Mean Incidence Rate Research Articles

Occurrence of Idiopathic Pulmonary Fibrosis in Italy: Latest Evidence from Real-World Data.

The aim of the study was to evaluate the trend in the incidence of idiopathic pulmonary fibrosis (IPF) in a real-world setting of the Marche region, a region of Central Italy, between 2014 and 2019. This observational prospective study was based on administrative databases of hospital discharges and drug prescriptions. All adult residents in the Marche Region with a first prescription of antifibrotic drugs, or a first hospitalization with a diagnosis of IPF during the study period, were identified as incident cases of IPF. A multiple Poisson regression analysis was used to estimate the IPF incidence trend, adjusted for age, sex, and health conditions. The mean incidence rate was 9.8 cases per 100,000 person-years. A significant increasing trend of 6% per year was observed. The incidence rates were significantly higher in males than females, older subjects, and those with poorer health conditions. To our knowledge, this is the first study evaluating incidences of IPF over a 6-year period in Italy, combining hospital discharge and drug prescription databases. The study highlights that the combined use of two secondary sources is a reliable strategy to accurately identify new cases of IPF when the appropriate disease registry is lacking.

Total, gender- and age-specific incidence rates of upper extremity nerve injuries in Finland.

The aim of this study was to describe the epidemiology of nerve injuries of the upper extremity in the whole population of Finland (1998-2016). Data based on diagnosis codes were obtained from the Care Register for Health Care, including cases of median, radial, ulnar, musculocutaneous, axillary and digital nerves. Age- and gender-specific incidence rates, both crude and standardized (for the European normal population in 2011), were calculated. Our study included 13,440 patients with upper extremity nerve injury. The mean standardized annual incidence rate of any upper extremity nerve injury was 18.18 among men and 8.15 among women per 100,000 person-years over the study period. The incidence peaked among men at working age. Nerve injuries occurred most commonly in the fingers and thumb, with 5532 cases and mean standardized incidence rates per 100,000 person-years of 7.84 among men and 2.95 among women. The annual incidence did not change significantly over the study period.Level of evidence: III.

Trends in the Surgical Incidence of Cystic Echinococcosis in Uzbekistan from 2011 to 2018.

Cystic echinococcosis (CE) is a zoonosis with a cosmopolitan distribution caused by Echinococcus granulosus sensu lato tapeworms. Although Uzbekistan and other countries in Central Asia are considered endemic, estimates of disease burden are lacking. We present data regarding surgically managed cases of CE obtained from Uzbekistan's national disease surveillance registry. These data are from medical centers in Uzbekistan authorized to treat the disease and reported to the Uzbek Center for Sanitation and Epidemiology from the period 2011 to 2018. Information included patient age class (children 14 years or younger versus adults 15 years and older), but no data regarding cyst location. Incidence rates were calculated using data from the national population registry, and the Cuzick nonparametric test for trends was used to test for differences in the incidence over time at the country and regional levels. A total of 7,309 CE cases were reported. Of these, 857 (11.73%) involved pediatric patients. The mean incidence rates were 4.4 per 100,000 population in 2011 and 2.3 per 100,000 population in 2018 (P = 0.016). One region (Republic of Karalpakistan) showed a nonstatistically significant increase (P = 0.824). All other regions except three showed a statistically significant decrease. We present data showing a decrease in the overall incidence of surgically treated CE in Uzbekistan from 2011 to 2018. However, the presence of cases involving children suggests ongoing parasite transmission. The absence of clinical information (starting with cyst stage and localization) needs to be addressed to improve the national surveillance system. Field studies are also needed to further explore the epidemiology of CE in the country.

