Hospital Diagnosis Research Articles

Comparing Italian hospital discharge and mortality data: implications for epidemiological research

Abstract Background In Italy, regional governments maintain data warehouses of linked administrative health data (AHD) linked to demographic information including mortality. Legal reporting pathways for death certificate detail bypass the Region, resulting in significant amounts of missing data on cause and location of death in regional AHD warehouses and limiting epidemiological research on mortality and incidence. In this study, we determine for the first time in Italy the degree of agreement between last hospital diagnosis and primary cause of death, and how that agreement changes over time. Previous studies have found agreement ranging from 40% to 60%. Methods The COV-CVD cohort is comprised of 7.3 million adults aged 30+ from the Lombardy region of northwest Italy, representing all Lombardy residents registered with the health system as of 31 December 2019. Concordance was assessed using the first three characters of the reported cause of death (ICD-10 codes) and primary diagnosis at last hospitalization (converted from ICD-9CM). Results In the COV-CVD cohort there were 401,085 deaths between 1 January 2020 and 23 June 2023. Cause and location of death is missing for 50% and 54% of these deaths, respectively. 60% of deceased individuals had a hospitalization in the year before their death. Agreement between primary diagnosis at last hospitalization and cause of death was 27% overall and 40.5% for deaths in hospital. Missing location of death was reduced from 54% to 26%. Conclusions When using AHD from Italy, primary diagnosis at last hospitalization prior to death is not an appropriate proxy for cause of death, even when the death occurred in hospital. Different coding systems (ICD-10, ICD-9CM) further complicate comparisons and definitions in observational studies. Key messages • In Italy, primary diagnosis at last hospitalization before death is not an appropriate proxy for cause of death. • Poor linkage of mortality and health data limits epidemiological research.

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study.

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

Importance and limits of cardiovascular risk factors on the prediction of SCD using machine learning approach

Abstract Background SCD is mainly due to lethal ventricular arrhythmias and occurs often among patients with ischemic heart disease. SCD and ischemic heart disease share a similar pattern of cardiovascular risk factors (CVRF). Commonly developed risk scores have been focused on cardiac-related risk factors. We aimed to investigate whether non-CVRF variables could enhance predictive performance beyond standard CVRF of SCD. Method We compared 2 different strategies for variable inclusion. First, we built a prediction model containing EHR data restricted to cardiovascular diseases and risk factors (CVD MR model) that occurred up to 5 years before SCD. We selected all available main cardiovascular variables as surrogate markers for coronary artery disease, stroke, diabetes, hypertension, smoking status, obesity, lipid disorders and chronic renal failure. On the other hand, our global approach (ALL MR model) includes all medical records codes, without any prior selection. To estimate the risk of SCD over three months, we trained a machine learning model on EHR data representing 8,566,229 drug prescriptions and 801,352 hospital diagnoses up to five years prior to SCD. The data were obtained from a cohort of 12,338 SCD in France and 12,338 controls from 2011 to 2015. We then validated the results on two external cohorts: one temporal in the same area between 2016 and 2020 with 11,620 SCD and 11,620 controls and one geographical from the USA with 892 SCD and 892 controls from 2013 to 2021. Results The CVD MR + ML model (CatBoost algorithm) yielded moderate performances with an AUC of 0.68 (95%CI 0.65-0.68), a sensitivity of 45%.(95%CI 42-47) and a specificity of 82% (95%CI 80-84). We found that the EHR model with all medical records (All MR + ML model) offered better performances. In the derivation cohort, this model achieved an AUC of 0.80 (95% CI: 0.78–0.82) with a sensitivity of 67% (95% CI 64-69), a specificity of 80% (95% CI 78-82) (Figure 1). The logistic regression (All MR + LR) applied on all medical records performed better than the CatBoost algorithm when restricted to CVD medical records (Figure 1). Conclusion The inclusion of all potential variables beyond the usual CVRF significantly improves the performances of SCD prediction models, independently of the methods (AI and logistic regression). Figure 1 : Receiver operating characteristic curves of the different models (ALL MR + ML, ALL MR + LR, CVD MR + ML and CVD MR + LR) in the derivation cohort and two validation cohorts (temporal and geographical)Figure 1.ROC curves

Youth mental health care use during COVID-19: Evidence from administrative data in Alberta, Canada

Abstract Background The COVID-19 pandemic affected health care service delivery and accessibility. Our study examined how Canadian youth used mental health services before and during the COVID-19 pandemic, and whether youth access and use patterns differed for subgroups based on social determinants previously associated with health care access. Methods Cross-sectional population-based administrative health care data from the province of Alberta in Canada was used to examine youth (ages 15-24) mental health care use from 2018/19 to 2021/22. Data was analyzed using an interrupted time series design and segmented regression modeling on type of mental health care use. Outcome measures were mental health care use for: general physician visits, psychiatrist visits, emergency department, hospitalization, and different mental health diagnoses. We stratified by factors related to social determinants, including gender and socioeconomic status. Results The analysis indicates an overall increase in the proportion of youth that used mental health care from 2018/19 to 2021/22 (14.4% vs 17.5%, respectively). There was an immediate drop in use with the onset of the COVID-19 pandemic in Canada, followed by a steady rise during the pandemic years, which was largely due to an increase in general physician visits. This rise was seen for most mental health diagnoses of study (i.e., anxiety, adjustment, attention-deficit/hyperactivity disorder, schizophrenia, and self-harm disorders). Service use increased for young women/girls compared to young men/boys and for youth from wealthier neighborhoods. Conclusions This study provides evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies. Key messages • Our study findings indicate changes in health care use for mental health among Canadian youth (ages 15-24) during the COVID-19 pandemic, with use patterns differing for youth subgroups. • Administrative health data can provide evidence to support health services planning and delivery to respond to the mental health needs of youth and to prepare for future public health emergencies.

