Hospital-based Diagnosis Research Articles

The risk of diabetes and HbA1c deterioration during antipsychotic drug treatment: A Danish two-cohort study among patients with first-episode schizophrenia.

Antipsychotics increase the risk of developing diabetes, but clinical trials are not generalizable with short follow-up, while observational studies often lack important information, particularly hemoglobin A1c (HbA1c). We followed two Danish cohorts with schizophrenia. First, using Danish nationwide registers, we identified all individuals diagnosed with first-episode schizophrenia (FES) between 1999 and 2019 (n = 31,856). Exposure was a redeemed prescription for an antipsychotic, and the outcome was diabetes, defined via hospital-based diagnosis and redeemed prescriptions for glucose-lowering drugs. Adjusted Cox regression calculated hazard rate ratios (HRR). Second, using data from the Central Denmark Region, we identified all individuals diagnosed with FES from October 2016 to September 2022 (n = 2671). Using a within-subject design, we analyzed the change in HbA1c during the 2 years after initiation of specific antipsychotics compared to the 2 years before. In the nationwide cohort, 2543 (8.0%) individuals developed diabetes (incidence rate = 9.39 [95% CI = 9.03-9.76] per 1000 person-years). Antipsychotics, compared to periods without, were associated with an increased risk of developing diabetes (HRR = 2.04, 95% CI = 1.75-2.38). We found a dose-response association, particularly for second-generation antipsychotics, and different risk rates for specific antipsychotics. In the Central Denmark Region cohort, a total of 9.2% developed diabetes but mean HbA1c levels remained stable at 37 mmol/mol during the 2 years after initiation of antipsychotic medication. This comprehensive real-world two-cohort study emphasizes that diabetes affects almost 10% of patients with FES. Antipsychotics increase this risk, while HbA1c deterioration requires longer treatment. These findings are important for clinicians and young patients with FES.

Mapping Prehospital Clinician Impression to Hospital-Based Diagnoses in Children Transported to the Hospital by Emergency Medical Services

Objectives Emergency medical services (EMS) serves a critical role in the delivery of services to children with out-of-hospital emergencies. The EMS clinicians’ initial field diagnoses, termed “impressions,” facilitate focused patient assessments, guide the application of prehospital treatment protocols, and help determine transport destination. We sought to evaluate the concordance of the EMS clinician impression to a child’s hospital-based diagnosis. Methods We retrospectively studied de-identified pediatric (<18 years old) scene runs transported to the hospital and with available linked hospital data from the 2021 ESO Data Collaborative, a multi-agency prehospital electronic health record dataset. EMS impressions and primary emergency department or admission-based diagnoses were categorized into one of twenty-one major groups in the Diagnosis Grouping System. We identified the most common hospital-based discharge diagnoses and evaluated for the agreement between EMS impression and hospital-based diagnosis using Cohen’s Kappa statistic. Results We included 35,833 pediatric transports from the scene with linked prehospital and in-hospital data (median age 11 years, interquartile range, 3-15 years; 50.9% male). The most common categories for both EMS impressions and hospital-based diagnoses were as follows respectively: trauma (26.1%; 24.6%), neurologic diseases (18.9%; 16.4%), psychiatric and behavioral diseases and substance use disorder (11.8%; 11.6%), and respiratory diseases (11.1% and 9.5%). A total of 23,224 out of 35,833 patients, or 64.8%, had concordant EMS impressions and hospital-based diagnoses. There was high agreement between common EMS impression and in-hospital diagnoses (trauma 77.3%; neurologic diseases 70.3%; respiratory diseases 64.5%; and psychiatric, behavioral disease and substance use disorder 73.9%). Hospital-based diagnoses demonstrated moderate concordance with prehospital data (Cohen’s κ = 0.59). Conclusions We found moderate concordance between EMS primary impression and hospital diagnoses. The EMS encounter is brief and without capabilities of advanced testing, but initial impressions may influence the basis of the triage assignment and interventions during the hospital-based encounter. By evaluating EMS impressions and ultimate hospital diagnoses, pediatric protocols may be streamlined, and specific training emphasized in pursuit of improving patient outcomes. Future work is needed to examine instances of discordance and evaluate the impact on patient care and outcomes.

The mediating effect of blood biomarkers in the associations between inflammatory bowel disease and incident psychiatric disorders: a prospective cohort study.

