Incidence Rates And Rate Ratios Research Articles

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

PurposeWe aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. MethodsInternational observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. Results23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. ConclusionsStroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. Trial registrationACTRN12620000421932 registered on 30/03/2020.

Racial inequities in HIV incidence among men who have sex with men prior to and amidst an Ending the HIV Epidemic initiative.

The aim of this study was to examine trends in HIV incidence among men who have sex with men (MSM) relative to the scale up of Ending the HIV Epidemic (EHE) initiatives, including biomedical prevention strategies, and to describe racial inequities over time. A cross-sectional study, matching annual cohorts of New York City (NYC) Sexual Health Clinic (SHC) patients from 2010 to 2018 to the citywide HIV registry to identify seroconversions during 1 year of follow-up, through 2019. We examined HIV incidence for each annual cohort of MSM using diagnoses within 1 year after last negative HIV test. We calculated incidence rates and rate ratios (IRR) pooled across 3-year intervals (2010-2012, 2013-2015, 2016-2018) by race/ethnicity, age, neighborhood poverty level, recent STI diagnosis, and condom use during anal sex. There were 36 156 study visits among MSM attending NYC SHCs, including 37% among White MSM and 63% among MSM of color. From 2010 to 2018, HIV incidence decreased overall from 2.82 to 0.82/100 person-years, and among all race/ethnicity, age, poverty, STI, and condom use subgroups. For 2010-2012 vs. 2016-2018, adjusted IRRs (95% CI) increased for Black MSM [1.8 (1.3-2.6) vs. 6.0 (3.5-10.2)], Latino MSM [1.4 (1.0-2.0) vs. 4.0 (2.3-6.8)], and MSM of other races [1.0 (0.6-1.7) vs. 2.5 (1.3-4.9)] compared with White MSM. Black and Latino MSM seroconverted at significantly higher rates than White MSM in the same age groups and neighborhood poverty level. Despite decreases in HIV incidence among MSM, racial inequities were exacerbated over time. Addressing structural factors that impact racial inequities in risk of HIV should undergird EHE initiatives.

Incidence of depression in patients with cardiovascular disease and type 2 diabetes: a nationwide cohort study.

Estimating how type 2 diabetes (T2D) affects the rate of depression in cardiovascular disease (CVD) can help identify high-risk patients. The aim is to investigate how T2D affects the rate of depression according to specific subtypes of CVD. Incident CVD patients, free of psychiatric disease, with and without T2D, were included from nationwide registries between 2010 and 2020. We followed patients from CVD diagnosis until the first occurrence of depression, emigration, death, 5years, or end of study (December 31, 2021). We used time-dependent Poisson regression to estimate the incidence rates and rate ratios (IRR) of depression following subtypes of CVD with and without T2D. The model included age, sex, comorbidities, calendar year, T2D duration, educational level, and living situation as covariates. A total of 165,096 patients were included; 45,845 had a myocardial infarction (MI), 63,691 had a stroke, 19,959 had peripheral artery disease (PAD), 35,568 had heart failure (HF), and 979 were diagnosed with 2 or more CVD subtypes (= > 2 CVD's). Baseline T2D in each CVD subtype ranged from 11 to 17%. The crude incidence rate of depression per 1000 person-years (95% confidence intervals) was: MI + T2D: 131.1 (109.6;155.6), MI: 82.1 (65.3;101.9), stroke + T2D: 287.4 (255.1;322.6), stroke: 222.4(194.1;253.6), PAD + T2D: 173.6 (148.7;201.4), PAD:137.5 (115.5;162.5), HF + T2D: 244.3 (214.6;276.9), HF: 199.2 (172.5;228.9), = > 2 CVD's + T2D: 427.7 (388.1;470.2), = > 2 CVD's: 372.1 (335.2;411.9). The adjusted IRR of depression in MI, stroke, PAD, HF, and = > 2 CVD's with T2D compared to those free of T2D was: 1.29 (1.23;1.35), 1.09 (1.06;1.12), 1.18 (1.13;1.24), 1.05 (1.02;1.09), and 1.04 (0.85;1.27) (p-value for interaction < 0.001). The presence of T2D increased the rate of depression differently among CVD subtypes, most notable in patients with MI and PAD.