Personalized prediction model specific for sudden cardiac death in the population: a machine learning study based on EHR

Abstract Background Predicting sudden cardiac death (SCD) in the general population remains a significant challenge, particularly at the individual level. SCD and myocardial infarction (MI) share similar pattern of characteristics and risk factors, making their specific prediction highly difficult. As a result, the current prediction models exhibit low specificity. Methods To estimate the specific risk of SCD over three months, we trained a machine learning model on electronic health record (EHR) data representing 8,566,229 drug prescriptions and 801,352 of hospital diagnoses up to five years prior to SCD. The data were obtained from a French cohort of 12,338 SCD and from a cohort of 12,338 controls from 2011 to 2015. We then validated the results on two external cohorts: one temporal cohort in the same area between 2016 and 2020 with 11,620 SCD cases and 11,620 controls and one geographical cohort from the USA with 892 SCD cases and 892 controls from 2013 to 2021. In order to address the specificity of our prediction model for SCD, SCD cases collected between 2016 and 2020 were also matched with a group of 35 000 controls who had myocardial infarction, with no SCD, following the same protocol as for the controls issued from the general population. Findings: The analysis reveals three distinct patterns of distribution for SCD cases, controls, and MI cases. We observed a semi linear increase of SCD cases over the deciles of predicted risk, and our model detected 24% (2,908) of SCD cases with a predicted risk exceeding 90% (highest decile). We observed the opposite among the controls that decreased linearly with increasing deciles of predicted risk: most of the controls were accurately identified in the lowest deciles, and there were only 214 controls (2%) in the highest decile. Interestingly, we observed a relatively stable distribution of MI cases across the deciles, with 10% of MI cases in the highest decile (Figure 1). Interpretation: We developed and validated a personalized prediction model that is able to identify subjects at high-risk for SCD specifically. Figure 1: Histogram of predicted risks for sudden cardiac death cases, controls and myocardial infarction cases in the validation cohort.Figure 1

Twenty-year trends in peripheral artery disease, lower extremity revascularization, and lower extremity amputation in newly diagnosed type 2 diabetes

Abstract Background Trends in risk of lower extremity complications in patients with newly diagnosed type 2 diabetes (T2DM) are largely unexplored. Purpose To examine the 5-year risk trends of peripheral artery disease (PAD), lower extremity revascularization (LER), and lower extremity amputation (LEA) in patients with newly diagnosed T2DM over a 25-year study period. Methods We conducted a cohort study that included all patients in Denmark diagnosed with T2DM from 1996 to 2015, who had no prior hospital diagnosis of atherosclerotic cardiovascular disease. These patients were age- and sex-matched with up to three comparisons from the general population. Individuals were assigned to 5-year calendar periods based on their year of inclusion and were followed for 5 years. The primary outcomes were the 5-year risks of PAD, LER, and LEA. Age- and sex-adjusted hazard ratios (aHR) were computed using Cox regression analysis. Results The study cohort consisted of 288,825 newly diagnosed T2DM patients (52% males; median age 61 years) and 782,232 comparisons from the general population. From 1996-2000 to 2015-2020, the 5-year risk of PAD decreased from 2.2% to 1.2% (aHR 0.56 [95% CI 0.52-0.61]), LER from 0.7% to 0.5% (aHR 0.73 [95% CI 0.63-0.84]), and LEA from 1.0% to 0.4% (aHR 0.44 [95% CI 0.38-0.50]) in T2DM patients (Figure). Compared with the general population, the 5-year risk differences decreased from 1.4% to 0.5% for PAD, from 0.4% to 0.2% for LER, and from 0.8% to 0.3% for LEA. The distribution of LEA types (hip/thigh, knee/lower leg, or ankle/foot/toe amputation) remained largely stable over time in T2DM patients. Use of prophylactic cardiovascular medications in T2DM patients increased notably during the study period, especially use of statins (5% to 50%) and multiple antihypertensive drugs (18% to 33%). Conclusions Over recent decades, the risks of PAD, LER, and LEA have decreased in patients with newly diagnosed T2DM, approaching the risk levels observed in the general population. This coincided with a great increase in use of prophylactic cardiovascular medications among T2DM patients.Trends in lower extremity complications.

A flattening systolic blood pressure response at the end of ramp exercise testing is not associated with all-cause mortality