Incidence and Prevalence of Rare Forms of Anemia in Children of Orel Region

Background. Anemia affects one third of the world's population. Many scientific publications are devoted to anemia. Side issues of morbidity and prevalence of rare forms of anemia (RFA) and severe iron deficiency anemia (IDA) in children are not sufficiently covered due to difficulties with its assessment.Objective. The aim of the study is to study incidence and prevalence of severe IDA and RFA among children of Orel.Materials and methods. Cohort epidemiological study of primary blood system diseases in children aged from 5 days to 18 years was conducted based on the only children's department of hematology in Orel region. Inclusion of new patients and event fixation (recovery, death, relapse, loss for observation) were performed prospectively. According to the obtained data, incidence and prevalence rates were calculated. Follow-up duration was 1–5 years.Results. 175 novel cases of blood diseases were recorded over 5 years. 160 were subject for analysis, including 28 cases of severe IDA and 27 cases of RFA. The mean incidence rate of severe IDA was almost equal to its prevalence and was 4.1 (standard deviation (SD) = 1.5), RFA — 4.0 (SD = 2.1) per 100,000 of children population. Mean incidence rate of hereditary spherocytosis was 1.48 (SD = 2.1), megaloblastic anemia (V12-DA) — 0.74 (SD = 0.90) acquired aplastic anemia (AA) — 0.59 (SD = 0.81), beta-thalassemia — 0.45 (SD = 0.66), autoimmune hemolytic anemia (AIHA) — 0.44 (SD = 0.66), congenital АА — 0.30 (SD = 066) per 100,000 of children population.Conclusion. The incidence and prevalence of severe IDA and RFA among children of Orel region is comparable to the world literature data. The incidence rate of children with megaloblastic anemia was calculated for the first time.

Myocarditis after RNA-based vaccines for coronavirus.

BackgroundThe incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest. MethodsWe performed an intention-to-treat meta-analysis, following the PRISMA statement. After a systematic search, without language restriction, 9 publications were selected. Two were excluded (one was only in subjects with age 12–17 and other might had included subjects from a larger publication). We followed the PRISMA guidelines for abstracting data and assessing data quality and validity. Data was verified by 2 investigators. ResultsWe analyzed 17,704,413 subjects, from 7 studies, that included 627 cases of confirmed myocarditis). The incidence of myocarditis was 0.0035% (95% CI 0.0034–0.0035). Mean incidence rate was 10.69 per 100.000 persons-year. Cases reported from Israel represented 45.14% from total (283 out of the 627). Only 1 case of fatal myocarditis or death was reported. There was significant heterogeneity between results. The meta-regression analysis excluded mean age, region, number of cases or number of people included as sources of heterogeneity. No small-study effect was observed (p = 0.19). Conclusions and relevanceMyocarditis incidence after RNA vaccines is very rare (0.0035%) and has a very favorable clinical course.

P640 Incidence, prevalence, disease phenotype and maximal therapeutic step in Crohn’s disease patients in Western Hungary – a population-based study between 2007–2018, data from the Veszprem county cohort

