Incidence Rate Ratio Research Articles

Long COVID and its risk factors in migrants: a nationwide register study from Sweden

BackgroundMany studies have found more severe COVID-19 outcomes in migrants and ethnic minorities throughout the COVID-19 pandemic, while recent evidence also suggests higher risk of longer-term consequences. We studied the risk of a long COVID diagnosis among adult residents in Sweden, dependent on country of birth and accounting for known risk factors for long COVID.MethodsWe used linked Swedish administrative registers between March 1, 2020 and April 1, 2023, to estimate the risk of a long COVID diagnosis in the adult population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios (IRR) of long COVID by country/region of birth. The contribution of sex, preexisting health status, disease severity, vaccination status, and socioeconomic factors to differences in long COVID diagnosis by country/region of birth were further investigated.ResultsOf the 1,869,188 persons diagnosed with COVID-19 that were included, 7539 had received a long COVID diagnosis. Compared with residents born in Sweden, we found higher risks of long COVID among migrants from East Europe (IRR: 1.44 CI: 1.29–1.60), Finland (IRR: 1.36 CI: 1.15–1.61), South Asia (IRR: 1.28 CI: 1.03–1.59), Other Asia (IRR: 1.35 CI: 1.13–1.62), Other Africa (IRR: 1.48 CI: 1.17–1.87), and the Middle East (IRR: 1.43 CI: 1.27–1.63) in models adjusted for age and sex. We discovered that disease severity, i.e., whether the person was hospitalized (IRR: 18.6 CI: 17.3–20.0) or treated in an intensive care unit (IRR: 120.5 CI: 111.7–129.8), primarily contributed to the higher risk of long COVID found in migrants while the contribution of vaccinations and social conditions were moderate. Preexisting health problems did not contribute to the increased risk of long COVID in migrants.ConclusionsThe greater exposure and impact of the COVID-19 virus among migrants also affected longer-term consequences. Disease severity was the most important risk factor for long COVID in migrants. The findings emphasize the need for targeted health interventions for migrant communities during an infectious disease pandemic, such as strategic vaccination campaigns and extending social insurance schemes, focusing on reducing disease severity to mitigate the longer-term health consequences of an infection.

An observational study evaluating the epidemiological and entomological impacts of piperonyl butoxide insecticide-treated nets (ITNs) compared to a combination of indoor residual spraying (IRS) plus standard pyrethroid-only ITNs in Amhara Region, Ethiopia, 2019–2023

IntroductionNational malaria programmes must weigh the relative benefits of different vector control and elimination tools to prioritise resource allocation with the greatest impact. This study assesses the epidemiological and entomological...

School Attendance Among Autistic Students in Aotearoa/New Zealand: A Population Cross-Sectional StudyUsing the Integrated Data Infrastructure.

Extant literature indicates autistic students have lower school attendance compared to the general population. However, there remains considerable heterogeneity between studies, a lack of large population-based studies beyond the UK and US, and insufficient consideration of age and sex differences in attendance rates. The aim of this study was to examine school attendance among autistic compared with non-autistic students including stratification by age and sex. This was a national retrospective cohort study using population-level data on students aged 5 to 16 years in 2018. Autism was identified using diagnostic information contained within multiple health datasets. Regular attendance was defined as attending 90% or more of school half days. The association between autism and attendance was estimated using complete-case 2-level random intercept modified Poisson regression. Among 654 438 students, 8427 (1.3%) were autistic. In adjusted analyses, autism was associated with significantly decreased likelihood of regular attendance (incident rate ratio [IRR] 0.88; 95% CI, 0.86-0.90). Age and sex stratification revealed significant age differences with likelihood of regular school attendance lower for younger autistic students (5-11 years) (IRR 0.85; 95% CI, 0.83-0.87) while sex differences were marginal. The most frequent type of non-attendance among autistic students was justified (including medical) absence (8.2% of recorded attendance hours for autistic students vs. 5.0% for non-autistic students). This study provides further, whole-population evidence of the significant disparities experienced by Autistic students. To improve attendance of autistic students, comprehensive and targeted supports are required to help the student, family and school.

Clinical performance of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear: a systematic review and meta-analysis.