Abstract Purpose Systolic blood pressure (SBP) is expected to rise linearly during ramp exercise, but sometimes plateaus before the end of exercise. We aimed to examine the predictive value of a plateauing SBP response at the end of a cycle exercise test. Methods We analyzed 9,001 consecutive patients aged ≥18 years with maximal cycle ergometer ramp tests, after excluding subjects with valvulopathy, pacemaker, arrhythmia during the test, or body mass index (BMI) >40kg/m², as well as tests with resting SBP <80mmHg or >200mmHg, exercise SBP <100 mmHg, <2 SBP measurements during the second half of the test or a test duration <4 minutes. The data were cross-linked with nationwide registries for mortality and in- and outpatient hospital diagnoses. The difference in SBP between the two last SBP measurements was standardized to the difference in Watts between the same time points, categorized as i) an SBP decrease (drop), ii) an SBP increase of <2.5 mmHg per 10 Watts increase (flat), iii) an SBP increase of 2.5-15 mmHg/10 Watts (intermediate), and iv) an SBP increase >15 mmHg/10 Watts representing the 97.5th percentile (steep). Hazards ratios (HR, [95% confidence interval, CI]) for all-cause mortality were calculated, stratified for exercise capacity (peak Watt % of predicted) with the intermediate SBP response as reference. Adjustments were made for age, sex, BMI, resting SBP, baseline diagnosis of ischemic heart disease, heart failure, chronic obstructive pulmonary disease, and the use of beta-blockers or anti-hypertensive medication. Results Decreasing, flat, intermediate, and steep SBP responses at the end of exercise were present in 1.1%, 25.6%, 70.8% and 2.5% of patients respectively (Table 1). During median follow-up 8.6 years (interquartile range 5.9–11.6 years) there were 844 deaths. When compared to an intermediate SBP response, a flat SBP response was not associated with all-cause mortality in any of the exercise capacity strata: lowest tertile of Wmax%pred unadjusted HR 0.88 (95% CI 0.69–1.11), middle tertile HR 0.91 (95% CI 0.66–1.24), and highest tertile HR 0.95 (95% CI 0.64–1.41), with HRs remaining non-significant after adjustment for covariates (Table 2). Conclusion In patients referred for exercise testing, a flattening SBP response at the end of exercise was not associated with increased all-cause mortality risk compared to an intermediate SBP response, consistent across the different exercise capacity strata.

Clinical predictive value of PD-1/PD-L1-induced electrocardiogram changes for cardiotoxicity

Objective: To observe the electrocardiogram (ECG) changes of programmed death receptor 1 (PD-1)/programmed death receptor-ligand 1 (PD-L1) immune checkpoint inhibitors before and after immunotherapy of patients during clinical antitumor process, and to explore the occurrence and influencing factors of cardiotoxicity of immune checkpoint inhibitors. Methods: A total of 93 patients with locally advanced or metastatic solid tumors confirmed by pathological diagnosis in Cancer Hospital of Chinese Academy of Medical Sciences from October 1, 2019 to September 30, 2020 were selected and treated with PD-1/PD-L1 inhibitor monotherapy. Groups were divided according to immunotherapy regimen: Group A (drug code: 609A), 16 patients were given 1 mg/kg of the drug for 21 days; Group B (drug code: HX008), 23 patients were treated with 200mg for 21 days; Group C (drug code: GB226), 28 patients were treated with 3mg/kg for 14 days; Group D (drug code: LP002), 26 patients were treated with 900mg for 14 days. The patients were monitored and followed up for 10 cycles. The ECG results of each group were recorded, and the correlation between ECG abnormality and cardiotoxicity was analyzed. Results: A total of 75 patients showed abnormal ECG that met the diagnostic criteria. There was no significant difference in abnormal ECG rate after immunotherapy in group A (P＞0.05), while the incidence of adverse cardiac events increased after immunotherapy in group B (P＜0.05), and the abnormal ECG rate increased significantly after chemotherapy in group C and group D. There was statistical difference before and after immunotherapy (P＜0.001). The number of abnormal cases in group A (8 cases, 50.0%, 8/16) was significantly lower than that of group B (20 cases, 87.0%, 20/23). The number of abnormal cases in group C and group D was 24 (85.7%) and 23 (88.4%), respectively, without statistical difference (P＞0.05), but their abnormal rates of ECG were higher than that in group A. The incidence of electrical adverse events in immunotherapy center of patients with underlying diseases was 1.93 times higher than that of patients without underlying diseases. The incidence of central electrical adverse events during immunotherapy in group B, C and D was 6.667, 6.000 and 7.667 times higher than that in group A, respectively. Conclusions: The high sensitivity of early ECG changes induced by immune checkpoint inhibitors enables early prediction of related cardiotoxicity. The presence or absence of comorbid underlying disease and drug dosage are correlated with the occurrence of adverse cardiac events, and these early changes provide a evidence for clinical treatment and prevention.

Red blood cell alloimmunization in transfused patients with hereditary hemorrhagic telangiectasia: A single centre retrospective study

BackgroundHereditary hemorrhagic telangiectasia (HHT) is a genetic blood vessel disorder which may lead to chronic bleeding and red blood cell (RBC) transfusions. Data on transfusion requirements and complications in HHT patients are sparse. Study Design and MethodsRetrospective chart review was conducted at St. Michael’s Hospital (SMH) in Toronto, Canada. All adults with a definite clinical diagnosis of HHT AND inpatient hospital visits between January 1, 2011 and December 31, 2020 AND had undergone transfusion compatibility testing at SMH, were identified. Data were abstracted from electronic medical records. Simple descriptive statistics were used to analyze data. Institutional Research Ethics Board approval was obtained. Results63 HHT patients underwent compatibility testing and were subsequently transfused at SMH. Median patient age at data abstraction was 70 years (Interquartile Range [IQR]: 18) and 35 (56 %) were female. RBC alloantibodies were found in 23 transfused patients (36.5 %) and were predominantly directed against Rh and Kell antigens: Anti-E (65 %), Anti-K (39 %) and Anti-c (22 %) were most common. Excluding an outlier who received 611 RBC units during the study period, the mean number of RBC units transfused per HHT patient at SMH was 22.1 units (Standard Deviation: 40.9, IQR: 17). Six (9.5 %) transfused patients experienced at least one transfusion reaction. ConclusionRBC alloimmunization rate was 36.5 % in our cohort of transfused HHT patients; this is much higher than described in the general population and another transfused HHT cohort. The most commonly observed alloantibodies were Rh and Kell, supporting our policy of prophylactic phenotypic matching for these antigens for all transfused patients with HHT.