Despite the growing evidence of an association between inflammatory bowel disease (IBD) and psychiatric disorders, there has been limited research exploring the underlying mediating role of blood biomarkers on the gut-brain axis. This study aimed to examine the association between IBD and the risk of incident psychiatric disorders and investigate whether and how blood biomarkers mediate this association. This prospective cohort study using data from the UK Biobank included participants without psychiatric diagnoses at baseline. The case cohort consisted of participants with a hospital-based diagnosis of IBD at baseline. The primary outcome was all psychiatric disorders. Secondary outcomes included 11 major psychiatric disorders. Cox regression models estimated adjusted hazard ratios (HRs) for psychiatric outcomes. Causal mediation models investigated the potential mediation effects of blood biomarkers. Among 491,131 participants, patients with IBD exhibited higher risks of overall psychiatric disorders (HR 1.23 [95% CI 1.13-1.33]), substance misuse (1.23 [1.09-1.38]), depression (1.36 [1.22-1.52]), anxiety (1.15 [1.01-1.30]) and post-traumatic stress disorder (1.87 [1.00-3.51]) compared with non-IBD participants. The association with incident substance misuse was only among patients with Crohn's disease (CD, 1.47 [1.23-1.76]), but not ulcerative colitis (UC, 1.01 [0.84-1.21]). Mediation analysis revealed 16, 14, 15, and 6 biomarkers partially mediated the associations for all psychiatric disorders, substance misuse, depression, and anxiety, respectively. Six blood markers showed the strongest mediating effects: neutrophil count (12.04%), C-reactive protein (10.29%), systemic immune-inflammatory index (8.94%), erythrocyte distribution width (16.51%), erythrocyte count (9.76%), and albumin (9.15%). Moreover, several blood mediators of CD identified in association with incident substance misuse may explain the risk discrepancy between IBD subtype. The blood biomarkers of inflammation, blood oxygen-carrying capacity, and metabolism mediate the effect of IBD on the risk of psychiatric outcomes and could be considered as a therapeutic target.

Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients

IntroductionResearch linking type 2 diabetes and depression mostly relied on hospital-based diagnoses or prescription data, overlooking many outpatient diagnoses. We aimed to quantify the risks of depression in individuals newly...

The Epidemiology of Hospital-Treated Alopecia Areata in Denmark, 1995-2016.

Alopecia areata (AA) is an autoimmune skin disease presenting as nonscarring hair loss. Information on the epidemiology of AA, especially the occurrence of AA and its subtypes within the general population, is scarce. The study aimed to estimate the incidence rates and prevalence of hospital-treated AA and its subtypes in Denmark and to examine the demographic and clinical characteristics of patients with AA, including comorbidities and use of prescription medications. This was a cohort study based on data from administrative and health registers in Denmark in 1995-2016. The study included individuals who were (1) registered with a hospital inpatient or hospital-based outpatient clinic diagnosis of AA between 1995 and 2016 in the Danish National Patient Registry covering encounters at all Danish hospitals, (2) alive and resided in Denmark anytime between 1995 and 2016, (3) aged ≥ 12years, and (4) resided uninterrupted in Denmark during the 12months before the first AA diagnosis during the study period. During the study period, 2778 individuals with an incident hospital-based diagnosis of AA were identified; 63.1% were female and 28.7% of the patients were aged ≥ 50years. Over the study period, the overall incidence rate for any hospital-treated AA per 100,000 person-years was 2.62 (95% confidence interval [CI], 2.53-2.72), and the overall prevalence in 2016 was 71.7 (95%CI 69.4-74.1) per 100,000 persons. Both incidence rate and prevalence increased over time. Prevalence of most hospital-treated comorbidities or history of medication use was below 10% and was similar in the alopecia totalis (AT)/alopecia universalis (AU) and non-AT/AU subtypes of AA. This cohort study reported incidence rates and prevalence over time and characteristics of individuals with hospital-treated AA in Denmark, which are in agreement with those previously reported in this population.

A retrospective study of sentinel lymph node biopsy for skin cancer in Japan: Comparison with breast cancer and evaluation of factors related to its use.