To evaluate short, mid and long-term clinical outcomes and patients' satisfaction of minimally invasive full-mouth rehabilitation using different materials and techniques for patients with moderate to severe tooth wear. Furthermore, materials were analyzed to identify their influences on clinical results. Search was conducted in PubMed, Cochrane Central Register of Controlled Trial, Embase, Web of science and Scopus until December 19, 2024. Randomized clinical trials (RCT), cohort studies and case series with at least mean period of 3years were included. The revised Cochrane risk of bias tool, Newcastle-Ottawa scale and Joanna Briggs Institute Critical Appraisal were used to evaluate the quality of RCT, cohort studies and case series. Meta-analysis and Poisson regression were conducted. Ten studies in this review included three case series, six cohort studies and one RCT with three low, six moderate risks and one some concerns. Annual failure rates (AFRs) and annual complication rates (ACRs) of direct composite restorations were 0-6.2% and 1.0%-4.2%, respectively. AFRs of indirect restorations were 0%-0.5%. Overall ACRs of indirect restorations fabricated by traditional indirect resin composites, polymer-infiltrated ceramic-network, resin nanoceramics and ceramics were at 1.6%-15.1%, 0.7%-4.8%, 0.5%-5.0% and 0.2%-1.1%, respectively. The estimated AFRs of direct composites, resin nanoceramics and ceramics were 0.64%, 0.13% and 0.04% respectively. Significantly lowest AFRs of ceramic was found after mid-term follow-up with incidence rate ratios of direct composites, resin nanoceramics and ceramics being 1: 0.68 (P = 0.60): 0.001 (P < 0.05). The estimated ACRs of the three materials were 2.16%, 2.14% and 0.62%. Overall AFRs of restorations using different techniques were 0%-0.5%. Overall ACRs of direct and indirect techniques were 1.1%-2.2% and 0.2%-4.8%, respectively. Overall ACRs of hybrid technique were 0.5% to 15.1%. Restoration fracture was the most predominant complication regardless of materials. High appreciation was expressed by patient reported outcomes measures. Minimally invasive full-mouth rehabilitation for patients with moderate to severe tooth wear presented good clinical performance apart from traditional indirect resin composite used in posterior teeth. Minimally invasive full-mouth rehabilitation should be strongly advocated for the patients with moderately and severely worn dentition.

Antihypertensive drug-related problems in Vietnamese ambulatory care

Evidence of antihypertensive drug-related problems (aDRP) is limited in Asian ambulatory care. To better detect aDRP without causing alert fatigue, we investigated whether adding more antihypertensive agents was associated with increasing aDRP risk and factors associated with physician acceptance of aDRP correction. We conducted a cross-sectional study targeting ambulatory prescriptions of Vietnamese patients with hypertension who either received standard therapy (using two or fewer medications, SdT) or standard plus add-on therapy (using more than two medications, SdT + add-on). Primary and secondary outcomes were number of aDRP and correction ratio of aDRP. We used multivariable Poisson regression to estimate the incidence rate ratio (IRR) and 95% confidence interval (95%CI). We analyzed 221 cases (patient age of 64.1 ± 9.0 years, 51.1% being female). On average, patients with SdT and SdT + add-on had 1.6 ± 1.3 and 1.6 ± 1.5 aDRP, respectively. Compared to the SdT group, SdT + add-on group did not have a higher number of aDRP (IRR = 1.11, 95%CI 0.87–1.43, p = 0.393) or likelihood of aDRP correction (IRR = 0.97, 95%CI 0.86–1.09, p = 0.578). We found the following factors to be associated with aDRP correction: unnecessary indication (IRR = 1.98, 95%CI 1.39–2.81, p < 0.001), missing indication (IRR = 1.93, 95%CI 1.68–2.21, p < 0.001), major-to-contraindicated drug interaction (IRR = 1.74, 95%CI 1.39–2.18, p < 0.001), adverse effects (IRR = 1.71, 95%CI 1.26–2.31, p < 0.001), nonconformity indication (IRR = 1.66, 95%CI 1.44–1.92, p < 0.001), and administration (IRR = 1.45, 95%CI 1.26–1.67, p < 0.001). In conclusion, adding antihypertensive agents was not associated with a higher number of aDRP or likelihood of aDRP corrections. Physician acceptance of aDRP corrections could be strongly related to unnecessary/missing indication, major-to-contraindicated drug interaction, and adverse effects. These findings could improve DRP alerts and maximize treatment outcomes in Asian patients with hypertension.