Associations between chest pain, diagnosis, and clinical outcome in patients hospitalized with acute dyspnea: Data from the ACE 2 Study.

Patients hospitalized due to dyspnea sometimes also report concomitant chest pain. Whether co-existing chest pain in patients with acute dyspnea associates with specific diagnosis and clinical outcome is not known. We included 313 patients admitted to Akershus University Hospital with acute dyspnea and asked the patients directly on hospital admission whether they had experienced chest pain during the last 24 h. We examined the associations between chest pain and (1) diagnosis of the index hospitalization and (2) clinical outcome during follow-up. The diagnosis for the index hospitalization was adjudicated as acute heart failure (HF) or non-HF etiology of acute dyspnea by two experts working independently. Non-HF patients were further sub-grouped into chronic obstructive pulmonary disease (COPD) or non-COPD etiology. In total, 143 patients were admitted with acute HF (46% of the population), 83 patients with COPD (26% of the population), and 87 patients with non-HF, non-COPD-related dyspnea (28% of the population). Ninety-six patients (31%) with acute dyspnea reported chest pain during the last 24 h prior to hospital admission. The prevalence of chest pain was not statistically different for patients that were hospitalized with acute HF (n= 42, 44%), acute exacerbation of COPD (n= 22, 23%), or non-HF, non-COPD-related dyspnea (n=32, 33%), p>0.05 for all comparisons between groups. During median 823 days follow-up, 114 patients died (36%). Patients with dyspnea and concomitant chest pain did not have different outcome compared to patients with dyspnea and no chest pain (log-rank test: p=0.09). Chest pain prior to admission was neither associated with all-cause mortality in any of the adjudicated diagnosis groups. Chest pain was reported in 31% of patients hospitalized with acute dyspnea but the prevalence did not differ according to adjudicated diagnosis. Patients with dyspnea and chest pain did not have worse outcome compared to patients with dyspnea and no chest pain.

Algorithm for Managing Patients Hospitalized in the Surgical Wards Due to COVID-19-Related Acute Abdominal Pathology

AIM OF THE STUDY. Was to improve the outcomes of treatment of patients with COVID-19-related acute abdominal pathology by developing and implementing an algorithm for the diagnosis and treatment of those patients.MATERIAL AND METHODS. The study involved 200 patients who were randomized into two groups. This research was retrospective, based on the analysis of the medical histories of patients hospitalized with clinical manifestations of acute abdominal pathology that developed against the background of COVID-19. All medical histories in emergency departments and centers of the Republic of Uzbekistan were analyzed in the period from the beginning of the declaration of the pandemic (March 2020) to July 2022 inclusive.RESULTS. In the context of an infectious disease pandemic (COVID–19 as an example), it is very important to develop an algorithm for managing patients with acute surgical pathology. This algorithm should include a diagnostic component with the purpose of timely diagnosis of acute surgical pathology and hospitalization in the surgical department. The next step is to identify patients with a high risk of perioperative complications and adverse outcomes. The final component of the algorithm is the correction of possible risk factors for adverse outcomes.CONCLUSION. The duration of hospitalization of patients who underwent surgery for acute abdominal pathology was significantly longer during the pandemic compared to that of in the post-pandemic period (10.35±7.01 vs. 5.83±3.85 days, p<0.001), which may be due to both changes in the structure of the pathology and a larger number of complicated forms. The application of the developed algorithm will optimize the management of patients with COVID-19-related acute surgical pathology, guarantee rapid decision-making while minimizing the risk of infection, reduce the risk of complications and adverse outcomes.

Incidence of Hospitalizations Involving Alcohol Withdrawal Syndrome in a Primary Care Population

Alcohol withdrawal syndrome (AWS) is an important cause and complication of hospitalizations. Although common and preventable, the incidence of AWS during hospitalizations is poorly described. To evaluate the incidence and proportional incidence of hospitalizations involving AWS in an adult primary care population overall and across patient characteristics. This retrospective cohort study used electronic health records and insurance claims from Kaiser Permanente Washington (KPWA) between July 1, 2018, and June 30, 2022. The study included adults with 1 or more primary care visits during this period or the year prior, where primary care included annual standardized alcohol screening using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Age, sex, race, Hispanic ethnicity, AUDIT-C scores, and comorbid diagnoses. Hospitalizations involving AWS were defined by diagnosis codes documented during hospitalizations (incidence numerator). Time enrolled in KPWA determined person-enrolled-years (incidence denominator). Proportional incidence was calculated as the incidence of hospitalizations involving AWS divided by the incidence of all-cause hospitalizations. Proportional incidence was also estimated for hospitalizations involving other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension), which were also defined using hospital diagnosis codes. Among 544 825 adults engaged in primary care (mean [SD] age, 47.0 [17.9] years; 310 069 [56.9%] female; 3656 [0.7%] American Indian or Alaska Native, 55 206 [10.1%] Asian, 25 406 [4.7%] Black, 5204 [1.0%] Native Hawaiian or Other Pacific Islander, 365 780 [67.1%] White, 19 791 [3.6%] multiracial, 15 963 [2.9%] other races, and 53 819 [9.9%] unknown race; 33 987 [6.2%] Hispanic, 414 269 [76.0%] not Hispanic, and 96 569 [17.7%] unknown ethnicity), incidence of hospitalizations involving AWS was 169 (95% CI, 159-179) per 100 000 person-enrolled-years overall but as high as 15 347 (95% CI, 13 502-17 331) in patients with other alcohol-attributable diagnoses. The proportional incidence of hospitalizations involving AWS was 2.3% overall, with variation by age, sex, and AUDIT-C scores (eg, 9%-11% in male patients aged 30-49 years and 23%-44% in patients with high-risk AUDIT-C scores of 7-12 points). In most cases, among adults younger than 60 years, proportional incidence of hospitalizations involving AWS matched or surpassed that of other common chronic conditions (chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension). In this cohort study of a large primary care population served by an integrated health system, AWS hospitalizations were common, especially in male patients, younger age groups, and individuals with high-risk alcohol use. During hospitalizations, the burden of AWS was similar to or exceeded complications of other chronic diseases that receive greater medical attention.

