Higher Incidence Rate Ratio Research Articles

DOP06 Antibiotics as a risk factor for older onset IBD: A population-based cohort study

Abstract Background Older adults are the fastest growing subpopulation of patients with IBD, with approximately 15% diagnosed after 60 years-of-age. Moreover, environmental exposures are thought to play a significant role in the development of older-onset IBD, given the lower genetic risk. Antibiotics have been associated with development of IBD in earlier generations, but the impact on IBD risk in older adults is uncertain. In this population-based cohort study, we assessed the impact of cumulative antibiotic use, the timing of antibiotic use, and the association between specific antibiotic classes and the development of older-onset IBD. Methods Using Denmark nationwide registries, a cohort of residents ≥60 years-of-age was established between 2000–2018. Information on exposure to antibiotics was retrieved from the Danish National Prescription Register. The number of courses of antibiotics (overall and specific classes) was considered a time-varying variable. The outcome, IBD, was identified based on ICD-10 codes in the Danish National Patient Register. Incidence rate ratios (IRRs) for IBD according to antibiotic use 1 to 5 years prior to IBD diagnosis were calculated by log-linear Poisson regression, and adjusted for age, sex, and calendar period. Results There were a total of 2,327,796 individuals aged 60 to 90 years included in the cohort, resulting in 22,670,484 person-years of follow-up. There were 10,773 new cases of ulcerative colitis (UC) and 3,825 new cases of Crohn’s disease (CD). Overall, any antibiotic use was associated with an IRR for the development of IBD (IRR 1.64, 95%CI 1.58–1.71), with a positive dose response observed (1 course of antibiotics IRR 1.27 95%CI 1.21–1.33; 2 courses IRR 1.54 95%CI 1.46–1.63; 3 courses IRR 1.66 95%CI 1.67–1.77; 4 courses IRR 1.96 95%CI 1.83–2.09; 5+ courses IRR 2.35, 95%CI 2.24–2.47). A higher IRR was noted between the timeframe of 1–2 years before diagnosis (IRR 1.87, 95%CI 1.79–1.94) as compared to 2–5 years before diagnosis (IRR 1.42, 95%CI 1.36–1.48). Additionally, all antibiotic classes were associated with the development of IBD, including those not used to treat gastrointestinal infections. Antibiotics with the highest IRR were fluoroquinolones (IRR 2.27, 95%CI 2.08–2.48), nitroimidazoles (IRR 2.21, 95%CI 1.95–2.50), and macrolides (IRR 1.74, 95%CI 1.64–1.84). All results remained statistically significant when stratifying by UC and CD, with effect estimates slightly higher for CD as compared to UC. Conclusion Use of antibiotics, regardless of class studied, was associated with an increased risk of older-onset IBD. This risk was highest one to two years prior to diagnosis, but persisted even prior to that, suggesting a link between overall antibiotic use and development of older-onset IBD.

Venous Thromboembolism Risk in Asian Patients with Inflammatory Bowel Disease: A Population-Based Nationwide Inception Cohort Study.

Background/AimsInflammatory bowel disease (IBD) is associated with the occurrence of venous thromboembolism (VTE). However, to date, there have been few studies on the risk of VTE in Asian IBD patients. We aimed to estimate the incidence of VTE in Asian IBD patients and to determine if IBD is related to increased VTE risk.MethodsWe performed a population-based cohort study between 2004 and 2015 using Korean National Health Insurance data. IBD and VTE were defined by ICD-10 codes. Incidence rates of VTE were calculated among patients with IBD and among age- and sex-matched controls. Hazard ratios were estimated using Cox regression with adjustment for multiple variables. We performed additional analyses stratifying by age, sex, Charlson comorbidity index (CCI) score, and disease type.ResultsAmong the 45,037 patients with IBD (IBD cohort) and 133,019 matched controls (non-IBD cohort) included in our analysis, 411 IBD patients and 641 controls developed VTE. The IBD cohort had a higher incidence rate ratio and risk of VTE than the non-IBD cohort (incidence rate ratio 1.92 and hazard ratio 1.93). Older age, female sex, higher CCI scores, cardiovascular disease, chronic kidney disease, use of steroids, and hospitalization were significant risk factors for VTE in patients with IBD.ConclusionsThe IBD patients in this study were approximately two times more likely to develop VTE than the non-IBD individuals. Our findings support the need for thromboprophylaxis in Asian IBD patients with various factors that further increase the risk of VTE.

Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia.

Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment-related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2·0-17·9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non-high-risk protocol. Prospective treatment-related toxicities registered every three-month interval were used. Patients were classified according to sex- and age-adjusted international childhood cut-off values, corresponding to adult body mass index: underweight, <17 kg/m2 ; healthy weight, 17 to <25 kg/m2 ; overweight, 25 to <30 kg/m2 ; and obese, ≥30 kg/m2 . Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1·55 [95% confidence interval (CI) 1·07-2·50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy-weight children. Obese children aged ≥10 years had increased IRRs for asparaginase-related toxicities compared with healthy-weight older children: thromboses [IRR 2·87 (95% CI 1·00-8·21)] and anaphylactic reactions [IRR 7·95 (95% CI 2·15-29·37)] as well as higher risk for truncation of asparaginase [IRR 3·54 (95% CI 1·67-7·50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged ≥10 years with ALL.

The effects of the COVID-19 lockdown and socio-economic factors on stroke hospitalizations in France

BackgroundWorldwide, the COVID-19 pandemic has been associated with a drop in overall stroke hospitalizations. Additionally, there is a well-known association between stroke and socioeconomic status. This study aims to assess the COVID-19 effect on stroke admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity.MethodsIn this retrospective nationwide study, we used data from the French hospital discharge database (PMSI) to estimate rates of admission for stroke to all public and private hospitals in 2019 and 2020. We used negative binomial regression to test for a nationwide change in stroke admissions during the first lockdown, compared to the same period in 2019 (from week 12 to week 19). We conducted a multivariate analysis to explore the factors associated with the stroke admission incidence rate ratio variation (2020 incidence rate/2019 incidence rate) at the county level.ResultsWe found a significant nationwide reduction in stroke admissions during the first wave of COVID-19 (incidence rate ratio 0,91 [0,86 - 0.97]), with notable geographic variations. After adjustment on hospital bed capacity, cumulative in-hospital COVID-19 incidence, standardized death rate at age 65 and unemployment rate, a higher share of labourers at the county level was associated with a higher incidence rate ratio (p < 0.01).ConclusionsDuring the first national lockdown, there has been an overall decrease in stroke admission rates. Socio-economic determinants such as low-skilled jobs were independently associated with an increase in the stroke admission incidence rate ratio, while we did not find any independent effect from the local COVID 19 burden and hospital capacities.Key messages The first national lockdown led to an overall decrease in stroke admissions in France.This decrease varied between counties according to socio-economic determinants.

Examining risky riding behavior in India using Motorcycle rider behavior questionnaire

Powered two-wheelers (PTW) constitute the most vulnerable type of road user, primarily due to their lack of protection compared to other motorized vehicles, which can lead to a severe accident in the event of crashes. A notable increase in the percentage of PTW accidents resulting in fatalities has raised a serious need for further research in understanding riding behavior. The Motorcycle rider behavior questionnaire (MRBQ) based studies have shown promising results by using MRBQ to relate riding behavior with crash risk. Despite numerous studies using the MRBQ technique and inconsistency in derived inferences across the studies highlighted the need to revise MRBQ and carry out predictive validity for capturing the correct riding behavior of Indian riders. Therefore, this research modified the previously available questionnaire by considering the focus group's opinion, consisting of twenty professional riders, two transportation experts, and two traffic police officers. Additionally, the predictive validity check of MRBQ was carried out using a sample of Indian riders consisting of 392 participants. The exploratory factor analysis of the MRBQ revealed a 32 item version of the questionnaire divided into a four-factor structure (traffic errors, control errors, speed violations, and stunts). The present research highlighted some critical dissimilarities between PTW riders of India and other countries. The low mean score (based on the Likert scale) of the items under the four-factor structure indicated overall a safe PTW rider behavior of Indian riders. Among the four factors, speed violation showed the highest mean score and stunts showed the least mean score indicating frequent and infrequent aberrant ridding behaviors, respectively. A known group construct validity check revealed that gender had a significant and age an insignificant effect on the reporting of aberrant riding behaviors. Furthermore, a negative binomial regression analysis revealed that traffic error had the highest incidence rate ratio, confirming it to be the most significant predictor of crash risk for Indian riders. Finally, the study briefly discussed counter-measure strategies targeting specific riding behavior.