Sentinel lymph node biopsy (SLNB) underuse has been reported for skin cancers; however, actual performance rates have not been compared. The objective of this study was to investigate the SLNB performance rate in skin cancers covered by health insurance in Japan and compare it with that in breast cancer. This was a retrospective study of the SLNB performance rate in SLNB-eligible patients with breast or skin cancer from 2018 to 2019, utilizing a database linked to the Hospital-Based Cancer Registry and Diagnosis Procedure Combination survey. Demographic and tumor characteristics were analyzed using logistic regression. A total of 71,652 patients were included in this study. SLNB was performed in 86.4% (57,904/67,036) of the patients with breast cancer, 44.7% (694/1552) with melanomas, 3.1% (89/2849) with squamous cell carcinomas (SCCs), and 13.5% (29/215) with Merkel cell carcinomas (MCCs). The performance rate of SLNB was significantly lower for skin cancers than for breast cancers (odds ratio [OR], 0.03; p < 0.001). In addition, the performance rates of SLNB were significantly lower for SCCs and MCCs than for melanomas (SCC: OR, 0.04; p < 0.001; MCC: OR, 0.19; p < 0.001). Factors associated with SLNB performance included age, sex, year of incidence, primary tumor site, T stage, and number of hospital beds. SLNB is underutilized for skin cancer. Further investigation is required to explore the reasons for its underutilization so that it may be implemented more universally.

Comorbidities and mortality among patients with chronic obstructive pulmonary disease

IntroductionComorbidities are common in patients with chronic obstructive pulmonary disease (COPD). Estimates of prevalence, incidence and prognostic impact of comorbidities provide foundational knowledge of COPD epidemiology. We examined the prevalence,...

The bidirectional association between psychiatric disorders and sheltered homelessness.

Psychiatric disorders and homelessness are related, but temporal associations are unclear. We aimed to explore the overlap between hospital-based psychiatric disorders and sheltered homelessness. This population-based cohort study was conducted using the Danish registers e.g., the Danish Homeless Register and the Danish National Patient Register. The study cohort included all individuals aged 15 years or older, living in Denmark at least one day during 2002-2021 (born 1984-2006). First psychiatric diagnosis was used to define psychiatric disorder and first homeless shelter contact to define homelessness. Adjusted incidence rate ratios (IRRs) and cumulative incidences were estimated. Among 1 530 325 individuals accounting for 16 787 562 person-years at risk aged 15-38 years, 11 433 (0.8%) had at least one homeless shelter contact. Among 1 406 410 individuals accounting for 14 131 060 person-years at risk, 210 730 had at least one psychiatric disorder. People with any psychiatric disorder had increased risk of sheltered homelessness relative to individuals with no psychiatric disorder [IRR 9.2, 95% confidence interval (CI) 8.8-9.6]. Ten years after first psychiatric disorder, 3.0% (95% CI 2.9-3.1) had at least one homeless shelter contact. Individuals experiencing homelessness had increased risk of any psychiatric disorder compared to individuals with no homeless shelter contact (IRR 7.0, 95% CI 6.7-7.4). Ten years after first homeless shelter contact, 47.1% (45.3-48.0) had received a hospital-based psychiatric diagnosis. Strong bidirectional associations between psychiatric disorders and homelessness were identified. Health and social care professionals should be aware of and address these high risks of accumulated psychiatric and social problems.

Utilization of healthcare prior to endometriosis diagnosis: a Danish case-control study.

Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary healthcare in all 10 years prior to diagnosis. Endometriosis is associated with a diagnostic delay, but only a few studies have investigated the potential consequences of this delay with regard to the utilization of healthcare. To the best of our knowledge, no study has investigated it in a period corresponding to the estimated diagnostic delay. This national Danish registry-based case-control study included 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017. We identified 21 616 cases using density sampling. Each case was matched on age at the date of diagnosis (index date) to five women without diagnosed endometriosis (n = 108 080). The utilization of healthcare was assessed for the 10 years before the index. Cases had significantly higher use of healthcare in all 10 years preceding the index. The mean number of yearly contacts with the GP was 9.99 for cases and 7.85 for controls, with an adjusted incidence rate ratio of 1.28 (1.27; 1.29). For hospital contacts, the association increased slightly in the first 9 years and was most profound in the last year preceding index when the adjusted incidence rate ratio was 2.26 (95% CI 2.28; 2.31). We were not able to include women with an endometriosis diagnosis from the general practitioner or private gynaecologist. Therefore, our results are only applicable to hospital-based diagnoses of endometriosis. We do not have information on the specific reasons for contacting the healthcare providers and we can therefore only speculate that the higher utilization of healthcare among cases was related to endometriosis. This study is in agreement with the other known studies on the subject. Future studies should include specific reasons for contacting the healthcare system and thereby identify any specific contact patterns for women with endometriosis. With this knowledge, healthcare professionals could be better at relating certain healthcare seeking behaviour to endometriosis earlier and thereby reduce the time from onset of symptoms to diagnosis. This study is supported by grants from the project 'Finding Endometriosis using Machine Learning' (FEMaLe/101017562), which has received funding from The European Union's Horizon 2020 research and innovation program and Helsefonden (21-B-0141). K.Z. report grants from Bayer AG, Roche Inc. and Volition, royalties from Oxford-Bayer scientific collaboration in gynaecological therapies, non-financial collaboration with the World Endometriosis Society and World Endometriosis Research Foundation and is a Wellbeing of Women research advisory committee member. All this is outside the submitted work. The other authors have no conflict of interest to declare. N/A.

Risk of infections in non-alcoholic fatty liver disease: A nationwide population-based cohort study.

Previous literature suggests an association between non-alcoholic fatty liver disease (NAFLD) and infections. We aimed to determine the rate and risk of severe infections in NAFLD compared to the general population. In this population-based cohort study, we used national registers to identify all patients with a hospital-based diagnosis of NAFLD in Sweden 1987-2020 (n = 14 869). The patients were matched with ≤10 comparators from the general population for age, sex, municipality, and calendar year (n = 137 145). Cox regression was used to estimate hazard ratios (HR) for infections in patients with NAFLD compared to comparators. Cumulative incidences were calculated while accounting for competing risks (non-infection death and liver transplantation). Severe infections leading to death or hospitalization occurred in 1990 (13.4%) patients with NAFLD and 9899 (7.2%) comparators during a median of 4.5 and 6.1 years of follow-up, respectively. The rate of severe infections per 1000 person-years was higher in patients with NAFLD (21.0) than comparators (9.1) independently of components related to the metabolic syndrome (adjusted HR 1.9, 95% CI = 1.8-2.0). Infection-related mortality was also higher in NAFLD compared to comparators (adjusted HR 1.8, 95% CI = 1.6-2.2). The 10-year cumulative incidence of severe infections was 16.6% (95% CI = 15.8-17.4) in NAFLD and 8.0% (95% CI = 7.8-8.2) in comparators. NAFLD was associated with severe infections and infection-related mortality, independently of components associated with the metabolic syndrome. Increased clinical vigilance of severe infections in NAFLD may diminish the risk of premature death.

P-764 Mode of conception and future neurologic morbidity of the offspring: a sibling analysis

Abstract Study question To investigate the risk of long-term neurological morbidity among children born following fertility treatments while employing sibling matched analysis to maximize confounder control. Summary answer Fertility treatments appear to be an independent risk factor for long-term neurological morbidity of the offspring up to 18 years of age. What is known already Controversy exists regarding the association between fertility treatments and long-term morbidity of the offspring. Study design, size, duration A retrospective population-based cohort analysis was performed, including all sibling deliveries occurring between 1991 and 2021 at a tertiary medical center. Offspring were followed-up until the age of 18 years. Participants/materials, setting, methods The study population included 10,810 siblings of women who had at least one spontaneous pregnancy and at least one pregnancy following fertility treatments - in vitro fertilization (IVF) and ovulation induction (OI). A Kaplan–Meier survival curve was used to compare the cumulative neurologic morbidity incidence and a multivariable Cox survival hazards regression model was used to control for confounders. Main results and the role of chance There were 5,935 siblings (54.9%) conceived following fertility treatment and 4875 spontaneously conceived siblings (45.1%). Gestational diabetes mellitus and hypertensive disorders were more common in the fertility treatment group (9.9% vs. 5%, and 7.7% vs. 4.7%, respectively, p &amp;lt; 0.001). Likewise, the rates of Cesarean delivery (33.6% vs. 2.3%, p &amp;lt; 0.001), preterm delivery (11.9% vs 7.6%, p &amp;lt; 0.001) and low birth weight (12.1% vs.7.2%, p &amp;lt; 0.001) were higher in the fertility treatments group, as compared with the spontaneous pregnancy group. Neurological morbidity was significantly higher among siblings born following fertility treatments as compared with those conceived spontaneously (10.2% vs. 8.2%; p &amp;lt; 0.001). In particular, psychiatric emotional disorders were more common in the fertility treatment group (4.4% vs. 3.3% p = 0.002). Using a Kaplan-Meier survival curve, siblings conceived following fertility treatments had higher cumulative incidence rates of neurological morbidity (Log-Rank, p = 0.012). After controlling for confounders, such as maternal age, diabetes mellitus, preterm delivery and hypertensive disorders, using a Cox regression model, being born following fertility treatments was associated with long term neurological morbidity (adjusted HR = 1.2, 95% CI 1.02-1.32, p = 0.027). Limitations, reasons for caution This retrospective cohort study can only provide evidence of association but not causation. Also, our study results are hospital-based diagnoses which most likely represent acute and severe disease. Wider implications of the findings In this large retrospective cohort study of siblings, a significant and independent association was found between fertility treatments and long-term neurological morbidities. Trial registration number N/A