Essential Thrombocythemia: A Review.

Essential thrombocythemia, a clonal myeloproliferative neoplasm with excessive platelet production, is associated with an increased risk of thrombosis and bleeding. The annual incidence rate of essential thrombocythemia in the US is 1.5/100 000 persons. Patients with essential thrombocythemia have a persistent platelet count of 450 × 109/L or greater. The differential diagnosis includes myeloproliferative neoplasms (polycythemia vera, primary myelofibrosis, chronic myeloid leukemia); inflammatory conditions such as rheumatoid arthritis and systemic lupus erythematosus; infections; splenectomy; iron deficiency anemia; and solid tumors such as lung cancer. Approximately 90% of individuals with essential thrombocythemia have genetic variants that upregulate the JAK-STAT (signal transducer and activator of transcription 5) signaling pathway, including Janus kinase 2 (JAK2, 64%), calreticulin (CALR, 23%), and myeloproliferative leukemia virus oncogene (MPL, 4%). The median age at diagnosis of essential thrombocythemia is 59 years. The median overall survival exceeds 35 years in those diagnosed at 40 years or younger. Patients with essential thrombocythemia are at increased risk of arterial thrombosis (11%), venous thrombosis (7%), and hemorrhagic complications (8%). Thrombosis risk is increased among those with a history of thrombosis, age older than 60 years, a JAK2 gene variant, and cardiovascular risk factors (eg, hypertension, diabetes mellitus, hyperlipidemias, tobacco use). Use of aspirin (81-100 mg/d) is suggested for most patients with essential thrombocythemia to lower thrombosis risk. In a retrospective study of 300 affected patients with a low thrombosis risk (younger than 60 years with no prior thrombosis), those not taking aspirin (100 mg/d) had a risk of arterial thrombosis of 9.4/1000 patient-years and a venous thrombosis risk of 8.2/1000 patient years; cardiovascular risk factors were associated with a higher risk of arterial thrombi (incidence rate ratio, 2.5 [95% CI, 1.02-6.1]), and a JAK2 gene variant was associated with increased risk of venous thrombosis (incidence rate ratio, 4.0 [95% CI, 1.2-12.9]). In a randomized trial of 114 patients at higher risk for thrombosis (age older than 60 years or a prior thrombotic event), cytoreduction with hydroxyurea significantly lowered the risk of arterial or venous thrombotic events compared with no cytoreductive therapy (3.6% vs 24%; P < .01). At a median of 8.5 years from diagnosis, approximately 10% of patients with essential thrombocythemia develop myelofibrosis and about 3% develop acute myeloid leukemia. Essential thrombocythemia is a rare clonal myeloproliferative neoplasm associated with an increased risk of venous and arterial thrombosis, hemorrhage, myelofibrosis, and acute myeloid leukemia. Based on individual risk factors for thrombosis, persons with essential thrombocythemia may be treated with low-dose aspirin, either alone or in combination with a cytoreductive drug such as hydroxyurea.

Pediatric SARS-CoV-2 Incidence in California by Vaccination Status, December 2021–April 2023

OBJECTIVE This study aimed to provide evidence on trends related to the effects of coronavirus disease 2019 (COVID-19) vaccines (BNT162b2 and mRNA-1273) among children and adolescents in California during December 2021 through April 2023. METHODS We used a surveillance cohort study design to compare case and hospitalization incidence rate ratios (IRR) between vaccinated and unvaccinated children and adolescents considering age, dose received, and time since vaccination. We evaluated the Omicron BA.1/2 predominant period and the time from which vaccines became available to 1–4-year-olds through when administration of original strain monovalent doses was discontinued. RESULTS Across all age groups and time periods, vaccinated children were less likely to be hospitalized than unvaccinated children. For all but the youngest age group, vaccinated children were also less likely to have a documented COVID-19 infection. IRR for cases who received any mRNA vaccine primary series compared to unvaccinated children ranged from 1.13 (95% CI: 0.82, 1.55) for 1–4-year-olds to 0.21 (95% CI: 0.19, 0.23) for 12–17-year-olds. Hospitalization IRR ranged from 0.33 (95% CI: 0.16, 0.65) for 1-4-year-olds to 0.17 (95% CI: 0.13, 0.21) for 12–17-year-olds. CONCLUSIONS California surveillance data indicates that receipt of an mRNA vaccine was associated with reduced rates of COVID-19 infection and hospitalization across all childhood age groups. Although reductions in protection against infection appeared to be attenuated among the youngest age group, protection against hospitalization remained high for this population. Administration of COVID-19 vaccine is a valuable tool for reducing COVID-19 associated morbidity in children and adolescents.