Incident Cognitive Impairment During Aging in Rural South Africa: Evidence From the HAALSI Cohort, 2014 to 2019

We estimated the incidence of cognitive impairment and its key sociodemographic, social, and health-related predictors at the first longitudinal follow-up of the population-representative “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort of adults aged ≥40 in rural Agincourt, South Africa. Cognitive impairment was defined as scoring ≥1.5 SD below the baseline mean composite time orientation and episodic memory score, or requiring a proxy interview with “fair” or “poor” proxy-reported memory. Activity of daily living (ADL) limitations were compared according to incident cognitive impairment status. Incidence rates (IRs) and rate ratios (IRRs) for cognitive impairment according to sociodemographic, social, and health-related predictors were estimated using Poisson regression with robust standard errors, and weighted to account for mortality. Over a 3.7-year mean follow-up, 309/3,861 at-risk participants newly developed cognitive impairment (IR=24.0/1000 person-years (PY); 95% CI: 21.6-26.8). Incidence increased from IR=9.1/1000 PY (95% CI: 5.5-16.1) among those aged 40-44 at baseline to IR=76.5/1000 PY (95% CI: 63.2-93.4) among those aged 80+. At least one ADL limitation was prevalent in 39% of those with incident cognitive impairment, compared to 7% of non-impaired participants. Incident cognitive impairment did not vary by sex/gender, HIV status, or cardiovascular factors, but was strongly graded according to education, literacy, household assets, employment, marital status, and frequency of alcohol consumption. This study presents one of the first incidence rate estimates for cognitive impairment in sub-Saharan Africa. Social disparities in cognitive impairment were apparent in patterns similar to many high-income countries.

Racial and Ethnic Variation in PSA Testing and Prostate Cancer Incidence Following the 2012 USPSTF Recommendation.

The 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race and ethnicity remains unclear. The proportion of 40- to 74-year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (2012-2018). Odds ratios (ORs) of undergoing screening by race and ethnicity were estimated, adjusting for healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race and ethnicity were estimated using Surveillance, Epidemiology, and End Results registry data (2004-2017). PSA testing frequencies were 32.3% (95% confidence interval [CI] = 31.7% to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3% to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9% to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1% to 21.3%) among Asian and Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity = .005), driven by a larger decline among NHB men ages 40-54 years. The NHB to NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial and ethnic groups. The frequency of prostate cancer screening varies by race and ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB to NHW IRR for localized prostate cancer modestly increased following 2012.

Long-term risk of tuberculosis among migrants according to migrant status: a cohort study.

The majority of tuberculosis (TB) cases in low-incidence countries occur in migrants. Only few studies have assessed the long-term TB risk in migrants after immigration, and datasets have not considered this across a range of diverse migrant groups. This nationwide study aimed to investigate long-term TB risk among migrants according to migrant status and region of origin. This cohort study included all migrants aged ≥ 18 years who obtained residence in Denmark from 1993 to 2015, with a mean follow-up of 10.8 years [standard deviation (SD) 7.3]. Migrants were categorized based on legal status of residence and region of origin. Incidence rates (IR) and rate ratios (IRR) were estimated by Poisson regression. A total of 142314 migrants were included. Across all migrants, the TB risk was highest during year 1 of residence (IR 275/100000 person-years; 95% CI 249-305) followed by a gradual decline, though TB risk remained high for over a decade. Compared with the Danish-born population, the IRRs after 7-8 years were particularly higher among former asylum seekers (IRR 31; 95% CI 20-46), quota refugees (IRR 31; 95% CI 16-71), and family-reunified with refugees (IRR 22; 95% CI 12-44). Sub-Saharan African migrants also experienced elevated risk (IRR 75; 95% CI 51-109). The proportion of migrants with pulmonary TB was 52.4%. All migrant groups experienced an initial high TB risk, but long-term risk remained high in key migrant groups. Most European countries focus TB screening on or soon after arrival. Our study suggests that approaches to TB screening should be adapted, with migrant populations benefiting from long-term access to preventive health services.

