Population Prevalence Estimates Research Articles

Bayesian estimation of the prevalence of antimicrobial resistance: a mathematical modelling study.

Estimates of the prevalence of antimicrobial resistance (AMR) underpin effective antimicrobial stewardship, infection prevention and control, and optimal deployment of antimicrobial agents. Typically, the prevalence of AMR is determined from real-world antimicrobial susceptibility data that are time delimited, sparse, and often biased, potentially resulting in harmful and wasteful decision-making. Frequentist methods are resource intensive because they rely on large datasets. To determine whether a Bayesian approach could present a more reliable and more resource-efficient way to estimate population prevalence of AMR than traditional frequentist methods. Retrospectively collected, open-source, real-world pseudonymized healthcare data were used to develop a Bayesian approach for estimating the prevalence of AMR by combination with prior AMR information from a contextualized review of literature. Iterative random sampling and cross-validation were used to assess the predictive accuracy and potential resource efficiency of the Bayesian approach compared with a standard frequentist approach. Bayesian estimation of AMR prevalence made fewer extreme estimation errors than a frequentist estimation approach [n = 74 (6.4%) versus n = 136 (11.8%)] and required fewer observed antimicrobial susceptibility results per pathogen on average [mean = 28.8 (SD = 22.1) versus mean = 34.4 (SD = 30.1)] to avoid any extreme estimation errors in 50 iterations of the cross-validation. The Bayesian approach was maximally effective and efficient for drug-pathogen combinations where the actual prevalence of resistance was not close to 0% or 100%. Bayesian estimation of the prevalence of AMR could provide a simple, resource-efficient approach to better inform population infection management where uncertainty about AMR prevalence is high.

From transthyretin cardiac amyloidosis diagnosis to tafamidis treatment: Association of drop-off with patient sociodemographic characteristics.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Compared to estimated population prevalence rates, relatively few patients at risk are diagnosed with and treated for transthyretin cardiac amyloidosis (ATTR-CA). Where along the clinical pathway patient drop-off occurs, as well as the association of drop-off with patient sociodemographic characteristics, remains unknown. Using data from a healthcare system-wide cardiovascular imaging repository and specialty pharmacy, we characterized the clinical pathway from diagnosis with pyrophosphate scintigraphy (PYP) to tafamidis prescription, initiation, and adherence. Standardized differences (d values of ≥0.20, indicating at least a small effect size) were used to compare sociodemographics (age, sex, race, Area Deprivation Index) among patients with PYP-identified ATTR-CA by tafamidis prescription status and among patients prescribed tafamidis by initiation status. Tafamidis adherence was measured with the proportion of days covered (PDC). Of 97 patients with ATTR-CA, 58.8% were prescribed tafamidis, with 80.7% of those initiating therapy. Patients with ATTR-CA prescribed tafamidis were younger than those not prescribed tafamidis (d = -0.30). Utilization of a specialty pharmacy resulted in enrichment of treatment in subgroups traditionally undertreated in cardiovascular medicine, with higher rates of tafamidis initiation among women (100% initiation), patients of Black/African American race (d = 0.40), and those living in more economically disadvantaged areas (d ≥ 0.30). Adherence was high (PDC of >80%) in 88.4% of those initiating tafamidis. These findings highlight the tremendous opportunity for more robust ATTR-CA clinical programs, identifying potential patient subgroups that should be targeted to reduce disparities. For patients diagnosed with ATTR-CA, utilization of a specialty pharmacy process appears to ensure equitable provision of tafamidis therapy.

Prevalence of cannabis use and the frequency, types, and sources of cannabis products used in northern remote territories of the Canadian legal cannabis market.