Incidence of Occupational Injuries Among Military Working Dog Handlers, 2016-2023.

This study examines the incidence of injuries among active component service members in Military Working Dog (MWD) handler occupations compared to three other active component occupational groups. A retrospective cohort study was conducted with a total of 2,524,092 active component service members including, 3935 MWD handlers, 2025 veterinary personnel, 113,413 military police, and 2,404,719 all other active component service members (ACSM). Incidence rate and incident rate ratios of injuries were determined. MWD handlers had the second highest rates of injuries (14,194.42 injuries per 10,000 p-yrs.) with veterinary personnel having the highest rate of injuries (17,320.11 injuries per 10,000 p-yrs.). Military police (11,521.71 injuries per 10,000 p-yrs.) and other ACSM (11,708.60 injuries per 10,000 p-yrs.) had similar incidence rates. Risk for injury was highest among women and older service members. This study is among the first investigations into MWD handlers' occupational health outcomes. These results suggest the importance of continued MWD handler health assessment.

Injury epidemiology in international basketball: a six-season study of the Great Britain men’s basketball team

ABSTRACT Objectives To report the injury epidemiology of the Great Britain’s (GB) men’s basketball team games and training over a 6-season period. Methods Non-time loss (NTL) and time-loss (TL) injuries were recorded throughout 14 international windows (2018–2024). Exposure (player-hours) was recorded for team training and games. NTL and TL injury incidence is presented per 1000 player-hours (p/1000 h; 95% CI) for training, games and overall exposure. TL severity (days-lost) and burden (days-lost/1000 h; 95% CI) was calculated, with incidence rate ratios (IRR, 95% CI) comparing game and training incidence for each definition. Results Throughout the study period, 113 injuries were recorded, of which 65 were GB related (43 NTL and 22 TL). Game injury incidence was significantly greater than training for TL (96/1000 h; 95% CI 33–159 versus 6/1000 h; 95% CI 2–9; IRR = 17; 95% CI 7–44) and NTL (75/1000 h; 95% CI 10–131 versus 7/1000 h; 95% CI 3–11; IRR = 11; 95% CI 4–28) injury definitions. Overall, most TL injuries occurred at the ankle (36%, 5/1000 h; 95% CI 2–9) and NTL injuries at the knee (19%, 5/1000 h; 95% CI 2–9). 31 overuse injuries were recorded, with 25% lower limb tendinopathies. TL injury severity ranged from 1 to 30 days, with injury burden for games (675/1000 h; 95% CI 234–1116) greater than training (48/1000 h; 95% CI 55–133). Conclusion The reported game injury incidence is high, with a large prevalence of NTL injuries. Lower limb injuries were most common, particularly overuse knee injuries. Preventative strategies need to be specific in the international basketball context, where camps are short but intense in duration.

Certolizumab Pegol Treatment in Patients with Crohn’s Disease: Final Safety Data from the SECURE Registry

Abstract Background Crohn’s disease (CD) treatment is associated with increased risks of infection and malignancies. Although the safety of certolizumab pegol (CZP) is well-established, long-term data from community-based observational studies are lacking. Aim This study aimed to evaluate long-term safety outcomes of patients from the SECURE registry receiving CZP relative to other CD treatments, including corticosteroids, immunosuppressants, and biologics. The primary outcome of this observational study was the evaluation of malignancies. Methods Adult patients with CD were prospectively monitored for up to eight years. Prespecified data were collected for all enrolled patients. Adverse events of interest (AEoIs) were reported per 100 patient-years (PY) of exposure. Incidence rate ratios (IRRs) were calculated for AEoIs using multivariate regression analysis accounting for exposure to multiple treatments. Malignancies reported after any exposure to CZP were attributed to CZP. Post-hoc analyses were conducted to evaluate non-melanoma skin cancer (NMSC), lymphoma, and pregnancy outcomes. Results A total of 3,072 patients were enrolled in the study. The risk of AEoIs was similar between patients with only CZP exposure versus comparator exposure. Among patients with any CZP exposure, there was a higher frequency of serious infections (IRR: 2.56 [95% confidence interval (CI): 2.00, 3.29]) and hypersensitivity or anaphylactic reactions (IRR: 4.11 [95% CI: 1.80, 9.38]) versus patients with comparator exposure. Malignancy rates were similar across groups, however concomitant use of thiopurines was associated with higher odds of NMSC (odds ratio: 2.30 [95% CI: 1.09, 4.89]). Most cases of lymphoma (5/7) occurred in patients with exposure to thiopurines. Pregnancy outcomes were similar across groups. Conclusions No new safety signals were identified for CZP; use of thiopurines was identified as a risk factor for NMSC.