PSA Testing and Prostate Cancer Incidence Following the 2012 Update to the U.S. Preventive Services Task Force Prostate Cancer Screening Recommendation: Implications for Racial/Ethnic Disparities

Abstract The 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against prostate specific antigen (PSA) testing led to a decrease in prostate cancer screening, but its impact on prostate cancer racial/ethnic disparities remains unclear. Methods: The proportion of men ages 40–74 years who received a routine PSA test in the past year was estimated over time in the Behavioral Risk Factor Surveillance System (BRFSS; 2012–2018) and the National Health Interview Survey (NHIS; 2005–2018). Screening trends by race/ethnicity were evaluated using logistic regression models to estimate odds ratios (ORs) of screening adjusting for socioeconomic and healthcare-related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race/ethnicity were estimated in the Surveillance, Epidemiology and End Results (SEER) registry data over time (2004–2016). Results: In the 2012 BRFSS, PSA testing rates were highest among non-Hispanic white (NHW) men (32.3%), followed by non-Hispanic black (NHB; 30.3%), Hispanic (21.8%), and Asian/Pacific Islander men (17.7%). The absolute screening frequency declined by 9.5% overall from 2012 to 2018, with a greater decline among NHB (11.6%) than NHW men (9.3%). Adjusting for socioeconomic and healthcare-related factors, the relative decline was greater among NHB (OR per year = 0.86, 95% CI 0.84–0.88) than NHW men (OR = 0.89, 95% CI 0.89–0.90; p-het. = 0.005), driven by a steeper drop among NHB men ages 40–54. In the NHIS, the 2012 update was associated with a 35% decrease in the odds of screening (OR = 0.65, 95% CI 0.51–0.82), though there was no annual change since 2012 (OR = 1.00, 95% CI 0.98–1.03). Trends in the NHIS did not differ by race/ethnicity. The NHB:NHW IRR for total prostate cancer increased from 1.73 in 2011 to 1.87 in 2012 and has remained elevated, driven by differences in the incidence of localized tumors. Disparity IRRs have been consistent since 2012 for other racial/ethnic populations. Conclusions: Although the frequency of prostate cancer screening varies by race/ethnicity, the impact of the 2012 USPSTF recommendation against PSA testing on screening trends did not robustly differ by race/ethnicity. Following 2012, there was a modest increase in the disparity for localized prostate cancer incidence between NHB and NHW men.

Evaluation of racial disparities in pediatric optic pathway glioma incidence: Results from the Surveillance, Epidemiology, and End Results Program, 2000–2014

BackgroundRacial predilection to pediatric cancer exists; however optic pathway glioma (OPG) risk differences by race/ethnicity are undefined. We estimated differences in OPG incidence across racial/ethnic groups in a multi-state cancer surveillance registry in the United States. MethodsOPG data were obtained from the Surveillance, Epidemiology, and End Results (SEER-18) Program, 2000–2014. Race/ethnicity was categorized as: White; Black; Asian; Other; and Latino/a (“Spanish-Hispanic-Latino”). Latino/a included all races, while all other categories excluded those identified as Latino/a. Age-adjusted incidence rates and rate ratios (IRR) with 95% confidence intervals (CIs) were generated in SEER-STAT (v8.3.4). ResultsData on 709 OPG cases ages 0–19 were abstracted from SEER-18. Minority children experienced lower age-adjusted OPG incidence rates compared to White children (IRRBlack = 0.38, 95% CI: 0.28–0.50; IRRAsian = 0.41, 95% CI: 0.29–0.58; and IRRLatino/a = 0.39, 95% CI: 0.32–0.48). In subgroup analyses among the highest risk age categories (0–4, 5–9), minority children experienced lower incidence rates compared to White children. Specific patterns for Latinos/as also emerged. Latino/a children ages 0–4 experienced the lowest incidence rates of all racial/ethnic groups compared to Whites (0.24 per 100,000 person-years versus 0.66 per 100,000 person-years, respectively), whereas among those ages 5–9, Black and Asian children experienced the lowest incidence rates (0.08 per 100,000 person-years each). ConclusionsIncidence of OPGs was highest among White children. This study represents one of the largest to assess differences in OPG susceptibility by race/ethnicity. These findings may inform future studies that seek to evaluate modifying factors for this pediatric tumor including tumorigenesis, treatment, outcome, and long-term late effects.