P-769 fertility treatments and the risk for long-term respiratory morbidity of the offspring; a sibling analysis

Abstract Study question Is the risk of long-term respiratory morbidity increased among children born following fertility treatments (in-vitro fertilization and ovulation induction)? Sibling analysis to maximize confounder control. Summary answer Fertility treatments do not appear to be an independent risk factor for long-term respiratory morbidity of the offspring up to 18 years of age. What is known already Studies have found an association between fertility treatments and long-term respiratory morbidity of the offspring, specifically obstructive sleep apnea (OSA). Study design, size, duration A retrospective population-based cohort analysis was performed, including all sibling deliveries occurring between 1991 and 2021 at a tertiary medical center. Offspring were followed-up until the age of 18 years. Participants/materials, setting, methods The study population included 10,691 siblings of women who had at least one spontaneous pregnancy and at least one pregnancy following fertility treatments. A Kaplan–Meier survival curve was used to compare the cumulative respiratory morbidity incidence, and a multivariable Cox survival hazards regression model was used to control for confounders. Main results and the role of chance There were 5,869 siblings (54.9%) conceived following fertility treatment and 4,822 spontaneously conceived siblings (45.1%). Using a univariable analysis, respiratory morbidity was higher among siblings born following fertility treatments as compared with those conceived spontaneously (9.6% vs. 8.4%; p = 0.023), in particular, OSA (2.6% vs. 1.8%; p = 0.005). However, using a Kaplan-Meier survival curve, being born following fertility treatments did not have a higher cumulative incidence rate of long-term respiratory morbidity (Log-Rank, p = 0.339). Likewise, when using a Cox regression model, controlling for confounders such as maternal age, diabetes mellitus, preterm delivery, and hypertensive disorders, the association between being born following fertility treatments was no longer associated with long-term respiratory morbidity (adjusted HR = 1.0, 95% CI 0.88-1.14, p = 0.957). Limitations, reasons for caution This retrospective cohort study can only provide evidence of association but not causation. Also, our study results are hospital-based diagnoses of respiratory morbidity which most likely represent acute and severe disease. Wider implications of the findings In this large retrospective cohort study of siblings, we showed that, in contrary to current literary findings, and after matching for siblings, fertility treatments are not associated with long-term respiratory morbidity of the offspring. These findings raise questions about the existence of certain maternal predispositions that may associate the two. Trial registration number Not applicable

The skin of people experiencing homelessness: more (known) is less (neglected)