Evaluating programmatic reactive focal drug administration impact on malaria incidence in northern Senegal: an interrupted time series analysis

BackgroundThe World Health Organization conditionally recommends reactive drug administration to reduce malaria transmission in settings approaching elimination. However, few studies have evaluated the impact of reactive focal drug administration (rFDA) in sub-Saharan Africa, and none have evaluated it under programmatic conditions. In 2016, Senegal’s national malaria control programme introduced rFDA, the presumptive treatment of compound members of a person with confirmed malaria, and reactive mass focal drug administration (rMFDA), an expanded effort including neighbouring compounds during an outbreak, in 10 low transmission districts in the north of the country. This evaluation sought to measure the impact of rFDA and rMFDA on malaria incidence.MethodsAn interrupted time series analysis was conducted with routine surveillance data on health post-level monthly confirmed malaria case counts from the District Health Information Software (DHIS2). The study evaluated the change in incidence following rFDA and rMFDA rollout (level change), which ranged from August 2016 to November 2019, and monthly thereafter (trend change), using an adjusted negative binomial regression model with data from January 2015 through January 2020. The model was used to estimate the number of cases averted via a counterfactual simulation.ResultsNo incidence rate reductions were estimated immediately following rollout (level change: incidence rate ratio (IRR) = 1.00, 95% credible interval (CI) = 0.76, 1.33). However, rFDA and rMFDA were associated with a 4% monthly decline in incidence relative to the baseline trend (trend change: IRR = 0.96, 95% CI = 0.95, 0.98). Over the study period, RFDA and rMFDA were estimated to avert 2,070 (95% CI = 577, 4,367) of 4,108 (95% CI = 2,620, 6,425) malaria cases.ConclusionsRFDA and rMFDA were associated with reduced malaria incidence in northern Senegal, supporting their use in malaria control in very low transmission areas. However, additional strategies are likely needed to achieve elimination in this setting.

Cardiovascular disease risk in Korean patients with systemic lupus erythematosus compared to diabetes mellitus and the general population

To evaluate the incidence and risk of cardiovascular disease (CVD) among Korean patients with systemic lupus erythematosus (SLE) comparing them to diabetes patients and the general population. This nationwide cohort study focused on incident SLE patients aged over 40 years, matched with diabetes patients and the general population (1:4:4 ratio). CVD was defined as ischaemic heart disease, ischaemic stroke, and cardiac arrest. Incidence rate and incidence rate ratio (IRR) of CVD were calculated using generalised estimating equation models. The Fine-Gray model assessed risk factors for CVD in both SLE and diabetes patients. The study included 4272 incident SLE patients, 17,003 diabetes patients, and 17,088 from the general population. SLE patients had higher CVD risk compared to the general population, with adjusted IRRs of 1.99 for overall CVD. Diabetes patients showed increased CVD risk, but to a lesser extent, with an IRR of 1.39. SLE patients aged 40–59 years displayed a significantly elevated CVD risk. Advanced age, male gender, and current use of glucocorticoids, immunosuppressive, and anti-platelet agents were associated with increased CVD risk in SLE patients. SLE patients have a higher risk of CVD compared to the general population, more so than diabetes patients.

Impact of SARS-CoV-2 spike antibody positivity on infection and hospitalisation rates in immunosuppressed populations during the omicron period: the MELODY study.