Abstract Background The number of epidemiological population-based studies are still limited from Eastern Europe. The present study is a continuation of the Veszprem IBD population based cohort with a follow-up of the incidence and disease course of IBD since 1977. Our aim was to analyze the incidence and disease phenotype at diagnosis, and the maximal therapeutic step distributions during follow-up in a prospective population-based database from Veszprem Province, including incident Crohn’s disease (CD) patients diagnosed between January 1, 2007 and December 31, 2018. Methods Data of 421 incident CD patients were analyzed (male/female: 237/184; median age at diagnosis: 29 years(y) [IQR: 21–42]). Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. The source of age- and gender-specific demographic data was derived from the national population census in 2011. Results Adjusted mean incidence rate was 9.94(CI95%: 9.0–10.9)/105 person-years in this 12 year period[males:11.5(CI95%:10.2–13.2)/105; females:8.4(CI95%:7.3–9.7)/105]. Prevalence rate was 191.18(CI95%:177.0–205.7)/105 persons in 2011 and 236.78(CI95%:220.8–252.8) in 2015. For detailed annual incidence rates and age-specific mean incidence rates see Figure1 and 2. Peak onset age in CD was 20–29 years of age. Diagnostic delay from symptom onset was ≥1year in 26.6%, and ≥3 years in 10% of the patients. Disease location was ileal(L1) in 29.7%, colonic(L2) in 24.5%, and ileo-colonic(L3) in 45.8% at diagnosis. Upper gastrointestinal manifestation or perianal disease were present in 7.6% and 13.5%. Disease behavior at diagnosis was luminal(B1) in 62.5%, stenosing(B2) in 17.6%, penetrating(B3) in 16.4%, and B2+B3 in 3.6%. Patients with ileocolonic disease were younger (29.2y,SD:14.6) at diagnosis compared to patients with ileal(35.7y,SD:15.5;p<0.001) or colonic disease(37.7y;SD:18.1;p<0.001). Extraintestinal manifestations were as follows: hepatic5.0%(PSC 1.9%), arthritis13.8%, ocular1.7%, cutan4.3%. Active smokers at diagnosis were 35.4%. Distribution of maximal therapeutic steps during the course of follow-up (8.53y,SD: 3.3) were 5-ASA in 15.7%, systemic corticosteroids in 14.3%, immunosuppressive therapy in 42.5%; anti-TNF biologic therapy in 23.3% and other biologic therapy in 2.9%. Conclusion The incidence of CD in this 12 year period was high, comparable to high-incidence areas in Western European countries, and comparable to previous data from the Veszprem cohort, while prevalence rates continue to rise.(Lakatos 2011, IBD). Ileocolonic location and penetrating disease behavior were somewhat higher compared to previous population-based data from Western Europe.(Burisch 2018, JCC).

P635 Incidence, prevalence, disease phenotype and maximal therapeutic step in Ulcerative Colitis patients in Western Hungary – a population-based study between 2007–2018, data from the Veszprem County cohort

Abstract Background Recent trends indicate a change in the epidemiology of inflammatory bowel disease (IBD) with previously low incidence areas now reporting progressive rise. The number of epidemiological population-based studies are still limited from Eastern Europe. The present study is a continuation of the Veszprem IBD population-based cohort with a follow-up of the incidence and disease course of IBD since 1977. Our aim was to analyze the incidence and disease phenotype at diagnosis, and the maximal therapeutic step distributions during follow-up in a prospective population-based database from Veszprem Province, including incident ulcerative colitis (UC) patients diagnosed between January 1, 2007 and December 31, 2018. Methods Data of 467 incident UC patients were analyzed (male/female:236/231; median age at diagnosis:36 years(y)[IQR: 25–54]). Both in-hospital and outpatient records were collected and comprehensively reviewed at diagnosis and during clinical follow-up. The source of age- and gender-specific demographic data for statistical analysis was derived from the results of a national population census in 2011. Results Adjusted mean incidence rate was 11.02(CI95%:10.1–12.1)/105 person-years in this 12 year period[males:11.53(CI95%:10.2–13.1)/105; females:10.54(CI95%:9.3–12.0)/105]. Prevalence rate was 283.51(CI95%:265.7–300.7)/105 persons in 2011 and 317.79(CI95%:298.8–335.8) in 2015. For detailed annual incidence rates and age-specific mean incidence rates see Figure 1 and 2. Peak onset age in UC was 20–29 years of age. Diagnostic delay from symptom onset was ≥1year in 19.1%, and ≥3 years in 4.1% of the patients. Disease extension was proctitis(E1) in 22.3%, left sided colitis(E2) in 43.9%, and extensive colitis(E3) in 33.8% of the patients at diagnosis. Patients with extensive colitis were younger(32.9y,SD:16.6) at diagnosis compared to patients with proctitis(40.1y,SD:15.9;p<0.001) or left sided colitis(44.0y;SD:19.1;p<0.001). Extraintestinal manifestations were as follows: hepatic5.4%(PSC 2.1%), arthritis10.7%, ocular0.9%, skin3.6%. Active smokers at diagnosis were 12.6%. Distribution of maximal therapeutic steps during the course of follow-up (8.34y,SD: 3.5) were 5-ASA in 46.9%, systemic corticosteroids in 16.3%, immunosuppressive therapy in 19.3%; anti-TNF biologic therapy in 12.2% and other biologic therapy in 4.3%. Conclusion The incidence of UC in this 12 year period was high, comparable to high-incidence areas in Western European countries, and comparable to previous data from the Veszprem cohort, while prevalence rates continue to rise compared to our previous data.(Lakatos 2011, IBD). Disease extension at diagnosis and distribution of highest treatment step was comparable to European population-based data.(Burisch 2019, JCC).