The Cannabis Policy Study in the Territories (CPST) is an annual repeat cross-sectional study aiming to evaluate the impacts of cannabis legalization in the Canadian territories (Yukon, Northwest Territories, and Nunavut), where there is a paucity of data on cannabis use. This current study's objective was to describe the 2022 CPST, including methods, population prevalence estimates of cannabis use, and legal cannabis sources and perceptions in the territories. The 2022 CPST includes 2462 respondents (aged 16 +) residing in the territories who either use or do not use cannabis. Respondents were recruited through mail-push-to-web invitations sent via licensed mailing lists, sampling from a near census of households in the territories. Population-weighted indicators of cannabis use are described. Past 12-month cannabis use was self-reported by 46.1%, and 21.8% self-reported daily/almost daily use. The most commonly used product types among past 12-month consumers were dried flower (73.4%), edibles (59.0%), and vape oils (35.7%). On average, 74.8% of cannabis products used in the past 12months were from legal sources, though legal sourcing varied by product type (54.4‒92.2%). Cannabis consumers reported favourable perceptions of legal compared to illegal cannabis products regarding quality, convenience, and safety, but a lesser extent for price. Cannabis use is highly prevalent in the territories, particularly daily/almost daily use, and legal market penetration is high despite region remoteness. Following cannabis legalization, monitoring cannabis use prevalence and patterns in remote regions is important for informing the development of harm reduction and prevention initiatives that consider the unique needs of these regions.

Triangulating Truth and Reaching Consensus on Population Size, Prevalence, and More: Modeling Study.

Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges.

Identification of Hypertension in Electronic Health Records Through Computable Phenotype Development and Validation for Use in Public Health Surveillance: Retrospective Study.

Electronic health record (EHR) systems are widely used in the United States to document care delivery and outcomes. Health information exchange (HIE) networks, which integrate EHR data from the various health care providers treating patients, are increasingly used to analyze population-level data. Existing methods for population health surveillance of essential hypertension by public health authorities may be complemented using EHR data from HIE networks to characterize disease burden at the community level. We aimed to derive and validate computable phenotypes (CPs) to estimate hypertension prevalence for population-based surveillance using an HIE network. Using existing data available from an HIE network, we developed 6 candidate CPs for essential (primary) hypertension in an adult population from a medium-sized Midwestern metropolitan area in the United States. A total of 2 independent clinician reviewers validated the phenotypes through a manual chart review of 150 randomly selected patient records. We assessed the precision of CPs by calculating sensitivity, specificity, positive predictive value (PPV), F1-score, and validity of chart reviews using prevalence-adjusted bias-adjusted κ. We further used the most balanced CP to estimate the prevalence of hypertension in the population. Among a cohort of 548,232 adults, 6 CPs produced PPVs ranging from 71% (95% CI 64.3%-76.9%) to 95.7% (95% CI 84.9%-98.9%). The F1-score ranged from 0.40 to 0.91. The prevalence-adjusted bias-adjusted κ revealed a high percentage agreement of 0.88 for hypertension. Similarly, interrater agreement for individual phenotype determination demonstrated substantial agreement (range 0.70-0.88) for all 6 phenotypes examined. A phenotype based solely on diagnostic codes possessed reasonable performance (F1-score=0.63; PPV=95.1%) but was imbalanced with low sensitivity (47.6%). The most balanced phenotype (F1-score=0.91; PPV=83.5%) included diagnosis, blood pressure measurements, and medications and identified 210,764 (38.4%) individuals with hypertension during the study period (2014-2015). We identified several high-performing phenotypes to identify essential hypertension prevalence for local public health surveillance using EHR data. Given the increasing availability of EHR systems in the United States and other nations, leveraging EHR data has the potential to enhance surveillance of chronic disease in health systems and communities. Yet given variability in performance, public health authorities will need to decide whether to seek optimal balance or declare a preference for algorithms that lean toward sensitivity or specificity to estimate population prevalence of disease.

Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini.

Despite declining TB notifications in Southern Africa, TB-related deaths remain high. We describe patient- and population-level trends in TB-related deaths in Eswatini over a period of 11 years. Patient-level (retrospective cohort, from 2009 to 2019) and population-level (ecological analysis, 2009-2017) predictors and rates of TB-related deaths were analysed in HIV-negative and HIV-coinfected first-line TB treatment cases and the population of the Shiselweni region. Patient-level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient-level and population-level predictors of deaths. Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV-negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV-status. The treatment case fatality ratio remained above 10% in most years. At patient-level, fatality risk was higher in PLHIV (aRR 1.74, 1.51-2.02), and for older age and extra-pulmonary TB irrespective of HIV-status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18-1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47-1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB-LAM testing (aRR 0.65, 0.35-0.90). At population-level, mortality rates decreased 6.4-fold (-147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (-826/100,000 vs. HIV-negative: -23/100,000), the relative population-level mortality risk remained higher in PLHIV (aRR 4.68, 3.25-6.72) compared to the HIV-negative population. TB-related mortality rapidly decreased at population-level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.