Characteristics and outcomes of patients with cardiac conditions requiring emergency medical retrieval from the Great Barrier Reef, Australia.

There is limited published data on the burden of cardiac disease among patients requiring emergency medical evacuation from the Great Barrier Reef, a popular tourist destination in Far North Queensland, Australia. The aim of this study was to examine the characteristics and outcomes of patients with cardiac conditions who were retrieved from the northern Great Barrier Reef to Cairns Hospital. This observational study was a planned substudy of a broader analysis of medical retrievals from the Cairns/Cooktown section of the Great Barrier Reef. It included all patients retrieved to Cairns Hospital between July 2016 and January 2020 who were assigned a cardiac diagnosis during their hospital stay. Data were collected about electrocardiograph, cardiac troponin blood test and invasive coronary angiography results as well as final hospital diagnosis. During the study period, 120 patients were retrieved from the Great Barrier Reef to Cairns Hospital, of which 46 (38%) were subsequently diagnosed with a primary cardiac condition(s) or other disease process with clinically significant cardiac involvement. The most common diagnoses were type 2 myocardial infarction (20; 16.7% of all retrievals), primary cardiac arrhythmia (14; 12.5%) and acute coronary syndrome (5; 4.2%). An elevated troponin was recorded in 30% of all retrievals and in 78% of those with a cardiac diagnosis. A total of 14 (30.4%) of patients with a cardiac diagnosis died during their hospital admission. Invasive coronary angiography was performed in 18 cases, of which six patients had obstructive coronary artery disease. Four patients required percutaneous coronary intervention. A high proportion of patients retrieved to Cairns Hospital from the Great Barrier Reef were diagnosed with a primary cardiac condition. This data may assist tourism operators, retrieval organisations and health services to plan for, and respond to, cardiac events among visitors to the reef.

6777 Exploring the comorbidity in males with 45,X/46,XY mosaicism unveils a pattern mirroring that of Turner syndrome

Abstract Disclosure: K. Stochholm: None. C.H. Gravholt: None. A. Berglund: None. Background: Males with 45,X/46,XY mosaicism are rare with an apparent prevalence of 6 per 100,000 newborn males. Knowledge about associated health outcomes are limited. Females with 45,X/46,XY fall under the Turner syndrome diagnosis but males do not. Aim: To investigate the comorbidity pattern in a national cohort of males with 45,X/46,XY. Methods: Morbidity were investigated using Cox regression analysis on administratively longitudinally collected registry data regarding hospital diagnoses, prescribed medication, and surgery codes. Data were retrieved for all males diagnosed with 45,X/46,XY from 1960 to 2018 (n=135) and for 13,500 age-matched males from the general population, who served as comparator. Results: 45,X/46,XY was associated an increased overall risk of receiving a hospital diagnosis (HR: 1.6, CI: 1.3-1.9), being prescribed medication (HR: 1.2, CI: 1.03-1.5), and undergoing a surgical procedure (HR: 1.8, CI: 1.4-2.1). Dividing hospital diagnoses into 18 chapters according to the International Classification of Diseases (ICD-10), 45,X/46,XY had a significantly increased risk of diagnoses in all but three chapters. Among diagnoses with a significantly increased risk were gonadal dysfunction (HR=63.7, CI: 34.8-116.9), short stature (HR=24.7, CI: 10.0-60.6), pubertal disorders (HR=25.8, CI:7.2-92.6), type 1 (HR=4.1, CI: 1.8-9.4) and type 2 diabetes mellitus (HR=3.4, CI: 1.7-6.6), thyroid disorders (HR=3.8, CI: 1.4-10.4), obesity (HR=4.4, CI: 2.3-8.2), osteoporosis and osteopenia (HR=5.4, CI: 2.4-12.3), hearing loss (HR=2.2, CI: 1.3-3.8), otitis media (HR=1.6, CI: 1.3-1.9), ischemic heart disease (HR=2.4, CI: 1.3-4.4), hypertension (HR=2.3, CI: 1.4-3.9), inflammatory bowel disease (HR=2.5, CI: 1.2-5.4), cryptorchidism (HR=11.9, CI: 7.8-17.8), hypospadias (25.9, CI: 14.0-47.8), testis cancer (HR=6.4, CI: 2.0-20.6), infertility (HR=23.5, CI: 16.0-34.4), gynecomastia (HR=4.6, CI: 1.7-12.5), horse shoe kidney (HR=177,8, CI: 16.1-1968.8), coarctation of the aortae (HR=66.0, CI: 11.0-394.9), and bicuspid aortic valve (HR=53.4, CI: 12.7-223.7). Conclusion: Males with 45,X/46,XY mosaicism exhibit heightened morbidity, evidenced by a notable surge in hospital diagnoses, prescribed medications, and surgical interventions. This increased morbidity is linked to a broad spectrum of diseases, showcasing a comorbidity pattern reminiscent of Turner syndrome. This study emphasizes the need for systematic follow-up in individuals with 45,X/46,XY mosaicism, highlighting the imperative for proactive healthcare management in this population. Presentation: 6/1/2024