Increased incidence of ovarian cancer in both endometriosis and adenomyosis

ObjectiveAssessing the association between endometriosis and/or adenomyosis and ovarian cancer. MethodsWe identified all women with histological proven endometriosis (51,544 women) and/or adenomyosis (85,015 women) from the Dutch pathology database (1990–2015) and matched with women with a benign dermal nevus (132,654 women). Histology results for ovarian cancer were retrieved. We estimated crude and age-adjusted incidence rate ratios (IRR) for ovarian cancer. ResultsWe found 1017 (2.0%), 1284 (1.5%) and 471 (0.4%) ovarian cancer cases in the endometriosis, adenomyosis and nevus cohort, respectively. The age-adjusted IRRs were 19.75 (95% CI 16.70–23.35) in the endometriosis cohort and 5.93 (95% CI 4.91–7.16) in the adenomyosis cohort. The highest IRRs were found for endometrioid and clear cell ovarian cancer subtypes. Excluding the first year of follow-up did not result in a significant IRR for ovarian cancer overall but resulted in a statistically significant age-adjusted IRR of 3.92 (95% CI 2.19–7.01) for clear cell ovarian cancer and 2.39 (95% CI 1.28–4.45) for endometrioid ovarian cancer in the endometriosis cohort. Additionally, we found a statistically significant age-adjusted IRR of 2.51 (95% CI 1.29–4.90) for endometrioid ovarian cancer in the adenomyosis cohort. ConclusionWe found an increased ovarian cancer incidence in both histological proven endometriosis and adenomyosis. This increased incidence was largest for endometriosis. Excluding the first year of follow-up resulted in an increased incidence for endometrioid ovarian cancer in both cohorts and clear cell ovarian cancer in the endometriosis cohort. This study shows that gynecologist should also be aware of an increased ovarian cancer incidence in women with adenomyosis.

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018.

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018.

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.

Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018. Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year. Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity. Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.

Association between weather factors and dengue in Dhaka: a time-series analysis

Background: There was an epidemic of dengue fever that happened in Bangladesh in the year of 2019. Temperature of this country has been raising which leads to changing in rainfall pattern. This study was aimed to investigate the relationship of weather factors and dengue incidence in Dhaka.&#x0D; Methods: A time series analysis was carried out by using 10 years weather data as average , maximum and minimum monthly temperature, average monthly humidity and average and cumulative monthly rainfall. Reported number of dengue cases was extracted from January 2009 to July 2019. Firstly, dengue incidence rate was calculated. Correlation analysis and negative binomial regression model was developed.&#x0D; Results: Dengue incidence rate had sharp upward trend. Dengue incidence and mean, maximum and minimum average temperature showed statistically significant negative correlation at 3 months' lag. Highest incidence Rate Ratio (IRR) of dengue was found at minimum average temperature at 0 and I-month lag. Average humidity showed positive and significant correlation with dengue incidence at 0-month lag. Average and cumulative rainfall also showed negative and significant correlation only at 3-months lag period.&#x0D; Conclusion: Weather variability influences dengue incidence and the association between the weather factors are non­ linear and not consistent. So the study findings should be evaluated area basis with other local factors to develop early warning for dengue epidemic prediction.&#x0D; JOPSOM 2020; 39(1): 43-49

Sociodemographic risk factors for coronavirus disease 2019 (COVID-19) infection among Massachusetts healthcare workers: A retrospective cohort study.

To better understand coronavirus disease 2019 (COVID-19) transmission among healthcare workers (HCWs), we investigated occupational and nonoccupational risk factors associated with cumulative COVID-19 incidence among a Massachusetts HCW cohort. The retrospective cohort study included adult HCWs in a single healthcare system from March 9 to June 3, 2020. The SARS-CoV-2 nasopharyngeal RT-PCR results and demographics of the study participants were deidentified and extracted from an established occupational health, COVID-19 database at the healthcare system. HCWs from each particular job grouping had been categorized into frontline or nonfrontline workers. Incidence rate ratios (IRRs) and odds ratios (ORs) were used to compare subgroups after excluding HCWs involved in early infection clusters before universal masking began. A sensitivity analysis was performed comparing jobs with the greatest potential occupational risks with others. Of 5,177 HCWs, 152 (2.94%) were diagnosed with COVID-19. Affected HCWs resided in areas with higher community attack rates (median, 1,755.2 vs 1,412.4 cases per 100,000; P < .001; multivariate-adjusted IRR, 1.89; 95% CI, 1.03-3.44 comparing fifth to first quintile of community rates). After multivariate adjustment, African-American and Hispanic HCWs had higher incidence of COVID-19 than non-Hispanic white HCWs (IRR, 2.78; 95% CI, 1.78-4.33; and IRR, 2.41, 95% CI, 1.42-4.07, respectively). After adjusting for race and residential rates, frontline HCWs had a higher IRR (1.73, 95% CI, 1.16-2.54) than nonfrontline HCWs overall, but not within specific job categories nor when comparing the highest risk jobs to others. After universal masking was instituted, the strongest risk factors associated with HCW COVID-19 infection were residential community infection rate and race.