Socioeconomic status and healthcare utilization disparities among children with epilepsy in the United States: Results from a nationally representative sample

Epilepsy affects 1% of the US population. Healthcare disparities are well-studied among adults with epilepsy but less so among children. We examined whether children with epilepsy (1) have lower income than or (2) utilize the emergency department (ED) differently from children without epilepsy, and (3) if income moderates ED utilization. Data from the 2016–2019 National Survey of Children’s Health were used to identify children with active “epilepsy or seizure disorder”. Children with versus without epilepsy were compared. Income and ED visits were modeled with logistic and Poisson regressions. This analysis included 131,326 children; 835 were diagnosed with epilepsy. Estimated population prevalence of epilepsy was 0.6%. Children from higher-income-households were less likely to have epilepsy (aOR: 0.7). Children with epilepsy were more likely to visit EDs (aOR = 10.2), see healthcare professionals (aOR: 2.7), and receive care from specialists (aOR: 10.3). Income moderated the relationship between having epilepsy and ED visits. 7.7% of children with epilepsy did not receive needed healthcare. Some barriers were acquiring appointments (aOR: 3.9) and transportation (aOR: 4.7). In conclusion, children with epilepsy were more likely than children without epilepsy to live in lower-income-households, visit EDs, see healthcare professionals, and not receive needed healthcare. Barrier-specific policy interventions may improve medical access for children with epilepsy.

Epidemiology and Functional Impact of Early Peripheral Neuropathy Signs in Older Adults from a General Population

Introduction: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60–97, and their impact on physical and autonomic function. Methods: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1–Q4). Results: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4–Q1: male 10.8–9.6 s; female 11.7–10.2 s), 15 m Walk test (Q4–Q1: male 11.1–9.9 s; female 11.2–10.4 s), and fewer repetitions in Step test (Q4–Q1: male 15.2–17.0 steps; female 14.5–15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7–3.8); female 2.1 (1.1–3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2–6.7]; female 1.8 [1.3–2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. Conclusions: In a general population, 20–25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.

Where do those data go? Reuse of screening results from clinical trials to estimate population prevalence of HBV infection in adults in Kilifi, Kenya

Chronic hepatitis B infection (CHB) is a significant problem worldwide with around 300 million people infected. Ambitious goals have been set towards its elimination as a public health threat by 2030. However, accurate seroprevalence estimates in many countries are lacking or fail to provide representative population estimates, particularly in the WHO African Region (AFRO). This means the full extent of HBV infection is not well described, leading to a lack of investment in diagnostics, treatment and disease prevention. Clinical trials in the WHO AFRO region have been increasing over time and many test for infectious diseases including hepatitis B virus (HBV) to determine baseline eligibility for participants, however these screening data are not reported. Here we review data from six clinical trials completed at the KEMRI-Wellcome Trust Research Programme between 2016 and 2023 that screened for HBV using hepatitis B surface antigen (HBsAg) as part of the trial exclusion criteria. 1727 people had HBsAg results available, of which 60 tested positive. We generated a crude period HBV prevalence estimate of 3.5% (95% CI 2.6–4.5%), and after standardisation for sex and age to account for the population structure of the Kilifi Health Demographics Surveillance System (KHDSS), the prevalence estimate increased to 5.0% (95% CI 3.4–6.6%). The underrepresentation of women in these trials was striking with 1263/1641 (77%) of participants being male. Alanine aminotransferase (ALT) was significantly higher in the HBsAg positive group but was not outside the normal range. We argue that routine collation and publishing of data from clinical trials could increase precision and geographical representation of global HBV prevalence estimates, enabling evidence-based provision of clinical care pathways and public health interventions to support progress towards global elimination targets. We do acknowledge when using clinical trials data for seroprevalence estimates, that local population structure data is necessary to allow standardisation of results, and the point of care tests used here are limited in sensitivity and specificity.