Incidence, Demographic, and Seasonal Risk Factors of Infections Caused by Five Major Enteric Pathogens, Ontario, Canada, 2010-2017.

In Canada, enteric infections cause significant health and economic burden. We evaluated the individual characteristics of laboratory-confirmed cases of Campylobacter spp. (n = 28,728), non-typhoidal Salmonella spp. (n = 22,640), Yersinia spp. (n = 1674), Verotoxin-producing Escherichia coli (VTEC; n = 1340), and Listeria monocytogenes (n = 471), reported between 2010 and 2017 inclusive, in Ontario, Canada (population ∼13,500,000). We calculated overall and pathogen-specific annual and mean incidence rates (IRs) for Ontario. We used multivariable Poisson and negative binomial regression models to estimate incidence rate ratios (IRRs) for years, seasons, age groups, and sexes, and we included two-way age and sex interaction terms in the models. Campylobacter and Salmonella infections had the highest IRs whereas Listeria infections had the lowest IRs. None of the infections showed long-term trends over the 8-year study period; however, rates of all five infections were elevated in the summer. More Salmonella, VTEC, and Listeria infections were linked to disease outbreaks than were Campylobacter and Yersinia infections. Overall, mean IRs of Campylobacter, Salmonella, Yersinia, and VTEC infections were highest in children 0-4 years old, whereas Listeria IRs peaked in adults 60 years and older. Higher mean IRs of Campylobacter were observed in males. No other differences by sex were statistically significant. The same mean rate was observed in both sexes for Listeria. Adjusting for all other factors, significant age- and sex-specific differences in IRs were observed in Campylobacter, Salmonella, and VTEC infection rates. No significant interactions of age and sex were found for Yersinia and Listeria infections. Future research should focus on the pathogen-specific socioeconomic, environmental, or agricultural risk factors that might be responsible for these infections.

Impact of treatment with immunomodulators and tumour necrosis factor antagonists on the incidence of infectious events in patients with inflammatory bowel disease.

BackgroundCorticosteroids, immunomodulators (IM) and tumour necrosis factor antagonists (anti-TNF) are commonly used in the treatment of inflammatory bowel disease (IBD) but they also supress the defence against infectious disease. The aim of this study was to analyse the incidence of infectious events in patients with IBD and the association to concomitant medical therapy.MethodsWe performed a retrospective medical chart review of patients with IBD aged 18–65 years included in the Swedish Registry of Inflammatory Bowel Disease in the catchment area of Umeå University Hospital, Sweden. Data were collected from the period 01 January 2006, to 31 January 2019. An infectious event was defined as an outpatient prescription of antimicrobials or a positive diagnostic test for infection.ResultsDuring a period of 5,120 observation-years, we observed 1,394 events in 593 patients. The mean number of infectious events per 100 person-years was 27.2 (standard deviation [SD]: 0.46). There were no differences in mean incidence rates between patients treated with no immunosuppression (23.0 events per 100 person-years, SD: 50.4), patients treated with IM monotherapy (27.6 events per 100 person-years, SD: 49.9), patients treated with anti-TNF monotherapy (34.3 events per 100 person-years, SD: 50.1) and patients on combination therapy (22.5 events per 100-person-years, SD: 44.2). In a multivariate logistic regression, female gender (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI]: 1.49–3.37) and combination therapy (AOR: 3.46; 95% CI: 1.52–7.85) were associated with higher risks of infection (>32 events per 100 person years). Also, patients treated with any immunosuppression treatment for 25–75% (AOR: 2.29; 95% CI: 1.21–4.34) and for >75% (AOR: 1.93; 95% CI: 1.19–3.12) of the observation period were at higher risks compared to patients treated with immunosuppression <25% of the observation period.ConclusionWe observed no significant difference in risk for infections between patients on monotherapy with IM or anti-TNF and patients with low use of immunosuppression, but there was a significant risk for combination therapy.