Social Determinants of Health Mediate COVID-19 Disparities in South Florida.

BackgroundThere are several reports of health disparities related to COVID-19. Understanding social determinants of health (SDoH) could help develop mitigation strategies to prevent further COVID-19 spread. Our aim is to evaluate self-reported and census-based SDoH as a mediator of health disparities in COVID-19.MethodsWe conducted a cross-sectional ecological study and included all COVID-19 cases report by the COVID-19 Florida dashboard as the dependent variable. The independent variables were census-based median household income, population and household size, and self-reported SDoH using a validated survey. We calculated the incidence rate ratio (IRR) of COVID-19 by zip code using Poisson regression and structured equation modelling to evaluate the mediation effect of income and SDoH on COVID-19 cases.ResultsWe included 97,594 COVID-19 positive cases across 79 Miami-Dade ZIP codes with a median age of 43 years; females represented 50.7% of the cases. The highest IRR (4.44) were for ZIP code 33125 (income $21,106, 6% Black, 93% Hispanic), while the lowest IRR (0.86) was for ZIP code 33146 (median household incomes $96,609, 3% Black and 53% Hispanic). In structured equation models, the indirect coefficient of income in the relationship between race/ethnicity and COVID-19 were only significant for Blacks and not Hispanics.ConclusionsThis ecological analysis using ZIP code and aggregate individual-level SDoH shows that in Miami-Dade county, COVID infection is associated with economic disadvantage in a particular geographical area and not with racial/ethnic distribution.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06341-9.

Abstract 14715: Diabetes and Relative Rates of Cardiovascular Events in Women Compared With Men

Data are inconsistent regarding sex-differences in the relative rates of cardiovascular events associated with diabetes. We aimed to investigate whether diabetes confers higher relative rates of cardiovascular events in women compared with men using contemporary data, and whether these sex-differences depend on age. Methods: All patients seen in French hospitals in 2013 with at least 5 years or follow-up (or dying earlier) without a history major adverse cardiovascular event, were identified and characterized by individual-level linkage of French nationwide administrative registers. They were categorized by diabetes-status and followed-up until 31 December 2019. Using Cox models, we calculated overall and age-dependent incidence rates, incidence rate ratios, and women-to-men ratios for myocardial infarction, heart failure, ischemic stroke, or cardiovascular death (MACE-HF). Results: The study included 3,381,472 individuals among whom 482,848 (14.3%) had diabetes (88.1% with type 2 diabetes). Among 482,848 (45% women) patients with diabetes, the absolute rate of MACE-HF was higher in men than in women (9.7 vs. 7.4 per 100 person-years). Corresponding absolute rates in men and women without diabetes were 4.9 vs. 3.1 per 100 person-years. Comparing individuals with and without diabetes, women had higher incidence rate ratio (IRR) of MACE-HF than men (IRR 2.42 95% confidence interval [CI] 2.40-2.44) in women vs. 1.99, 95% CI 1.98-2.01 in men) with a women-to-men ratio (WMR) of 1.22 (CI 1.20-1.23, p&lt;0.001). The IRRs of MACE-HF for diabetes vs no diabetes were highest in women aged 45 and in the youngest men and decreased with advancing age for both men and women, but the IRRs were higher in women across all ages, with the highest WMR between age 45 and 70 years. This effect was more apparent for myocardial infarction (women-to-men ratio 1.43, 95%CI 1.39-1.47 after adjustment) than for ischemic stroke (WMR 1.10, 95%CI 1.07-1.13 after adjustment) or overall MACE-HF (WMR 1.16, 95%CI 1.15-1.18 after adjustment). Conclusion: Although men have higher absolute rates of cardiovascular complications, the relative rates of cardiovascular complications associated with diabetes are higher in women than in men across all ages in recent years.