Estimated population prevalence of cardiac transthyretin amyloidosis as an incidental finding on bone scintigraphy in a university hospital in Colombia

Abstract Background Cardiac uptake in bone scintigraphy is highly sensitive and specific for transthyretin cardiac amyloidosis (ATTR), allowing a useful noninvasive diagnostic pathway even before echocardiographic or electrocardiographic abnormalities are present. Early diagnosis translates into early treatment and, thus, improves morbidity and mortality. In Colombia, ATTR diagnosis is still delayed or missed, and no studies have described incidental cardiac uptake on bone scintigraphy. Regarding health resources, the economic impact derived from the treatment of CA in Latam requires rigorous patient selection. This study aims to bridge this gap and improve the local clinical context. Methods We performed a retrospective cohort study which included all patients older than 65 who underwent bone scintigraphy using 99m Technetium labeled hydroxy-methylene- diphosphonate (HMDP) between January 2020 to December 2022 at our institution. Two independent physicians screened the bone scans, which a Nuclear Imaging specialist following the American Society of Nuclear Radiology guidelines then graded. Bone scans indicated for suspicion of ATTR were excluded. The prevalence of cardiac uptake and demographic characteristics were assessed. Results A total of 1206 patients were analyzed. Thirty-eight were excluded due to suspected CA. The study population, therefore, consisted of n=1168 patients with musculoskeletal (58%) and oncologic (40%) indications for scintigraphy. 55% of the sample were men; the median age was 75. Cardiac uptake was found in 1.5% of patients, from which 28% had Grade Perugini 1, 17% had Grade Perugini 2, and 56% had Grade Perugini 3. Among patients with incidental uptake, 78% were men, with a median age of 84 years; 17% had heart failure, 11% had aortic stenosis, 11% had dysautonomia, 6% had polyneuropathy, 22% had spinal stenosis, and 17% had carpal tunnel syndrome. Conclusion We describe the first South American cohort of incidental cardiac uptake in HMDP scintigraphy. The observed incidence in this cohort was 1.5%, in concordance with previously published data in other continents. Bone scintigraphy is highly available in all regions of Colombia, allowing the identification of subclinical ATTR before severe functional impairment occurs and prompt treatment initiation in CA patients. The development of reference centers for the healthcare of CA patients allows the incorporation of clinical pathways that facilitate the approach of patients with incidental myocardial uptake in bone scans requested for non-cardiac causes, which warrant further clinical assessment and follow-up.Clinical characteristicsIncidental cardiac uptake

Descriptive epidemiology of sickle cell disease in Tennessee: population-based estimates from 2008 to 2019

IntroductionThe Sickle Cell Data Collection Program (SCDC) is a multi-state initiative utilizing multiple data sources to estimate population prevalence of Sickle Cell Disease (SCD) with the goal of improving quality of life and health outcomes among those affected. SCDC in Tennessee operates as a multi-site, interdisciplinary team using multiple sources of data to learn more about SCD in Tennessee.MethodsThis analysis characterizes the number, demographics, and proximity to specialty care of individuals living with SCD in Tennessee who have been covered by Medicaid or identified by newborn screening. We compared demographic patterns of individuals with SCD living in rural areas with those living in urban areas, as well as those living in counties contributing more than 50 individuals to the cohort, respectively, to demographic patterns of individuals with SCD in the rest of the state, using Chi-Square or Fisher’s exact tests.ResultsFindings show that overall, 66.1% of all SCD patients identified through newborn screening were residents of Davidson and Shelby counties at the time of birth, and 81.8% of those identified through Medicaid claims lived in Davidson, Hamilton, Knox, Madison, Montgomery, Rutherford, or Shelby County. In total, 8.6% of the cohort lived in rural settings and 91.4% in urban settings. Of the 95 counties in Tennessee, 75 (78.9%) had at least 1 to 40 residents with SCD, yet of these 75 counties, less than half had a hematology/oncology trained provider practicing within them.DiscussionThis analysis brings us closer to understanding how many people with SCD live in rural areas of Tennessee and the challenges they face in seeking the care needed to adequately manage their disease. Acute healthcare utilization remains highest in the young adulthood years. This analysis provides insight into how healthcare utilization patterns among individuals with SCD vary by age group and over time.