6777 Exploring the comorbidity in males with 45,X/46,XY mosaicism unveils a pattern mirroring that of Turner syndrome

Abstract Disclosure: K. Stochholm: None. C.H. Gravholt: None. A. Berglund: None. Background: Males with 45,X/46,XY mosaicism are rare with an apparent prevalence of 6 per 100,000 newborn males. Knowledge about associated health outcomes are limited. Females with 45,X/46,XY fall under the Turner syndrome diagnosis but males do not. Aim: To investigate the comorbidity pattern in a national cohort of males with 45,X/46,XY. Methods: Morbidity were investigated using Cox regression analysis on administratively longitudinally collected registry data regarding hospital diagnoses, prescribed medication, and surgery codes. Data were retrieved for all males diagnosed with 45,X/46,XY from 1960 to 2018 (n=135) and for 13,500 age-matched males from the general population, who served as comparator. Results: 45,X/46,XY was associated an increased overall risk of receiving a hospital diagnosis (HR: 1.6, CI: 1.3-1.9), being prescribed medication (HR: 1.2, CI: 1.03-1.5), and undergoing a surgical procedure (HR: 1.8, CI: 1.4-2.1). Dividing hospital diagnoses into 18 chapters according to the International Classification of Diseases (ICD-10), 45,X/46,XY had a significantly increased risk of diagnoses in all but three chapters. Among diagnoses with a significantly increased risk were gonadal dysfunction (HR=63.7, CI: 34.8-116.9), short stature (HR=24.7, CI: 10.0-60.6), pubertal disorders (HR=25.8, CI:7.2-92.6), type 1 (HR=4.1, CI: 1.8-9.4) and type 2 diabetes mellitus (HR=3.4, CI: 1.7-6.6), thyroid disorders (HR=3.8, CI: 1.4-10.4), obesity (HR=4.4, CI: 2.3-8.2), osteoporosis and osteopenia (HR=5.4, CI: 2.4-12.3), hearing loss (HR=2.2, CI: 1.3-3.8), otitis media (HR=1.6, CI: 1.3-1.9), ischemic heart disease (HR=2.4, CI: 1.3-4.4), hypertension (HR=2.3, CI: 1.4-3.9), inflammatory bowel disease (HR=2.5, CI: 1.2-5.4), cryptorchidism (HR=11.9, CI: 7.8-17.8), hypospadias (25.9, CI: 14.0-47.8), testis cancer (HR=6.4, CI: 2.0-20.6), infertility (HR=23.5, CI: 16.0-34.4), gynecomastia (HR=4.6, CI: 1.7-12.5), horse shoe kidney (HR=177,8, CI: 16.1-1968.8), coarctation of the aortae (HR=66.0, CI: 11.0-394.9), and bicuspid aortic valve (HR=53.4, CI: 12.7-223.7). Conclusion: Males with 45,X/46,XY mosaicism exhibit heightened morbidity, evidenced by a notable surge in hospital diagnoses, prescribed medications, and surgical interventions. This increased morbidity is linked to a broad spectrum of diseases, showcasing a comorbidity pattern reminiscent of Turner syndrome. This study emphasizes the need for systematic follow-up in individuals with 45,X/46,XY mosaicism, highlighting the imperative for proactive healthcare management in this population. Presentation: 6/1/2024