https://doi.org/10.1093/bjd/ljad088 The skin is an Achilles heel of people experiencing homelessness, as their living conditions predispose them to skin disease from environmental exposures and poor hygiene care. People experiencing homelessness also experience challenges engaging with health care and implementing care recommendations.1,2 Increasing rates of homelessness have been reported in high-income countries (estimated in 2019 to be 700 000 individuals in the European Union).3 Epidemiological studies examining the association between homelessness and skin disease can be challenging to design and interpret across contexts because a consensus definition for homelessness is lacking, homelessness data may be unreliable, and housing status can be dynamic within a short time frame. Nilsson et al.4 used Danish health, social and administrative registers to conduct a nationwide cohort study. Homelessness was defined as having had at least one contact with a homeless shelter. The primary outcomes were a hospital-based (in- and outpatient) diagnosis of any skin condition and specific skin conditions. As expected, there was a higher risk [adjusted incidence rate ratio (aIRR) 2.31, 95% confidence interval (CI) 2.25–2.36] of any dermatological diagnosis associated with homelessness. Consistent with other studies,5,6 those experiencing homelessness had higher rates of diagnoses of inflammatory conditions (e.g. psoriasis and eczema), infectious conditions (e.g. ectoparasitic infestation, bacterial skin infection, sexually transmitted infections) and ulcers. Lice infestation had the highest risk estimate associated with homelessness (aIRR 29.55, 95% CI 13.34–65.46). Risk of body lice infestation may depend on whether or not an individual is sheltered: in one study from Paris, body lice and scabies were more prevalent in the unsheltered homeless population.7 Lice infestation is an important diagnostic consideration when evaluating pruritus in those experiencing homelessness.

One-year survival after out-of- hospital cardiac arrest: Sex-based survival analysis in a Canadian population.

We investigated sex differences in 1-year survival in a cohort of patients who survived out-of-hospital cardiac arrest (OHCA) to hospital discharge. We hypothesized that female sex is associated with higher 1-year posthospital discharge survival. A retrospective analysis of linked data (2011-2017) from clinical databases in British Columbia (BC) was conducted. We used Kaplan-Meier curves, stratified by sex, to display survival up to 1-year, and the log-rank test to test for significant sex differences. This was followed by multivariable Cox proportional hazards analysis to investigate the association between sex and 1-year mortality. The multivariable analysis adjusted for variables known to be associated with survival, including variables related to OHCA characteristics, comorbidities, medical diagnoses, and in-hospital interventions. We included 1278 hospital-discharge survivors; 284 (22.2%) were female. Females had a lower proportion of OHCA occurring in public locations (25.7%vs. 44.0%, P<0.001), a lower proportion with a shockable rhythm (57.7%vs. 77.4%, P<0.001), and fewer hospital-based acute coronary diagnoses and interventions. One-year survival for females and males was 90.5% and 92.4%, respectively (log-rank P=0.31). Unadjusted (hazard ratio [HR] males vs. females 0.80, 95% confidence interval [CI] 0.51-1.24, P=0.31) and adjusted (HR males vs. females 1.14, 95% CI 0.72-1.81, P=0.57) models did not detect differences in 1-year survival by sex. Females have relatively unfavorable prehospital characteristics in OHCA and fewer hospital-based acute coronary diagnoses and interventions. However, among survivors to hospital discharge, we found no significant difference between males and females in 1-year survival, even after adjustment.

Twins vs singletons-Long-term health outcomes.

Multiple gestations are a risk factor for most pregnancy complications. The current study aimed to study whether offspring born after twin pregnancies are at increased risk for long-term health complications. A retrospective cohort study was conducted in a large medical center, including all offspring born between the years 1991-2021, which were followed-up until 18 years of age. Hospital-based diagnoses of the offspring were categorized into main groups of morbidities: cardiac, respiratory, infectious, neurological, malignancy, and metabolic. Incidence of hospitalization with diagnoses from each main group was compared between twins and singletons, as well as time to first hospitalization. Cox proportional hazard models were used to study the association between twins vs singletons and hospitalizations by grouped morbidities, while adjusting for maternal age, ethnicity and gender, besides maternal recurrence in the cohort. A total of 369 478 offspring were included in the analysis; of these 11 986 (3.2%) were twins and 357 492 (96.8%) were singletons. Twins were more likely to be delivered preterm (odds ratio = 17.65, 95% CI: 16.74-18.60), by cesarean delivery and following infertility treatments. Incidence of hospitalizations with all morbidity groups was slightly, some significantly, higher among twins, including cardiac: 1.9% vs 1.5%, respiratory; 8.4% vs 7.1%, neurological: 7.7% vs 7.4%, infectious: 26.0% vs 24.1%, and malignancies: 0.7% vs 0.4%. The risk remained higher in the multivariable analyses (adjusted hazard ratios ranging between 1.09-1.75). When stratifying by gestational age at delivery, the risk for most morbidities was lower among twins vs singletons born in similar gestational ages. Twins as compared to singletons are at increased risk for most morbidities due to their risk of being born earlier.