In the UK, booster COVID-19 vaccinations have been recommended biannually to people considered immune vulnerable. We investigated, at a population level, whether the absence of detectable anti-SARS-CoV-2 spike protein IgG antibody (anti-S Ab) following three or more vaccinations in immunosuppressed individuals was associated with greater risks of infection and severity of infection. In this prospective cohort study using UK national disease registers, we recruited participants with solid organ transplants (SOTs), rare autoimmune rheumatic diseases (RAIRDs), and lymphoid malignancies. All participants were tested for anti-S Ab using a lateral flow immunoassay, completed a questionnaire on sociodemographic and clinical characteristics, and were followed up for 6 months using linked data from the National Health Service in England. SARS-CoV-2 infection was primarily defined using UK Health Security Agency data and supplemented with hospitalisation and therapeutics data, and hospitalisation due to SARS-CoV-2 was defined as an admission within 14 days of a positive test. Between Dec 7, 2021, and June 26, 2022, we recruited 21 575 participants. Anti-S Ab was detected in 6519 (77·0%) of 8466 participants with SOTs, 5594 (85·9%) of 6516 with RAIRDs, and 5227 (79·3%) of 6593 with lymphoid malignancies. COVID-19 infection was recorded in 3907 (18·5%) participants, with 556 requiring a COVID-19-related hospital admission and 17 dying within 28 days of infection. Rates of infection varied by sociodemographic and clinical characteristics but, in adjusted analysis, having detectable anti-S Ab was independently associated with a reduced incidence of infection, with incident rate ratios (IRRs) of 0·69 (95% CI 0·65-0·73) in the SOT cohort, 0·57 (0·49-0·67) in the RAIRD cohort, and 0·62 (0·54-0·71) in the lymphoid malignancy cohort. In adjusted analysis, having detectable anti-S Ab was also associated with a reduced incidence of hospitalisation, with IRRs of 0·40 (0·35-0·46) in the SOT cohort, 0·32 (0·22-0·46) in the RAIRD cohort, and 0·41 (0·29-0·58) in the lymphoid malignancy cohort. All people with immunosuppression require ongoing access to COVID-19 protection strategies. Assessment of anti-S Ab responses, which can be performed at scale, can identify people with immunosuppression who remain most at risk, providing a mechanism to further individualise protection approaches. UK Research and Innovation, Kidney Research UK, Blood Cancer UK, Vasculitis UK, and Cystic Fibrosis Trust.

Influence of frailty status on the incidence of intraoperative hypotensive events in elective surgery: Hypo-Frail, a single-centre retrospective cohort study.

Frailty is a predictor of morbidity and mortality in older patients. This study aimed to investigate the influence of frailty status on likelihood, rate, duration, and severity of intraoperative hypotension (IOH), which can lead to severe organ dysfunction. Surgical patients (≥70 yr old) with preoperative frailty assessment were analysed retrospectively. Frailty status was defined as robust, prefrail, or frail based on modified Fried criteria. IOH was defined as mean arterial pressure <65 mm Hg. For likelihood, rate, duration, and severity of IOH, logistic and Poisson regression were used. We included 2495 patients. There was no significant difference in likelihood of IOH. An increase of 9% in rate of IOH during surgery for prefrail (incidence rate ratio [IRR] 1.09 [95% CI 1.03-1.16], P=0.002), and 16% increase for frail patients (IRR 1.16 [1.04-1.29], P=0.007) was observed. During anaesthesia induction, prefrail patients exhibited a 28% increase in IOH (IRR 1.28 [1.12-1.47], P<0.001). Although there were no differences in the severity of IOH if surgery or anaesthesia induction duration was taken into account, frailty status was associated with a 15% longer time-weighted duration of IOH during anaesthesia induction (IRR 1.15 [1.06-1.24], P=0.001). Mediator analysis revealed that frailty status accounted for >90% after considering number of measured blood pressures and surgical duration and >70% after accounting for total propofol dose. Prefrail and frail patients aged ≥70 yr experienced up to 16% more IOH during surgery and 28% more during anaesthesia induction compared with robust patients. Preoperative optimisation (prehabilitation) and modification of intraoperative management (e.g. invasive blood pressure management) have the potential to reduce IOH in prefrail and frail patients.