Incidence of systemic autoimmune myopathies and their risk of cancer in Leeds, UK: an 11-year epidemiological study.

ObjectivesThe aims were to identify all incident adult cases of systemic autoimmune myopathies (SAMs) in the city of Leeds, UK, and to estimate the risk of cancer in SAMs as compared with the general population.MethodsCases of SAMs were ascertained by review of all muscle biopsy reports from the Neuropathology Laboratory. A review of medical records was undertaken for each case to review the clinical diagnosis and collect epidemiological data such as age, ethnicity, sex and comorbidities, including cancer. Leeds denominator population numbers were publicly obtainable.ResultsA total of 206 biopsy reports were identified and, after review, 50 incident cases were included in the study between June 2010 and January 2021. Of the 50 cases, 27 were male and 23 were female. The mean incidence rate of SAMs in Leeds throughout the study period was 7.42/1 000 000 person-years. The proportion of SAMs cases with a confirmed malignancy was 22%. Compared with the general population, the relative risk of cancer was significantly greater in the SAMs population (31.56; P < 0.01).ConclusionsThe incidence rate of SAMs in Leeds was consistent with data from previous literature; however, disagreement exists between different methods of SAMs case inclusion due to varying clinical criteria and definitions. SAMs are associated with an increased risk of cancer, but the pathogenesis of this relationship still requires investigating. This study supports the practice of malignancy screening and long-term surveillance in patients with SAMs.

Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor: Results from a systematic review and meta-analysis.

BackgroundIn patients with newly diagnosed glioblastoma, rapid early progression (REP) refers to tumor regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised previously published data on REP to better characterize and understand it.MethodsSystematic searches of MEDLINE, EMBASE and the Cochrane database from inception to October 21, 2021. Studies describing the incidence of REP—tumor growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly diagnosed glioblastoma were included. The primary outcome was REP incidence.ResultsFrom 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0–58.8 y). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1–1.5). The median number of days between MRI scans was 34 days (IQR 18–45 days). The mean incidence rate of REP was 45.9% (range 19.3%–72.0%) and significantly lower in studies employing functional imaging to define REP (P < .001). REP/non-REP groups were comparable with respect to age (P = .99), gender (P = .33) and time between scans (P = .81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30–2.43, P < .001), shortened progression-free survival (HR 1.78, 95% CI 1.30–2.43, P < .001), subtotal resection (OR 6.96, 95% CI 4.51–10.73, P < .001) and IDH wild-type versus mutant tumors (OR 0.20, 95% CI 0.02–0.38, P = .03). MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72–2.28, P = .39).ConclusionsREP occurs in almost half of patients with newly diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.

Incidence and Risk Factors of Dry Eye in Children and Adolescents With Diabetes Mellitus: A 3-Year Follow-Up Study.

