younger cohorts in some populations (e.g., Australia and New Zealand,), stabilizing or declining incidence rates of CM are observed, potentially caused by primary prevention campaigns aimed at reducing UV exposure. In contrast, incidence rates of CM are still rising in most European countries and in the USA. Ongoing trends towards thinner melanoma are largely ascribed to earlier detection.

Secular Trends of Stroke Epidemiology in Örebro, Sweden, 2017 Compared to the Trends in 1999: A Population-Based Study

Background and Purpose: A stroke incidence study in ­Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of ­Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.