Increased overall morbidity in women with endometriosis: a population-based follow-up study until age 50

To investigate whether there is an association between endometriosis and nongynecological diseases in the general female population by age 50? A prospective cohort study. Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years. Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis. International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities wereassessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed. Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis (adjusted odds ratio [aOR] 2.32; 95% CI, 1.07-5.02). In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56; 95% CI, 2.73-4.64), especially abdominal and pelvic pain (aOR 4.33; 95% CI, 3.13-4.76) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts. Women with endometriosis have a high risk for several chronic diseases compared with women without endometriosis, underlying the need for awareness and targeted resources for these women in the health care system. Moreover, endometriosis should be considered in the presence of nonspecific symptoms and abdominal pain, as they may conceal the disease and cause considerable delay in diagnosis and treatment.

Abstract 10042: Mental Health Conditions In Congenital Heart Disease: A Danish Population Based Cohort Study

Introduction: We aimed to investigate mental health condition development by 18 years of age among children with congenital heart disease (CHD). Methods: Using Danish health registry data, all children with CHD (n=17,153) were identified from 1996-2017. Mental health conditions were identified using hospital-based diagnoses, medication prescription, and treatment codes during the study period (1996-2019). Children with mental health conditions diagnosed prior to CHD were excluded (n=670, 3.9%). Comparison cohorts included the general population (matched 10:1 for age and sex), siblings of children with CHD, and children with non-CHD major congenital anomalies (MCAs) identified via EUROCAT codes and matched 3:1 for age and sex. Incidence rates per 1,000 person-years, cumulative incidence per 100 persons, and adjusted hazard ratios (aHR [95% CI]) were calculated and stratified by age-based follow-up periods, CHD severity, and sex. Results: The CHD cohort had higher overall rates of mental health conditions than their siblings (aHR 1.41 [1.30-1.52]) and the general population (aHR 1.66 [1.60-1.72]), and when stratified by age periods, CHD severity, and sex (Table 1). The cumulative incidence in the CHD cohort was 35.7% compared with 25.6%, 26.6%, and 35.1% for the general population, sibling, and MCA cohorts, respectively (Figure 1). Conclusions: This population-based cohort study shows that children with CHD are more likely to be diagnosed with mental health conditions by age 18 years than their siblings and the general population, but not children with non-CHD MCAs. Investigation to determine relevant clinical, sociodemographic, and family risk factors is ongoing.

Routine Clinical Care Creatinine Data in Denmark - An Epidemiological Resource for Nationwide Population-Based Studies of Kidney Disease.

Creatinine data are key in identifying acute and chronic kidney disease. In Denmark, routine clinical care creatinine data have been collected regionally in the Clinical Laboratory Information System Research Database (LABKA) since the 1990s and nationwide in the Register of Laboratory Results for Research (RLRR) since 2013. Here we describe the geographical coverage of the databases and characteristics of Danish individuals with creatinine tests. This information is pivotal for the design and interpretation of studies using these data to examine kidney disease epidemiology. We included all creatinine tests in LABKA and RLRR from 1990 through 2018. The daily number of creatinine tests by municipality and region of residence were plotted and geographical coverage was ascertained. In addition, we characterized a contemporary cohort of creatinine-tested individuals in 2016-2018. During 1990-2018, 61,011,941 creatinine tests were available for 4,647,966 unique Danish residents. The North Denmark Region was the first region to achieve complete reporting in November 2004, and nationwide reporting was complete starting in October 2015. In each year from 2016 to 2018, more than a third of Danish residents had a recorded creatinine measurement, with the highest proportion of tested individuals aged 77-87 years and the lowest proportion aged 3-5 years. During 2016-2018, the creatinine-tested cohort had a median age of 53 years (IQR, 35-67 years) and included 54.3% women. The most common comorbidity was a hospital-based diagnosis of hypertension (12.0%), and the most common prescription drug was angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (15.8%). In combination, the population-based LABKA and RLRR databases provide regional creatinine data with long follow-up and nationwide data for the Danish population. There was considerable variation in the time of complete geographical coverage by region, which needs to be considered when using these data for studies on kidney disease epidemiology.

Celiac Disease and Serious Infections: A Nationwide Cohort Study From 2002 to 2017.