Evaluating 17 years of latent tuberculosis infection screening in north-west England: a retrospective cohort studyofreactivation.

Approximately 72% of tuberculosis (TB) cases in England occur among non-UK born individuals, mostly as a result of reactivation of latent TB infection (LTBI). Programmatic LTBI screening is a key intervention of the TB strategy for England. This article reviews the results of a long-standing LTBI screening initiative in England.A retrospective cohort was created through probabilistic linkage between LTBI screening data and national TB case notifications. Screened persons were followed until they died, became a case, emigrated or until cohort-end. TB incidence rates and rate ratios (IRR) were calculated.97 out of 1820 individuals screened for LTBI were reported to have active TB. Crude incidence rates among LTBI-positive, treatment-naïve individuals were 4.1 and 2.3 per 100 person-years in the QuantiFERON and tuberculin skin test cohorts, respectively. Among the QuantiFERON cohort, Poisson regression showed that LTBI positivity (IRR 22.6, 95% CI 6.8–74.6) and no chemoprophylaxis increased the probability of becoming a TB case (IRR 0.17, 95% CI 0.05–0.6).We found high TB rates in LTBI-positive, treatment-naïve individuals and a strong association between no treatment and becoming a TB case, demonstrating feasibility and effectiveness of LTBI screening and providing important policy lessons for LTBI screening in England and beyond.

Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data.

Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity recording across hospitals would enhance accuracy of datasets and validity of case-mix adjustment.

Schizophrenia and other psychotic disorders in Caribbean-born migrants and their descendants in England: systematic review and meta-analysis of incidence rates, 1950-2013.

PurposeIncreased risk of schizophrenia and other psychotic disorders among black Caribbean migrants and their descendants have been described since the 1960s. It remains unclear whether this risk varies over time, between rural and urban areas, or according to methodological artefact.MethodsWe conducted a systematic review of the incidence of adult-onset psychotic disorders in black Caribbean groups relative to the baseline population in England, published 1950–2013. Subject to sufficient data (N ≥ 5) we used random effects meta-analyses to estimate pooled incidence rates (IR) and rate ratios (IRR) of seven psychotic disorder outcomes, and meta-regression to inspect whether any variation was attributable to study-level methodological features, including case ascertainment, denominator reliability, choice of baseline population and study quality.ResultsEighteen studies met inclusion for review. Sixteen demonstrated statistically significant elevated incidence rates in the black Caribbean group, present across all major psychotic disorders, including schizophrenia and bipolar disorder. Methodological quality increased over time (p = 0.01), but was not associated with estimated IR or IRR. For schizophrenia (N = 11 studies) the pooled IRR in the black Caribbean group was 4.7 (95 % CI 3.9–5.7) relative to the baseline; no evidence of publication bias was observed. We found weak evidence to suggest schizophrenia IRRs were smaller from studies in more urban settings (odds ratio 0.98; 95 % CI 0.96–1.00; p = 0.06).ConclusionsHigher incidence rates of psychotic disorders have been present for more than 60 years amongst black Caribbean ethnic groups in England, despite improved study methodologies over time. Aetiological explanations appear to more parsimoniously account for this excess than methodological biases.Electronic supplementary materialThe online version of this article (doi:10.1007/s00127-015-1021-6) contains supplementary material, which is available to authorized users.

Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

ObjectivesDespite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore...