Abstract 13659: Prevalence of Diagnosed Atrial Fibrillation in the United States

Background: A study done in 1996-1997 predicted that there would be 3.3 million people with atrial fibrillation (AF) in the United States in 2020. However, contemporary estimates of AF prevalence in the US are lacking. Therefore, we estimated the minimum age-, sex-, and race-stratified prevalence of diagnosed AF in California, and the number of people with diagnosed AF in US. Methods: California’s Department of Health Care Access and Information databases were used to identify adults aged ≥ 20 years who received care in an ambulatory surgery unit, emergency department, or inpatient hospital in California between January 01, 2005, and December 31, 2019. AF was defined based on ICD-9 and ICD-10 codes. We estimated the cumulative number of people diagnosed with AF in California from 2005 to 2019 and accounted for interim mortality using social security death index data. We applied age- and sex-specific AF prevalence data in California to census information on the US population to estimate the number of people with diagnosed AF in US. Results: The estimated population prevalence of diagnosed AF in adults in California was 2.04% in 2019. It was higher in males than females (2.42% vs 1.73%, p < 0.0001), and in Whites (3.82%) compared to Blacks (2.10%), Asian (1.13%), Hispanic (0.93%), < 0.0001. This prevalence increased with age, from 0.04% in the 20-24 age group, to 21.48% in those aged ≥ 85 years. After accounting for deaths, there was an estimated 657,584 people with diagnosed AF in California at the end of 2019. We estimated that at least 5,955,806 people (53.0% males) had AF in the US in 2019. The number of males with AF was higher than females in all age groups, except in those aged ≥ 80 years. The number of affected people increased with age, from 8,074 in those aged 20-24 years, to 1,416,282 in those aged ≥ 85 years. Conclusion: The prevalence of diagnosed AF in the US is higher than previously estimated. More efficient prevention and treatment strategies are needed to curb the burden of AF in the US.

Long-Term Outcomes and Risk of Pancreatic Cancer in Intraductal Papillary Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cysts that can give rise to pancreatic cancer (PC). Limited population data exist on their prevalence, natural history, or risk of malignant transformation (IPMN-PC). To fill knowledge gaps in epidemiology of IPMNs and associated PC risk by estimating population prevalence of IPMNs, associated PC risk, and proportion of IPMN-PC. : This retrospective cohort study was conducted in Olmsted County, Minnesota. Using the Rochester Epidemiology Project (REP), patients aged 50 years and older with abdominal computed tomography (CT) scans between 2000 and 2015 were randomly selected (CT cohort). All patients from the REP with PC between 2000 and 2019 were also selected (PC cohort). Data were analyzed from November 2021 through August 2023. CIs for PC incidence estimates were calculated using exact methods with the Poisson distribution. Cox models were used to estimate age, sex, and stage-adjusted hazard ratios for time-to-event end points. The CT cohort included 2114 patients (1140 females [53.9%]; mean [SD] age, 68.6 [12.1] years). IPMNs were identified in 231 patients (10.9%; 95% CI, 9.7%-12.3%), most of which were branch duct (210 branch-duct [90.9%], 16 main-duct [6.9%], and 5 mixed [2.2%] IPMNs). There were 5 Fukuoka high-risk (F-HR) IPMNs (2.2%), 39 worrisome (F-W) IPMNs (16.9%), and 187 negative (F-N) IPMNs (81.0%). After a median (IQR) follow-up of 12.0 (8.1-15.3) years, 4 patients developed PC (2 patients in F-HR and 2 patients in F-N groups). The PC incidence rate per 100 person years for F-HR IPMNs was 34.06 incidents (95% CI, 4.12-123.02 incidents) and not significantly different for patients with F-N IPMNs compared with patients without IPMNs (0.16 patients; 95% CI, 0.02-0.57 patients vs 0.11 patients; 95% CI, 0.06-0.17 patients; P = .62). The PC cohort included 320 patients (155 females [48.4%]; mean [SD] age, 72.0 [12.3] years), and 9.8% (95% CI, 7.0%-13.7%) had IPMN-PC. Compared with 284 patients with non-IPMN PC, 31 patients with IPMN-PC were older (mean [SD] age, 76.9 [9.2] vs 71.3 [12.5] years; P = .02) and more likely to undergo surgical resection (14 patients [45.2%] vs 60 patients [21.1%]; P = .003) and more-frequently had nonmetastatic PC at diagnosis (20 patients [64.5%] vs 130 patients [46.8%]; P = .047). Patients with IPMN-PC had better survival (adjusted hazard ratio, 0.62; 95% CI, 0.40-0.94; P = .03) than patients with non-IPMN PC. In this study, CTs identified IPMNs in approximately 10% of patients aged 50 years or older. PC risk in patients with F-N IPMNs was low and not different compared with patients without IPMNs; approximately 10% of patients with PC had IPMN-PC, and they had better survival compared with patients with non-IPMN PC.