Patients with celiac disease (CD) have an increased risk of encapsulated bacterial infections. Less is known about other serious infections in CD, especially in patients diagnosed in the 21st century. We contacted all 28 pathology departments in Sweden through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort study and identified 20,088 individuals with CD (defined as villous atrophy) diagnosed in 2002-2017. Patients were matched for sex, age, and calendar year to 80,152 general population comparators and followed up until December 31, 2019. Serious infections were defined as having a hospital-based (inpatient and outpatient) diagnosis in the National Patient Register. Cox regression yielded adjusted hazard ratios (aHR) controlling for education, country of birth, and comorbidities. During 173,695 person-years of follow-up, 6,167 individuals with CD (35.5/1,000 person-years) had a serious infection. This was compared with 19,131 infections during 743,260 person-years (25.7/1,000 person-years) in matched comparators, corresponding to an aHR of 1.29 (95% confidence interval [CI] = 1.25-1.33). aHR were similar when restricted to infection requiring hospital admission (1.23; 95% CI = 1.17-1.29). The excess risk of serious infections also persisted beyond the first year after CD diagnosis (aHR = 1.24; 95% CI = 1.20-1.29). Patients with CD were at risk of sepsis (aHR = 1.26; 95% CI = 1.09-1.45) and gastrointestinal infections (1.60; 95% CI = 1.47-1.74). Mucosal healing during CD follow-up did not influence the risk of subsequent serious infections. This nationwide study of patients with celiac disease diagnosed in the 21st century revealed a significantly increased risk of serious infections. While absolute risks were modest, vaccinations should be considered during CD follow-up care.

487-P: Posttranslational Modifications of Apolipoproteins C-I, C-II, and C-III and Peripheral Artery Disease in Multiethnic Study of Atherosclerosis (MESA)

Apolipoproteins (apo) C-I, C-II and C-III in circulation are in several post-translational forms with distinct effects on lipoprotein metabolism. ApoC-I and apoC-II exist as dominant native and minor truncated (C-I’; C-II’) forms; apoC-III appears as unglycosylated (C-III0a) , or glycosylated with zero (C-III0b) , one (C-III1, most abundant) or two (C-III2) sialic acids. The association of these proteoforms with peripheral artery disease (PAD) in a general population is unstudied. Total apoC-I, C-II and C-III concentrations and relative amounts of their proteoforms were measured in baseline plasma of 5,681 MESA participants. The ankle-brachial index (ABI) was assessed at baseline, 3 and years. Prevalent PAD was defined as baseline ABI ≤ 0.9. Incident PAD was follow-up ABI ≤ 0.9 or a hospital-based diagnosis of PAD to include revascularization. After adjustment for baseline characteristics, lipid lowering therapy and plasma lipids, low baseline ABI was associated with low C-III0b to C-III1 ratio (C-III0b/III1, p=0.01) and high C-III2 to C-III1 ratio (C-III2/III1, p&amp;lt;0.01) . Prevalent PAD (n=226) was only associated with C-III2/III1 (OR 1.16, 95% CI: 1.01-1.33, p=0.03) . Lower ABI at follow-up was associated with lower C-III0b/III1 and higher C-III2/III1 at baseline (p&amp;lt;0.both) . Incident PAD (n=244) was associated with C-III2/III1 (HR 1.22, 1.06-1.41, p=0.01) . Total apoC-I, C-II and C-III concentrations, or apoC-I and C-II truncations were not associated with ABI at baseline and follow-up, or with cross-sectional and prospective PAD determinations. ApoC-I and apoC-II and their truncations do not appear linked with PAD. In contrast, we find different associations of apoC-III0b and apoC-III2 with prevalent and incident PAD that are independent of other risk factors, including plasma lipids. Our data provide further support that proteoforms may have unique properties not captured by “total” apolipoprotein measures. Disclosure P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. J.Koska: None. S.Hansen: None. Y.Hu: None. J.Furtado: Research Support; Eli Lilly and Company, Pfizer Inc. S.Sinari: None. D.Billheimer: None. D.Nedelkov: None. M.Budoff: Research Support; Amarin Corporation, Novo Nordisk, Speaker's Bureau; Boehringer Ingelheim International GmbH, Lilly. R.Mcclelland: None. Funding National Institutes of Health (R01-HL138969)