Purpose: To investigate the incidence and risk factors of dry eye in children with diabetes mellitus (DM) over a period of 3 years.Methods: Children and adolescents with DM (age: 3–14 years) from the Shanghai Children and Adolescent Diabetes Eye (SCADE) study cohort who did not have dry eye in January 2018 were followed-up for 3 years and re-examined in January 2021, and the incidence rate and risk factors for dry eye were calculated.Results: Forty children and adolescents with DM came for follow-up in 2021. Nine of them were diagnosed with dry eye, resulting in a 3-year incidence rate of 22.5% and an annual mean incidence rate of 7.5% for dry eye. Univariate regression analysis confirmed that decreased corneal sensation (OR [Odds Ratio] = 25.60; 95%CI [Confidence Interval] = 1.31~501.69; P = 0.03) was the risk factor for dry eye incidence. Long course of DM (OR = 1.80; 95%CI = 0.96~3.38; P = 0.07), eye pain (OR = 12.27; 95%CI = 0.65~231.48; P = 0.09), and dry eye in parents (OR = 15.99; 95%CI = 0.76~337.75; P = 0.08) may interfere with the incidence of dry eye in them.Conclusions: The incidence of dry eye in children and adolescents with DM is high.

Radiotherapy Deserts: Impact of Race, Poverty and the Rural-Urban Continuum on Density of Radiation Oncologists in the United States

In the landmark work of Bates et al. (2020), per capita distribution of radiation oncologists was strongly linked to rural-urban continuum status. To build on this effort and further isolate resource-poor "radiotherapy deserts," we investigated associations between physician density and rural-urban continuum status, race, poverty, & prostate (PC) and invasive breast (BC) cancer metrics at the county level.We created an ecologic study model using data from US HRSA Area Health Resources Files, USDA Economic Research Service, and the AMA Physician Masterfile. The NIH Cancer State Profiles provided cancer-specific incidence and death rates per county. Physician to person at risk (PPR) density was defined as the number of attending-level radiation oncologists per 100,000 persons at risk (males and females ≥ 35 years for PC and BC, respectively). Uni- and multivariable regressions evaluated relationships between PPR density and race, percent poverty, and metro (vs. nonmetro) status per rural-urban continuum definitions. Logistic regression tested links between > 2 standard deviations (2SD) above mean cancer-specific incidence & death rates and PPR density, race, & metro status. Reported statistics are P < .05.Mean PPR density is 2.1 (SD 5.9) for PC and 1.9 (SD 5.3) for BC. Univariable analyses show higher PPR density is significantly associated with metro status (β coefficients 2.9 and 2.6), lower %poverty (both -.1), lower %White (-1.4 and -1.3) and higher %Black (2.5 and 2.2) for PC and BC, respectively. The table below shows β coefficients for PPR density on racial distribution by metro status, controlling for %poverty. For both PC and BC, lower %White and higher %Black race are associated with higher PPR density in metro but not nonmetro counties. This pattern may be due to higher %Black concentration in metro counties with the largest populations, which may be linked to nominal resource density. Such an association is absent in nonmetro counties. For PC and BC, respectively, mean (SD) incidence rate is 102.4 (25.6) and 120 (20.1), and death rate is 20.8 (6) and 21.4 (4.8). For PC, higher odds of > 2SD death rate but not incidence is tied to lower PPR density (odds ratio .9), whereas for BC, higher odds of both are associated with lower PPR density (.8 and .9, respectively). For both BC and PC, higher odds of these cancer metrics are also linked to higher %Black or nonmetro status.Radiation oncology PPR density is intricately linked to counties' rural-urban status, poverty rate, and racial distributions. Inverse relationships between PPR density and PC & BC incidence or death rates reveal mismatch in distributions between resources and need, particularly when considering race and nonmetro status. Interactive density maps at bit.ly/density maps show "radiotherapy deserts" for targeting interventions.

Is it justified to remove the intermediate risk group in the latest European guidelines for NSTEACS?