Prevalence and demographic variation of cardiovascular, renal, metabolic, and mental health conditions in 12 million english primary care records

BackgroundPrimary care electronic health records (EHR) are widely used to study long-term conditions in epidemiological and health services research. Therefore, it is important to understand how well the recorded prevalence of these conditions in EHRs, compares to other reliable sources overall, and varies by socio-demographic characteristics. We aimed to describe the prevalence and socio-demographic variation of cardiovascular, renal, and metabolic (CRM) and mental health (MH) conditions in a large, nationally representative, English primary care database and compare with prevalence estimates from other population-based studies.MethodsThis was a cross-sectional study using the Clinical Practice Research Datalink (CPRD) Aurum primary care database. We calculated prevalence of 18 conditions and used logistic regression to assess how this varied by age, sex, ethnicity, and socio-economic status. We searched the literature for population prevalence estimates from other sources for comparison with the prevalences in CPRD Aurum.ResultsDepression (16.0%, 95%CI 16.0–16.0%) and hypertension (15.3%, 95%CI 15.2–15.3%) were the most prevalent conditions among 12.4 million patients. Prevalence of most conditions increased with socio-economic deprivation and age. CRM conditions, schizophrenia and substance misuse were higher in men, whilst anxiety, depression, bipolar and eating disorders were more common in women. Cardiovascular risk factors (hypertension and diabetes) were more prevalent in black and Asian patients compared with white, but the trends in prevalence of cardiovascular diseases by ethnicity were more variable. The recorded prevalences of mental health conditions were typically twice as high in white patients compared with other ethnic groups. However, PTSD and schizophrenia were more prevalent in black patients. The prevalence of most conditions was similar or higher in the primary care database than diagnosed disease prevalence reported in national health surveys. However, screening studies typically reported higher prevalence estimates than primary care data, especially for PTSD, bipolar disorder and eating disorders.ConclusionsThe prevalence of many clinically diagnosed conditions in primary care records closely matched that of other sources. However, we found important variations by sex and ethnicity, which may reflect true variation in prevalence or systematic differences in clinical presentation and practice. Primary care data may underrepresent the prevalence of undiagnosed conditions, particularly in mental health.

Population health impact, cost-effectiveness, and affordability of community-based HIV treatment and monitoring in South Africa: A health economics modelling study.

Community-based delivery and monitoring of antiretroviral therapy (ART) for HIV has the potential to increase viral suppression for individual- and population-level health benefits. However, the cost-effectiveness and budget impact are needed for public health policy. We used a mathematical model of HIV transmission in KwaZulu-Natal, South Africa, to estimate population prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 2020 to 2060 for two scenarios: 1) standard clinic-based HIV care and 2) five-yearly home testing campaigns with community ART for people not reached by clinic-based care. We parameterised model scenarios using observed community-based ART efficacy. Using a health system perspective, we evaluated incremental cost-effectiveness and net health benefits using a threshold of $750/DALY averted. In a sensitivity analysis, we varied the discount rate; time horizon; costs for clinic and community ART, hospitalisation, and testing; and the proportion of the population receiving community ART. Uncertainty ranges (URs) were estimated across 25 best-fitting parameter sets. By 2060, community ART following home testing averted 27.9% (UR: 24.3-31.5) of incident HIV infections, 27.8% (26.8-28.8) of HIV-related deaths, and 18.7% (17.9-19.7) of DALYs compared to standard of care. Adolescent girls and young women aged 15-24 years experienced the greatest reduction in incident HIV (30.7%, 27.1-34.7). In the first five years (2020-2024), community ART required an additional $44.9 million (35.8-50.1) annually, representing 14.3% (11.4-16.0) of the annual HIV budget. The cost per DALY averted was $102 (85-117) for community ART compared with standard of care. Providing six-monthly refills instead of quarterly refills further increased cost-effectiveness to $78.5 per DALY averted (62.9-92.8). Cost-effectiveness was robust to sensitivity analyses. In a high-prevalence setting, scale-up of decentralised ART dispensing and monitoring can provide large population health benefits and is cost-effective in preventing death and disability due to HIV.