Ecologicassociationbetween ambient air pollutantsand NICU admissions in Floridabetween 2012 and 2018

Background/ Aim Neonatal intensive care units (NICU) in hospitals care for newborns with medical conditions such as preterm or low birthweight. While the association between ambient air pollution and adverse birth outcomes are well-studied, associations with NICU admission are under-studied. Our study investigates the ecological associations between short-term ambient PM 2.5 and NICU admissions and will assess if associations varies by place-based social stressors. Methods We conducted an ecological time-series analysis of electronic medical records (EMRs; n=1,019,253) for the state of Florida from January 1, 2012 to December 31, 2018. EMRs of births along with NICU admission were obtained from the OneFlorida Data Trust. Daily air pollutant average concentrations were obtained from the US EPA air monitoring database. We assigned daily Zip Code-level air pollution concentrations using inverse distance weighting. Socioeconomic indicators, greenspace, and maximum daily temperatures were used to control for time-invariant and time-variant spatial confounders. All variables were analyzed at the 5-digit zip code level. We used a multivariable zero-inflated Poisson regression model to test the ecologic association between PM 2.5 and NICU admissions with a random effect for metropolitan statistical area. Results Of the 1,019,253 neonates in our study, 4.8% (n=48,616) were admitted to a NICU. Controlling for daily maximum ambient temperature, socioeconomic status, and greenspace, random effects regression models showed each standard deviation increase of PM2.5 was significantly associated with a higher incidence rate ratio (IRR) for NICU admissions of IRRPM2.5=1.01 (95%CI=1.00, 1.02; p=0.004). Conclusion NICU admissions were significantly associated with short-term concentrations of PM2.5. This ongoing analysis will explore multiple day-lags of air pollutant levels as well as interaction between each air pollutant and place-based social stressors.

Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City.

Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence. HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses. Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area. HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.

Association of Household Exposure to Primary Clostridioides difficile Infection With Secondary Infection in Family Members

Clostridioides difficile infection (CDI) is a common hospital-acquired infection. Whether family members are more likely to experience a CDI following CDI in another separate family member remains to be studied. To determine the incidence of potential family transmission of CDI. In this case-control study comparing the incidence of CDI among individuals with prior exposure to a family member with CDI to those without prior family exposure, individuals were binned into monthly enrollment strata based on exposure status (eg, family exposure) and confounding factors (eg, age, prior antibiotic use). Data were derived from population-based, longitudinal commercial insurance claims from the Truven Marketscan Commercial Claims and Encounters and Medicare Supplemental databases from 2001 to 2017. Households with at least 2 family members continuously enrolled for at least 1 month were eligible. CDI incidence was computed within each stratum. A regression model was used to compare incidence of CDI while controlling for possible confounding characteristics. Index CDI cases were identified using inpatient and outpatient diagnosis codes. Exposure risks 60 days prior to infection included CDI diagnosed in another family member, prior hospitalization, and antibiotic use. The primary outcome was the incidence of CDI in a given monthly enrollment stratum. Separate analyses were considered for CDI diagnosed in outpatient or hospital settings. A total of 224 818 cases of CDI, representing 194 424 enrollees (55.9% female; mean [SD] age, 52.8 [22.2] years) occurred in families with at least 2 enrollees. Of these, 1074 CDI events (4.8%) occurred following CDI diagnosis in a separate family member. Prior family exposure was significantly associated with increased incidence of CDI, with an incidence rate ratio (IRR) of 12.47 (95% CI, 8.86-16.97); this prior family exposure represented the factor with the second highest IRR behind hospital exposure (IRR, 16.18 [95% CI, 15.31-17.10]). For community-onset CDI cases without prior hospitalization, the IRR for family exposure was 21.74 (95% CI, 15.12-30.01). Age (IRR, 9.90 [95% CI, 8.92-10.98] for ages ≥65 years compared with ages 0-17 years), antibiotic use (IRR, 3.73 [95% CI, 3.41-4.08] for low-risk and 14.26 [95% CI, 13.27-15.31] for high-risk antibiotics compared with no antibiotics), and female sex (IRR, 1.44 [95% CI, 1.36-1.53]) were also positively associated with incidence. This study found that individuals with family exposure may be at significantly greater risk for acquiring CDI, which highlights the importance of the shared environment in the transmission and acquisition of C difficile.