7131 The Morbidity Pattern in Females with 45,X/46,XY Mosaicism

Abstract Disclosure: K. Stochholm: None. C.H. Gravholt: None. A. Berglund: None. Background: Turner syndrome (TS) includes females with 45,X/46,XY mosaicism, a rare variant with a prevalence of 2.1 per 100,000 newborn females. Specific knowledge about their associated health outcomes is limited. Aim: To investigate the morbidity pattern in a national cohort of females with 45,X/46,XY. Methods: Data were retrieved for all females diagnosed with 45,X/46,XY from 1960 to 2018 (n=46) and for 4,377 age-matched females from the general population. Morbidity were investigated using Cox regression analysis on registry data regarding hospital diagnoses, redeemed medication, and surgery codes. Results: 45,X/46,XY was associated an increased overall risk of a hospital diagnosis (Hazard ratio (HR): 1.6, confidence interval (CI): 1.2-2.1). The risk of undergoing surgery was significantly increased before the age of 40 years (HR: 1.6, CI: 1.0-2.5), but not in total (HR: 1.2, CI: 0.8-1.7). The HR of redeeming medication was similar to comparators, HR: 1.2, CI: 0.86-1.66. Dividing hospital diagnoses into 18 chapters according to the International Classification of Diseases, 45,X/46,XY had a significantly increased risk of diagnoses due to endocrine disorders (HR=3.6, CI: 2.3-5.8), disorders of the ear (HR=7.1, CI: 4.5-11.3), disorders of the circulation (HR=2.8, CI: 1.7-4.9), and due to congenital malformations (HR=25.1, CI: 17.5-35.8). Among specific diagnoses with a significantly increased risk were gonadal dysfunction, valve diseases, hypertensive diseases, diseases of arteries and aneurisms. Surgery due to disorders of the heart and greater vessels were significantly increased in total (HR=9.3 CI: 2.2-40.4), as were surgery on the aortic valve (HR=36.9, CI: 3.3-409.2), and on female genitalia (HR=2.1, CI: 1.3-3.4), whereas obstetric surgery was significantly decreased (HR 0.2, CI: 0.0-0.7). In females with 45,X/45,XY, there were no registrations related to gonadoblastoma as neither ovarian surgery nor registrations on cancer of the ovary were present. The HR of redeeming a prescription was significantly decreased in the categories of dermatologicals (HR=0.6, CI: 0.4-0.9), musculoskeletal (HR=0.6, CI: 0.4-0.9), antiparasitics (HR=0.5, CI: 0.2-0.8), and in respiratory system (HR=0.6 CI: 0.4-0.9), and significantly increased in systemic hormones (HR=2.2, CI: 1.4-3.7) and in sex hormones (HR=2.9, CI: 2.0-4.1). Conclusion: 45,X/46,XY in females is associated with an increased morbidity with a skewed pattern, as indicated by an overall increased risk of hospital diagnoses, but a unaffected usage of prescribed medication. Surgical procedures were affected with a pattern as in others with Turner syndrome, with a surprisingly absent registration of procedures linked to gonadoblastoma. This study is most likely curtailed by the limited number of females diagnosed with 45,X/46,XY, however the imperative for systematic follow-up is underlined. Presentation: 6/1/2024

7955 Increased occurrence of psychiatric disorders and use of psychiatric-related medication in patients with congenital adrenal hyperplasia

Abstract Disclosure: M. Lind-Holst: None. D. Hansen: None. K.M. Main: None. A. Juul: None. M. Andersen: None. M. Dunø: None. Å.K. Rasmussen: None. N. Jørgensen: None. C.H. Gravholt: None. A. Berglund: None. Background: Clinical studies on psychiatric morbidity, quality of life and cognition in patients with congenital adrenal hyperplasia (CAH) imply impaired mental health. Epidemiological studies on psychiatric morbidity in CAH are, however, scarce. Methods: A registry study of hospital diagnoses and prescribed medication related to psychiatric disorders in a national cohort of patients (n=462) diagnosed with CAH from 1943 to 2018 compared to 100 randomly selected sex- and age-matched controls (n=44,527) from the general population. Psychiatric hospital diagnoses were available for in-patient contacts from 1968 and out-patient contacts from 1994. Medication data were available from 1995. Outcomes: CAH was associated with an increased risk of hospital contacts related to any psychiatric diagnosis (incidence rate ratio (IRR)=2.73, 95% CI 1.85-4.04), and this applied to both males (IRR=2.48, 95% CI 1.57-3.91) and females (IRR=3.20, 95% CI 1.58-6.50). Psychiatric disorders due to psychoactive substance use were more common among CAH males (IRR=3.55, 95% CI 1.58-7.96) and females (IRR=3.81, 95% CI 1.71-8.48). Males with CAH also had an increased risk of suicidal behaviour (IRR=10.66, 95% CI 3.74-30.42). By the age of 30 years, 23% of CAH females and 21% of CAH males had at least one diagnosis related to a psychiatric disorder while this was the case in 14% of female controls and 15% of male controls. Stratifying by sex and CAH phenotype there were important differences among groups. Prescription of medication related to psychiatric disorders was increased for CAH overall (HR=1.73, 95% CI 1.48-2.03) and males (HR=1.80, 95% CI 1.35-2.38) and females (HR=1.70, 95% CI1.36-2.38), separately. Age at the first prescription of any psychiatry-related medication was significantly earlier for patients than for controls (HR males=1.67, 95% CI 1.2-2.3; HR females=1.48, 95% CI 1.2-1.8). Thirty-five per cent (157/448) of CAH patients and 24% of controls had at least one prescription related to a psychiatric disorder within the study period. Interpretation: An increased risk of psychiatric morbidity, psychoactive substance use and use of medication related to poor mental health was seen in both males and females with CAH. The risk of suicidal behaviour was increased for patients with CAH, yet only significantly in CAH males. The study underlines the need for more attention and extension of psychological care and support for patients with CAH. Presentation: 6/1/2024

8156 Exploring Gender-Specific Characteristics Of Diabetes Among Young Adults In Korea: The Korea National Health And Nutrition Examination Survey 2011-2012 And 2019-2020