Longer duration of combination antiretroviral therapy reduces the risk of Hodgkin lymphoma: A cohort study of HIV-infected male veterans

BackgroundHodgkin lymphoma (HL) incidence has increased since combined antiretroviral therapy (cART) introduction. It is unclear how different cART classes (e.g., protease inhibitors (PI), non-nucleoside reverse transcription inhibitors (NNRTI)) influence HL. This study aimed to determine the effects of cART duration on HL incidence among HIV-infected veterans. MethodsWe performed a retrospective cohort study utilizing the Veterans Affairs HIV Clinical Case Registry (1985–2010). HL cases were identified using ICD-9 codes (201.4-9). cART, PI, and NNRTI duration was the aggregate number of treatment days delivered. Incidence rates (IR) and rate ratios (IRR) were calculated from Poisson regression models to examine the effects of cART duration on HL. Results31,576 cART users contributed 288,736 person-years (PY) and 211 HL cases (IR=7.3/10,000 person-years). HL incidence decreased from 25.1/10,000 PY (95%CI=18.9–33.4) within the first year of cART to 0.6/10,000 PY (95%CI=0.3–1.6) after ≥10 years. In multivariable models, each additional year of cART was associated with decreased HL incidence (IRR=0.80; 95%CI=0.75–0.86); similar effects were observed in models assessing HL incidence by PI and NNRTI. ConclusionOur findings indicate long-term cART of any class is associated with decreased HL risk. High HL incidence directly following cART initiation supports a potential immune reconstitution mechanism in HIV-related HL. Further research is needed to evaluate the interaction between early cART, immune reconstitution, and HL.

Disparities in Liver Cancer Incidence by Nativity, Acculturation, and Socioeconomic Status in California Hispanics and Asians

Asians and Hispanics have the highest incidence rates of liver cancer in the United States, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring. Incidence rates and rate ratios (IRR) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988-2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 U.S. Census data for cases diagnosed in 1998-2002. Foreign-born Hispanic males had significantly lower liver cancer incidence rates than U.S.-born Hispanic males in 1988-2004 (e.g., IRR = 0.54, 95% confidence interval [CI] = 0.50-0.59 in 1997-2004), whereas foreign-born Hispanic females had significantly higher rates in 1988-1996 (IRR = 1.42, 95% CI = 1.18-1.71), but not 1997-2004. Foreign-born Asian males and females had up to 5-fold higher rates than the U.S.-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates. Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention. Liver cancer control efforts should especially target foreign-born Asians, U.S.-born Hispanic men, and residents of lower-SES ethnic enclaves.

Cancer risk in patients with inflammatory bowel disease: a population-based study.

The objective of the current study was to determine the incidence of cancer among persons with inflammatory bowel disease (IBD) and to compare these incidence rates with those of the non-IBD population using population-based data from the administrative claims data of Manitoba's universal provincial insurance plan (Manitoba Health). IBD patients were matched 1:10 to randomly selected members of the population without IBD based on year, age, gender, and postal area of residence. The incidence of cancer was determined by linking records from the IBD and non-IBD cohorts with the comprehensive Cancer Care Manitoba registry. Incidence rates and rate ratios (IRR) were calculated based on person-years of follow-up (Crohn's disease = 21,340 person-years and ulcerative colitis [UC] = 19,665 person-years) for 1984-1997. There was an increased IRR of colon carcinoma for both Crohn disease patients (2.64; 95% confidence interval [95% CI], 1.69-4.12) and UC patients (2.75; 95% CI, 1.91-3.97). There was an increased IRR of rectal carcinoma only among patients with UC (1.90; 95% CI, 1.05-3.43) and an increased IRR of carcinoma of the small intestine only in Crohn disease patients (17.4; 95% CI, 4.16-72.9). An increased IRR of extraintestinal tumors was observed only for the liver and biliary tract in both Crohn disease patients (5.22; 95% CI, 0.96-28.5) and UC patients (3.96; 95% CI, 1.05-14.9). There was an increased IRR of lymphoma for males with Crohn disease only (3.63; 95% CI, 1.53-8.62), and this finding did not appear to be related to use of immunomodulatory therapy. Compared with controls, Crohn's disease was associated with an increased risk of cancer overall, but UC was not. There appear to be similar increased risks for developing colon carcinoma and hepatobiliary carcinoma among patients with Crohn disease and UC. There is an increased risk of developing rectal carcinoma in UC patients, an increased risk of developing carcinoma of the small bowel in Crohn disease patients, and an increased risk of developing lymphoma among males with Crohn disease.