COPD: Schätzung der Änderungsrate der Lungenfunktion anhand klinischer Spirometriedaten aus der elektronischen Patientenakte

Rationale: In chronic obstructive pulmonary disease (COPD), accurately estimating lung function from electronic health record (EHR) data would be beneficial but requires addressing complexities in clinically obtained testing. This study compared analytic methods for estimating rate of forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;) change from EHR data. Methods: We estimated rate of FEV&lt;sub&gt;1&lt;/sub&gt; change in patients with COPD from a single centre who had ≥3 outpatient tests spanning at least 1 year. Estimates were calculated as both an absolute mL/year and a relative %/year using non-regressive (Total Change, Average Change) and regressive (Quantile, RANSAC, Huber) methods. We compared distributions of the estimates across methods focusing on extreme values. Univariate zero-inflated negative binomial regressions tested associations between estimates and all-cause or COPD hospitalisations. Results were validated in an external cohort. Results: Among 1417 participants, median rate of change was approximately -30 mL/year or -2%/year. Non-regressive methods frequently generated erroneous estimates due to outlier first measurements or short intervals between tests. Average change yielded the most extreme estimates (minimum=-3761 mL/year), while regressive methods, and Huber specifically, minimized extreme estimates. Huber, Total Change and Quantile FEV&lt;sub&gt;1&lt;/sub&gt; slope estimates were associated with all-cause hospitalisations (Huber incidence rate ratio 0.98, 95% CI 0.97 to 0.99, p&lt;0.001). Huber estimates were also associated with smoking status, comorbidities and prior hospitalisations. Similar results were identified in an external validation cohort. Conclusions: Using EHR data to estimate FEV&lt;sub&gt;1&lt;/sub&gt; rate of change is clinically applicable but sensitive to challenges intrinsic to clinically obtained data. While no analytic method will fully overcome these complexities, we identified Huber regression as useful in defining an individual’s lung function change using EHR data.

Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States.

Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes. To investigate the associations between self-recognition of hearing loss and hospitalization outcomes. This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study. The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss. Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss. In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.

Sex disparities in ICU care and outcomes after cardiac arrest: a Swiss nationwide analysis

BackgroundConflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients.MethodsAnalysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008–12/2022) using the nationwide prospective ICU registry. The primary outcome was ICU mortality, with secondary outcomes including ICU admission probability and advanced treatment provision.ResultsAmong 41,733 individuals (34.9% women), 21,692 patients (30.6% women) were admitted to ICUs (16,571 OHCA patients/5121 IHCA patients). Women were less likely to be admitted to the ICU than men (incidence rate ratio 0.82 [95% CI 0.80–0.85] and had a higher ICU mortality (41.8% vs 36.2%; p < 0.001). Mortality differences were more pronounced in OHCA patients (unadjusted HR: 1.35 [95% CI 1.28–1.43]; adjusted HR: 1.19 [95% CI 1.12–1.25]). In IHCA patients, mortality differences were less pronounced (unadjusted HR: 1.14 [95% CI 1.04–1.25]) and vanished after adjustment for confounders: adjusted HR: 1.03 [95% CI 0.94–1.13]). Women after cardiac arrest were older, more severely ill, and received fewer interventions before (44.7% vs 54.0%; p < 0.001) and during ICU stay. A subgroup analysis of 11,202 patients revealed that treatment limitations were more frequent in women (46.7% vs 38.7%; p < 0.001). However, these limitations were associated with an increased risk of death in both sexes.ConclusionsThis study highlights sex disparities in short-term mortality and ICU resource allocation among cardiac arrest patients, with women potentially facing disadvantages, in particular after OHCA. The limitations of ICU registry data, particularly the lack of detailed cardiac arrest-specific and comorbidity information, restrict definitive conclusions. Future research should prioritize prospective studies with more granular data to better understand and address these disparities.Graphical abstract

Differences in Postoperative Disposition by Kidney Disease Severity: A Population-Based Cohort Study.