Abstract Disclosure: C. Chung: None. Background: The escalating global incidence of diabetes among young adults could be linked to dynamic socio-environmental changes including pandemic and climate shifts. In this investigation, we aimed to discern the distinct features of diabetes among young adults in Korea. Methods: This cross-sectional study included 63,489,047 Korean young adults (32,173,248 male, 31,315,799 female) aged 20-39 years who participated in the Korean National Health and Nutrition Examination Survey 2011-2012 and 2020-2021. Diabetes cases were identified through hospital diagnoses or the prescription of insulin or non-insulinemic anti-diabetic medications. The significant insulin resistance was defined as HOMA-IR above 2.9. Complex sampling design and cross-tabulation analyses were used to examine both socioeconomic and laboratory factors. Results: The prevalence of diabetes was higher in men in both 2011-2012 and 2020-2021 (Men vs. Women, 2011-2012: 2.2 ± 0.5 vs. 1.2 ± 0.3 %, p<0.001; 2020-2021: 3.0 ± 0.5 vs. 1.6 ± 0.3 %, p<0.001). The use of insulin and oral hypoglycemic agent (OHA) was comparable between men and women in 2011-2012 (Insulin: 18.1 ± 8.2 vs. 5.2 ± 5.1 %, p=0.305; OHA, 18.2 ± 6.3 vs. 19.5 ± 6.5 %, p=0.239), but more women used insulin and more men used OHA in 2020-2021 (Insulin: 5.3 ± 3.7 vs. 28.7 ± 9.4 %, p=0.016; OHA: 31.4 ± 7.7 vs. 19.6 ± 7.3 %, p=0.009). Execution of fundus exam (25.7 ± 10.6 vs. 68.5 ± 14.1 %, p=0.021) and diagnosis of diabetic retinopathy (0 vs. 8.9 ± 3.3 %, p=0.001) was higher in women in 2020-2021. HbA1c was higher in men in 2020-2021 (8.1 ± 0.4 vs. 7.3 ± 0.3 %, p <0.001), but was similar between men and women in 2011-2012 (8.4 ± 0.6 vs. 8.1 ± 0.6 %, p=0.697). Obesity, one of the most common comorbidities of diabetes, was higher in women in 2011-2012 (24.8 ± 4.8 vs. 79.4 ± 9.3 %, p<0.001), but was higher in men in 2020-2021 (94.4 ± 2.9 vs. 67.8 ± 11.0 %, p<0.001). The factors associated with increase in HOMA-IR in 2020-2021 was different between men and women. Unexpectedly, men with low mental stress showed positive correlation with HOMA-IR (B = 3.9, 95% CI 0.1-7.7, p=0.047). For women, mental stress did not affect HOMA-IR, but those with regular anaerobic exercise (B = -10.5, 95% CI -18.3 - -2.6, p=0.011) and stable employment status (B = -11.9, 95% CI -19.4 - -4.8, p=0.002) presented negative correlation with HOMA-IR. Conclusion: In comparison to before the COVID-19 pandemic, men diabetic patients showed more obese tendency after COVID-19, and there was also a statistically significant difference in HbA1c disparity with women. The higher prevalence of diabetic retinopathy despite of lower HbA1c in women during pandemic era needs to be further investigated in well-designed cohort study. Presentation: 6/3/2024

7955 Increased occurrence of psychiatric disorders and use of psychiatric-related medication in patients with congenital adrenal hyperplasia

Abstract Disclosure: M. Lind-Holst: None. D. Hansen: None. K.M. Main: None. A. Juul: None. M. Andersen: None. M. Dunø: None. Å.K. Rasmussen: None. N. Jørgensen: None. C.H. Gravholt: None. A. Berglund: None. Background: Clinical studies on psychiatric morbidity, quality of life and cognition in patients with congenital adrenal hyperplasia (CAH) imply impaired mental health. Epidemiological studies on psychiatric morbidity in CAH are, however, scarce. Methods: A registry study of hospital diagnoses and prescribed medication related to psychiatric disorders in a national cohort of patients (n=462) diagnosed with CAH from 1943 to 2018 compared to 100 randomly selected sex- and age-matched controls (n=44,527) from the general population. Psychiatric hospital diagnoses were available for in-patient contacts from 1968 and out-patient contacts from 1994. Medication data were available from 1995. Outcomes: CAH was associated with an increased risk of hospital contacts related to any psychiatric diagnosis (incidence rate ratio (IRR)=2.73, 95% CI 1.85-4.04), and this applied to both males (IRR=2.48, 95% CI 1.57-3.91) and females (IRR=3.20, 95% CI 1.58-6.50). Psychiatric disorders due to psychoactive substance use were more common among CAH males (IRR=3.55, 95% CI 1.58-7.96) and females (IRR=3.81, 95% CI 1.71-8.48). Males with CAH also had an increased risk of suicidal behaviour (IRR=10.66, 95% CI 3.74-30.42). By the age of 30 years, 23% of CAH females and 21% of CAH males had at least one diagnosis related to a psychiatric disorder while this was the case in 14% of female controls and 15% of male controls. Stratifying by sex and CAH phenotype there were important differences among groups. Prescription of medication related to psychiatric disorders was increased for CAH overall (HR=1.73, 95% CI 1.48-2.03) and males (HR=1.80, 95% CI 1.35-2.38) and females (HR=1.70, 95% CI1.36-2.38), separately. Age at the first prescription of any psychiatry-related medication was significantly earlier for patients than for controls (HR males=1.67, 95% CI 1.2-2.3; HR females=1.48, 95% CI 1.2-1.8). Thirty-five per cent (157/448) of CAH patients and 24% of controls had at least one prescription related to a psychiatric disorder within the study period. Interpretation: An increased risk of psychiatric morbidity, psychoactive substance use and use of medication related to poor mental health was seen in both males and females with CAH. The risk of suicidal behaviour was increased for patients with CAH, yet only significantly in CAH males. The study underlines the need for more attention and extension of psychological care and support for patients with CAH. Presentation: 6/1/2024

98 - Levator ani avulsion in patients with pelvic organ prolapse: first steps in sonographic diagnosis in a regional hospital

98 - Levator ani avulsion in patients with pelvic organ prolapse: first steps in sonographic diagnosis in a regional hospital