Estimated Prevalence of Depressive Disorders in Children From 2004 to 2019

Depression during childhood (ie, age <13 years) poses a major health burden. Recent changes in environmental and lifestyle factors may increase children's risk of mental health problems. This has been reported for anxiety disorders, but it is unclear whether this occurs for depressive disorders. To provide prevalence estimates for the depressive disorders (ie, major depressive disorder [MDD], dysthymia, disruptive mood dysregulation disorder [DMDD], and overall) in children, and whether they have changed over time. The MEDLINE, PsycINFO, Embase, Scopus, and Web of Science databases were searched using terms related to depressive disorders, children, and prevalence. This was supplemented by a systematic gray literature search. Studies were required to provide population prevalence estimates of depressive disorder diagnoses (according to an established taxonomy and standardized interviews) for children younger than 13 years, information about participants' year of birth, and be published in English. Data extraction was compliant with the Meta-Analysis of Observational Studies in Epidemiology guidelines. A total of 12 985 nonduplicate records were retrieved, and 154 full texts were reviewed. Data were analyzed from 2004 (the upper limit of a previous review) to May 27, 2023. Multiple proportional random-effects meta-analytic and mixed-effects meta-regression models were fit. Pooled prevalence rates of depressive disorders, prevalence rate differences between males vs females and high-income countries (HICs) vs low-and middle-income countries (LMICs), and moderating effects of time or birth cohort. A total of 41 studies were found to meet the inclusion criteria. Pooled prevalence estimates were obtained for 1.07% (95% CI, 0.62%-1.63%) for depressive disorders overall, 0.71% (95% CI, 0.48%-0.99%) for MDD, 0.30% (95% CI, 0.08%-0.62%) for dysthymia, and 1.60% (95% CI, 0.28%-3.90%) for DMDD. The meta-regressions found no significant evidence of an association with birth cohort, and prevalence rates did not differ significantly between males and females or between HICs and LMICs. There was a low risk of bias overall, except for DMDD, which was hindered by a lack of studies. In this systematic review and meta-analysis, depression in children was uncommon and did not increase substantially between 2004 and 2019. Future epidemiologic studies using standardized interviews will be necessary to determine whether this trend will continue into and beyond the COVID-19 pandemic.

Assistive technology usage, unmet needs and barriers to access: a sub-population-based study in India.

Assistive technology (AT) is essential to minimize functional limitations. The current study aimed to estimate the prevalence of needs, met and unmet needs for AT, and barriers to accessing AT among a subnational population in India. This cross-sectional study was conducted in eight districts, representing four zones of India, using the WHO Rapid Assistive Technology Assessment (rATA) tool. The tool was administered by trained staff using read aloud technique. Multi-stage cluster random sampling was used, as well as the probability proportional to size, to select smaller administrative units from the larger ones. In total, 8486 participants were surveyed out of 8964 individuals enumerated with a response rate of 94.6%. The sample prevalence of at least one difficulty was 31.8% (2700), with 6.3% (532) having severe or total difficulties. The sample prevalence for AT need was 27.8% (2357) with an estimated population prevalence of 24.5% (95% CI: 23.5-25.4). Similarly, the sample prevalence of unmet needs was 9.7% (823) with an estimated population unmet needs of 8.0% (95% CI: 7.43-8.60). The unmet needs among persons with severe or total difficulties was 52.3% (278/532), and was higher among females, rural residents, and older persons. Spectacles were the most used products, followed by canes/sticks, tripods, and quadripods. Nearly two-thirds of AT users purchased assistive products at their own expense, particularly from the private sector. The inability to afford AT (36.9%) was the most common barrier. The results show that the need for AT was substantial in the study population, the highest being for seeing difficulties. The unmet needs are higher in females, older population, rural residents, and persons having serious difficulties. While the majority of users have to make out-of-pocket payments to obtain AT, inability to afford and limited availability were the common barriers among those with unmet needs. This research is non-commercial, and was conducted in the interest of public health. The authors have not declared any specific grant for this research.

Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Abstract Background Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers. Methods Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals’ catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level. Results The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73–83; and 82%; 95% CI, 79–85, respectively). Thirty-seven percent (95% CI, 34–41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6–13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8–14) in the community versus 7% (95% CI, 6–10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19–26 vs 21% (95% CI, 18–24). Conclusions The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.

AB1525 THE PRESENCE OF POWER DOPPLER SIGNALS IN THE DELTOID LIGAMENT, ESPECIALLY WITH A BROAD AND DEEP DISTRIBUTION, MAY PROVIDE DIAGNOSTIC CLUES FOR SPONDYLOARTHRITIS, PARTICULARLY UNDIFFERENTIATED SPONDYLOARTHRITIS

BackgroundPower Doppler (PD) signals are occasionally detected in the deltoid ligament on musculoskeletal ultrasound (MSUS) examination of symptomatic ankles in nontraumatic inflammatory rheumatic diseases. However, it is often neglected due to its unclear clinical significance.ObjectivesTo evaluate the significance of PD signals in the deltoid ligament detected by MSUS in inflammatory rheumatic diseases.MethodsWe reviewed the record of MSUS examined in Japanese Red Cross Medical Center between April 2015 and October 2022. We examined the characteristics of medical record information and images of cases in which power Doppler signals were observed in the deltoid ligament. Patients with only a few punctate signals or less were excluded. Patients with only traumatic or degenerative disorders were also excluded.ResultsPD signals more than a few punctate signals were observed in the deltoid ligament in 31 cases. The disease categories and diagnoses of the patients were as follows: 13 spondyloarthritis (SpA) patients (9 undifferentiated SpA (USpA), 2 psoriatic arthritis, 2 reactive arthritis), 10 rheumatoid arthritis (RA) patients (6 early RA, 4 established RA), 7 crystal-induced arthritis (CIA) (6 gout, 1 CPPD), and 1 primary Sjögren’s syndrome. All SpA patients met the ASAS criteria for peripheral SpA and all RA patients fulfilled the 2010 ACR/EULAR classification criteria.In SpA cases, PD signals tended to distribute widely to the deep layer of the ligament (broad distribution, 10 out of 13 cases), while they tended to be predominant on the outer surface of the ligament in RA cases (superficial distribution, 7 out of 10 cases). There was a significant difference in the PD signal distribution pattern between SpA and RA by Fisher’s exact test (p=0.0397). In all CIA patients, hyperechoic materials were detected in the ligament.ConclusionAccording to literature reports, SpA is considered relatively rare in Japan, where the HLA-B27 positivity rate is &lt; 0.3%, with an estimated population prevalence of &lt; 0.01%[1]. The estimated prevalence of patients with RA in Japan is 0.65%[2], similar to the rest of the world. Considering the prevalence of each disease, we speculate that PD signals in the deltoid ligament are more characteristic of SpA. The presence of PD signals in the deltoid ligament, especially with a broad and deep distribution, may provide diagnostic clues for SpA, particularly USpA.

Military Sexual Assault, Post-Service Employment, and Transition Preparation among U.S. Military Veterans: New Directions for Research

ABSTRACT Unlike studies of military sexual trauma (MST) among active-duty service members, most studies of veterans with MST have been clinical in nature, focused on estimating population prevalence rates, improving clinical responses or treatments, or have associated MST with subsequent health-related risk behaviors such as alcohol or drug abuse. The present study seeks to broaden our understanding of the corollaries of military sexual assault by considering the relationship between being a survivor of military sexual assault and post-service employment and transition experiences. Using secondary data from a survey of the members of a national organization for post-9/11 veterans, this exploratory study examines bivariate and multivariate relationships between self-reported experiences of military sexual assault and specific post-transition outcomes commonly used as indicators of a successful career transition from military to civilian life including employment status, time from transition to employment, and veterans’ perceptions of being prepared for their transition out of the military. Analysis from this study suggests that military sexual assault is impactful in the domains of employment and transition readiness. This paper’s findings point to a need to consider a range of inter-related social determinants of health and well-being when providing post-service career support for veterans.