People with advanced kidney disease undergo more non-cardiac operations compared to the general population, with a higher risk of perioperative cardiac events and death. However, little is known about the associations between severity of preoperative kidney dysfunction with postoperative length of hospitalization and discharge disposition; these were the focus of this study. Population-based retrospective cohort. Adults from Alberta, Canada undergoing inpatient major noncardiac surgery between April 2005 and February 2019. Categorical preoperative outpatient estimated glomerular filtration rate (eGFR) or kidney failure status. Length of stay (LOS), days alive at home after surgery within 30 and 90 days, and discharge disposition location. Associations were estimated with unadjusted and adjusted generalized estimating equation models. 927,560 inpatient surgeries in 666,770 people (55.9% female, median age 57.4 years) were identified. People receiving dialysis had the longest LOS (11 days [95% CI 6, 29), 2 times greater than that among people with normal kidney function (adjusted incidence rate ratio [IRR] 2.21 [95% CI 2.10, 2.32]). This group also had the fewest days alive at home within the first 30 days after surgery, with an IRR of 0.69 (95% CI 0.67, 0.70) compared to people with normal eGFR. The majority of people (82.8%) were discharged home without nursing support after surgery, though people receiving dialysis were discharged to a facility with 24-hour nursing care nearly 4 times more often. There were graded increases in risks of these outcomes with lower levels of kidney function. Many people did not have preoperative kidney function assessed, reflecting standard clinical practice in the general population. After major surgery, people with kidney disease spend more time recovering in hospital and have less independence from post-discharge nursing supports than otherwise similar patients who have normal or near normal kidney function. These differences were more pronounced for those with the most severe stages of kidney disease.

No Emergence of Colistin Resistance in the Respiratory Tract of Lung Transplant Patients Treated With Inhaled Colistin

Secondary prophylaxis using inhaled colistin (IC) was implemented to prevent recurrences of Pseudomonas aeruginosa or extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) pneumonia during the postoperative intensive care unit (ICU) stay after lung transplantation (LT). We evaluated the risk of emergence of colistin resistance in the respiratory tract during secondary IC prophylaxis. We conducted a prospective, single-centre, observational study of all adult patients who underwent LT between 1 July 2018 and 30 June 2019. IC was started and continued for at least 90 days for P. aeruginosa or ESBL-PE pneumonia. During the 90 days following LT, all respiratory samples were routinely tested for the presence of GNB of reduced susceptibility to colistin. Twenty-seven (38.6%) of the 70 included patients received IC. Among the 867 respiratory samples tested, IC did not promote the emergence of bacterial species with natural or acquired resistance to colistin (incidence-rate ratio of 0.21 [0.03–1.58], p = 0.13 and 1.68 [0.55–5.12], p = 0.37, respectively). Our study suggests no association between the use of IC and an increased risk of colistin resistance in the respiratory tract within 90 days of LT.

DOP011 Colectomy rates of newly diagnosed Finnish Ulcerative Colitis patients are decreasing

Abstract Background The effect of biological medication on colectomies is still unclear. Our aim was to determine colectomy risk in newly diagnosed Finnish ulcerative colitis (UC) patients and compare the risk of prebiological and biological era. Methods We used the registry of Social Insurance Institution of Finland to find newly diagnosed UC patients. Data on colectomies were collected from the Finnish Institute for Health and Welfare. Patients were stratified according to the UC diagnosis year and the availability of biological medication in Finland to three groups: 2000-2005 (prebiological), 2006-2012 (only infliximab available) and 2013-2020 (multiple advanced therapies available). We defined the subgroups as paediatric (aged &amp;lt;20), adults (aged 20-59), and the elderly (aged ≥60). Results We identified 32,108 UC patients and 2,195 colectomies performed on them. The 1-, 5- and 10-year cumulative colectomy risks were 1.0%, 4.7% and 7.3%, respectively. Throughout the study period, the risks were declining with the incidence rate ratio (IRR) 0.98 (p=0.009) in 1-year, IRR 0.97 (p&amp;lt;0.001) in 5-year and IRR 0.97 (p&amp;lt;0.001) in 10-year colectomy risk. Colectomy rates were lower in advanced therapy era (IRR 0.76 (p = 0.048) in 1-year and IRR 0.70 (p &amp;lt;0.001) in 5-year risk) and the 10-year risk also in infliximab era (IRR 0.87 (p = 0.010)) . The paediatric population had lower risk of surgery in advanced therapy era (IRR 0.33 (p =0.021) in 1 and 0.43 (p &amp;lt;0.001) in 5 years) , whereas the risk of the elderly stayed constant (IRR 1.33 (p =0.400) in 1 and IRR 1.12 (p =0.553) in 5 years postdiagnosis). Conclusion The risk of colectomy among newly diagnosed UC patients has decreased along the 21st century. This could be due to the use of advanced therapy options and more active treatment strategies.