Abstract Background Risk stratification in patients with non-ST elevation acute coronary syndrome (NSTEACS), becomes a priority after its diagnosis, due to the fact that it gives us information about prognosis and has crucial implications. The latest guidelines of European Society of Cardiology (ESC) suggest a new proposal of risk stratification dividing patients in three different groups: “low”, “high” and “very high risk”. Thus, they remove the intermediate risk group that defended the previous guidelines (2015). Purpose Our aim was to identify an intermediate risk group following the recommendations of the previous guidelines about risk stratification. We believe that the risk stratification in four groups if more accurate that the latest proposed in 2020 in three groups, because the “intermediate risk group” has a different prognosis that the subgroup nowadays considered “low risk”. Methods We included a cohort of 7 597 patients with NSTEACS admitted in two different Cardiology departments between 2003 and 2017 with 4,4±2,7 mean years of follow-up. Subsequently, a classification of the patients in four different risk groups was made following the 2015 guidelines and events during follow-up was assigned in the next categories:first adverse major cardiovascular event (MACE),all-cause mortality and cardiovascular mortality. Results Stratified analysis brought up that patients included in the intermediate risk group, had a different prognosis to the categories of “low” and “high risk” patients and we obtained the following results: Mean incidence rate for total mortality measured in cases per 100 person-year [confidence interval (CI 95%)] was 1.96; for “low risk” patients CI95% 1.30–2.95, “intermediate risk” 3.91; (CI95% 3.28–4.57), “high risk” 4.94; CI95% 4.87–5.21 and “very high risk” 8.74; CI95% 7.75- 9.85. Incidence rate for cardiovascular mortality for “low”, “intermediate”, “high” and “very high” was 1.02; (CI95% 0.58–1.18); 2.64 (CI95% 2.13–3.26); 3.32 (CI95% 3.11–3.55) and 6.71 (CI95% 4.84–7.69), respectively. Using Cox analysis, the “intermediate risk group” (refference), still achieved statistical significance. Results expressed in hazard ratio demonstrated that: Conclusion These findings suggest that the four categories proposal could have better ability for risk stratification in NSTEACS patients and make us doubt about the new three groups classification displayed in the current ESC guidelines, particularly the “intermediate risk” group exclusion that would be reassessed as “low risk”. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): No funding sources.

Epidemiological aspects of visceral leishmaniasis in Brazil and in international border regions

Objectives: To verify the number of visceral leishmaniasis (VL) cases in Brazil and its states and twin cities, with a focus on the state and twin city with the highest number of cases. We investigated social, demographic, laboratory and clinical aspects of these cases. Methodological design: We performed a descriptive study using a quantitative approach and data from 2010 to 2019 that were obtained through a public domain website, the Informatics Department of the Unified Health System. The incidence rate of VL cases was calculated per 100,000 inhabitants. software. Results: In Brazil, 35,886 VL cases were reported, with 2,834 cases in international border states and 148 cases in twin cities. The state and twin city with the highest number of cases were Mato Grosso do Sul (1,834 cases) and Corumbá (94 cases), respectively, with annual mean incidence rates of 6.4 and 8.3 cases per 100,000 inhabitants. In Mato Grosso do Sul and Corumbá, the disease was more frequent in male and brown-skinned individuals who had up to 8 years of education (age range: 1 to &gt; 80 years old). Most of the cases occurred in urban areas, was diagnosed by laboratory tests and evolved to cure (p &lt; 0.05). Conclusions: A high number of VL cases in Brazil was found during the period of study. The cases were distributed in 10 states with international borders and eight twin cities. These findings draw attention to the greater need for management programs to control and prevent VL.

Decreasing Incidence of Estrogen Receptor-Negative Breast Cancer in the United States: Trends by Race and Region.