Epidemiologic characteristics of injuries among 1–5 year-old children in hamadan province: Analysis of 4523 hospitalized children over a 6-year period

Background: Unintentional injuries are one of the major causes of death in Iranian children. Information on epidemiological pattern of injury among one-to 5-year-old children is limited in Hamadan. The aim of this study was to clarify the person, space and time pattern of injury among 1–5-year-old children in Hamadan Province. Methods: All registered incidence cases of injury among 1–5 year-old children in Hamadan Province from March 2009 to March 2015 were included in this cross-sectional study. We analyzed the data on county, gender, age category, type of injury, season and outcome of injury. Temporal trend was explored using time series regression with accounting autocorrelation, seasonality, and short-term variation. Results: This study included 4523 injury cases. During the studied period, urban residents and boys had a higher number of injuries. Motor vehicle-related injuries were the most common type of injury. A seasonality pattern was found so that most of the cases were occurred in summer months. The lowest and highest incidence rate ratios (IRRs) were occurred in January 2011 (IRR = 0.61 with 95% confidence interval [CI]: 0.31, 1.18) and May 2014 and August 2013 (IRR = 6.78 with 95% CI: 4.38, 10.51), respectively. Conclusion: In Hamadan Province, childhood injury has a variation in person, place, and time pattern, as some groups such as boys and urban residents among 1–5 year-old children are at a higher risk for the incidence of injury. Therefore, it is recommended that health service managers and health policymakers devote more healthcare and resources to the high-risk groups.

Perceived gender discrimination at work and subsequent long-term sickness absence among Finnish employed women.

Discrimination has many kinds of consequences for employees and their well-being. This is an important aspect when considering certain issues, such as the need to prolong working careers. The objective of this study is to investigate the association of perceived gender discrimination at work with subsequent long-term sickness absence among Finnish employed women. We used a representative sample of Finnish employed women (n = 8000) merged with register-based follow-up data. We examined the relationships of control variables with gender discrimination using cross tabulation, and the relationships of the controls with subsequent sickness absences were examined using analyses of variance. The effects of gender discrimination on long-term sickness absence were analysed using a negative binomial model. Perceived gender discrimination increased long-term sickness absence among employed women after controlling for age discrimination, various background, work and health-related factors. Employed women reporting perceived gender discrimination had a 1.4-times higher incidence rate ratios (IRR) of long-term sickness absence than those not reporting perceived gender discrimination. The association was strongest among upper-level socioeconomic group (IRR 2.2) in the adjusted model. Our findings suggest that gender discrimination at work is a risk factor for long sickness absence among women. Therefore, it is essential to increase awareness and prevention of discrimination to reduce negative gender-based treatment at work.

Greater Association of Relative Thresholds Than Absolute Thresholds With Noncontact Lower-Body Injury in Professional Australian Rules Footballers: Implications for Sprint Monitoring.

To examine the relationship between sprint workloads using relative versus absolute thresholds and lower-body soft-tissue and bone-stress injury incidence in professional Australian rules football. Fifty-three professional Australian rules football athletes' noncontact soft-tissue and bone-stress lower-body injuries (N = 62) were recorded, and sprint workloads were quantified over ∼18 months using the global positioning system. Sprint volume (m) and exposures (n) were determined using 2 methods: absolute (>24.9km·h-1) and relative (≥75%, ≥80%, ≥85%, ≥90%, ≥95% of maximal velocity). Relationships between threshold methods and injury incidence were assessed using logistic generalized additive models. Incidence rate ratios and model performances' area under the curve were reported. Mean (SD) maximal velocity for the group was 31.5 (1.4), range 28.6 to 34.9km·h-1. In comparing relative and absolute thresholds, 75% maximal velocity equated to ~1.5km·h-1 below the absolute speed threshold, while 80% and 85% maximal velocity were 0.1 and 1.7km·h-1 above the absolute speed threshold, respectively. Model area under the curve ranged from 0.48 to 0.61. Very low and very high cumulative sprint loads ≥80% across a 4-week period, when measured relatively, resulted in higher incidence rate ratios (2.54-3.29), than absolute thresholds (1.18-1.58). Monitoring sprinting volume relative to an athlete's maximal velocity should be incorporated into athlete monitoring systems. Specifically, quantifying the distance covered at >80% maximal velocity will ensure greater accuracy in determining sprint workloads and associated injury risk.