BackgroundIncidence of estrogen receptor (ER)-negative breast cancer, an aggressive subtype, is highest in US African American women and in Southern residents but has decreased overall since 1992. We assessed whether ER-negative breast cancer is decreasing in all age groups and cancer registries among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic White (HW) women.MethodsWe analyzed 17 Surveillance, Epidemiology, and End-Results (SEER) Program registries (12 for 1992-2016; 5 for 2000-2016) to assess NHW, NHB, and HW trends by ER status and age group (30-39 years, 40-49 years, 50-69 years, 70-84 years). We used hierarchical age-period-cohort models that account for sparse data, which improve estimates to quantify between-registry heterogeneity in mean incidence rates and age-adjusted trends vs SEER overall.ResultsOverall, ER-negative incidence was highest in NHB, then NHW and HW women, and decreased from 1992-2016 in each age group and racial or ethnic group. The greatest decrease was for HW women aged 40-49 years, with an annual percent change of –3.5%/y (95% credible interval = −4.4%, −2.7%) averaged over registries. The trend heterogeneity was statistically significant in every race or ethnic and age group. Furthermore, the incidence relative risks by race or ethnicity compared with the race-specific SEER average were also statistically significantly heterogeneous across the majority of registries and age groups (62 of 68 strata). The greatest heterogeneity was seen in HW women, followed by NHB women, and the least in NHW women.ConclusionsDecreasing ER-negative breast cancer incidence differs meaningfully by US region and age among NHB and HW women. Analytical studies including minority women from higher and lower incidence areas may provide insights into breast cancer racial disparities.

Evolution of the incidence of type 1 diabetes mellitus in the Community of Madrid, 1997–2016

IntroductionThe objective of this article was to estimate the type 1 diabetes mellitus (T1DM) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of T1DM. MethodsT1DM cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997−2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). ResultsA total of 2658 cases were identified as new diagnoses of T1DM. The mean incidence rate for 1997−2013 was 13.7 cases per 100 000 person-years. In the 2014−2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10−14 years in the two periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10–14 years in both periods (17.9 vs 30.4), and in girls, the age of 5–9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014−2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. ConclusionsThe CM is among the regions with a high incidence of T1DM. In its first phase, the regional registry underestimated the incidence of T1DM, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014−2016) are possibly closer to the actual incidence of T1DM. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records.

Estimating underreporting of leprosy in Brazil using a Bayesian approach.

BackgroundLeprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions.Methodology/Principal findingsUsing data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States.Conclusions/SignificanceThe magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission.

Ten years evaluation of epidemiology- and mortality-related factors in adults and children with Guillain-Barré syndrome in the north of Iran.

BackgroundGuillain-Barré syndrome (GBS) is the main cause of acute and subacute flaccid paralysis in western nations since the eradication of poliomyelitis.ObjectiveThe aim of this study is to investigate epidemiology and mortality characteristics of GBS in the north of Iran.Material and methodsIn this study, the hospital information system (HIS) was used to access each patient’s information. The final 174 cases were examined in terms of age, sex, place of residence, the year of referral, the month of referral, the season of referral, client city, accompanying background disease, and the type of GBS.ResultsThe mean incidence rate in Guilan province was about 0.69 in 100,000 persons, and the case fatality rate was 10.34%. The most reported type of GBS was AIDP (33.90%), and the most common symptom was upper and lower limbs paresis in 65 cases (37%). Respiratory distress (P = < 0.001), complications during hospitalization (P = 0.0001), and ICU requirement (P = 0.001) were significantly higher in dead patients.ConclusionIn this study, the incidence of GBS was higher in men than women and the highest number of cases was in the age group of 60 to 75 years. The significant point was the high-case fatality rate in Guilan province compared to the previous studies. The complications during hospitalization such as respiratory distress, ICU requirement, and underlying disease had a significant relation with the fatality of GBS.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10072-021-05562-y.

Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room

AimWe aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery. Materials and methodsThis was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ2 -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%. ResultsThe mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37–340.26), 3.96 (95% CI: 1.13–13.86), and 5.60 times (95% CI: 1.62–19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35–38.00) and 7.93 times (95% CI: 1.45–43.27) for<3 and ≥3 h’ duration, respectively. ConclusionThe difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.