Morbidity Ratio Research Articles

Age- and Sex-Related Differences in Morbidities of Sexually Transmitted Diseases in Children

Sexually transmitted diseases (STDs) are causes of public health burden globally. The purpose of this study is to document age-specific and sex-related changes in the morbidity of four representative STDs in children. Japanese national surveillance data from 1999 to 2017 on morbidities of the following four STDs were analyzed by age and sex: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), condylomata acuminate (CA), and genital herpes simplex virus (GHSV). The morbidities of males and females in each age group were compared through the male-to-female morbidity (MFM) ratios. The MFM ratios were not different from one in infants, less than one in children, and greater than one after puberty in all four STDs. The reversal of MFM ratio less than 1 to greater than 1 for NG infection was observed between 10–14 and 15–19 year of age, i.e., during the puberty, while that for GHSV infection was observed between 35–39 and 40–44 year of age, i.e., during adulthood. In conclusion, the morbidities of the four STDs were similar between the sexes in infants, and were higher in female children than in male children, while the morbidities in all four diseases were higher in men after puberty.

Mathematical Modelling of Spread COVID-19 Epidemic for Preventive Measures to Protect Life and Health of Elderly

Quantitative approaches based on mathematical modelling are used to justify a set of measures aimed at justifying a set of preventive measures to protect the life and health of older people in the context of COVID-19 pandemic. Analysis of the state of development of actuarial mathematical models of mortality in the COVID-19 epidemic shows the need to construct models that reflect the dynamics of the studied ratios of infection rates, morbidity, recovery and mortality in the dynamics of the pandemic, taking into account the influence of external factors on this process. Most of the known mathematical models for predicting the spread and consequences of COVID-19 are compartmental models that implement sequential transitions between states with the allocation of groups of individuals with different affiliation to the progression/decline of the spread of infection. To compensate for the shortcomings of the compartmental models due to the assumption of population homogeneity and the lack of adequate approaches to the scalability of the simulation results, models based on the Monte Carlo method and the concept of multi- agent systems are used. The development of modelling methods is associated with the need to expand information support for healthcare professionals and health care organizers with the possibility of online configuration of parameters of mathematical models and the use of data from 3/4 cloud services with visualization of the results of modelling.

Comparative Study between SOFA and qSOFA of Early Detection of Sepsis in Patients Admitted in Critical Care Unit

Introduction: The goal of Surviving sepsis campaign is to improve the patients’ outcome who suffers from sepsis that makes it vital to have defined policies and protocols to detect sepsis at the earliest and treat. The global burden of sepsis in relationship to mortality and morbidity ratio is increasing. But there is very minimal data about its occurrence in India. It is been estimated that more than 30 million people are affected by sepsis globally among which 6 million death happens every year. This triggers the need for early detection. There are various predictive tools used to detect sepsis and mortality. SOFA score one among them which is in use since 1994. qSOFA is also a predictive tool which was recommended by the Sepsis-3 consensus to be used as a predictor outside the ICU. Sepsis related mortality is more in India as compared with its western counterparts. The aim of the research is to compare and determine the predicting ability of the tools qSOFA and SOFA when used upon patients with suspected infection at Emergency department and critical care units in the setting of tertiary care teaching hospitals at Navi Mumbai. Methodology: The researcher conducted prospective observational non-experimental quantitative study on 100 patient samples. This study compared two tools to detect the effectiveness in predicting sepsis at the earliest. This study is conducted at Emergency department using qSOFA score and is conducted at critical care unit using SOFA criteria, at selected tertiary care teaching hospitals at Navi Mumbai. These institutions were selected for the study on the basis of ease in availability of the sample, researcher’s accessibility and familiarity with the institutions. The sensitivity and specificity of qSOFA and SOFA were assessed by area under the receiver operating curve (AUROC). The calculated sensitivity of qSOFA was 100%, with AUROC 0.70 (81.47% to 100% CI) and the specificity of qSOFA was 37.50%. The recorded sensitivity of SOFA was 95.45% with AUROC of 0.68 (77.16% to 99.88% CI). Results: In patients with suspected infection the AUROC of qSOFA in predicting sepsis was 0.70 (81.47% to 100% CI) with 100% sensitivity and 37.50% specificity in comparison to the AUROC of SOFA score which was 0.68 (81.47% to 100% CI) with 95.45% sensitivity and 39.29% specificity. The outcome was measured on the basis of patient shifted to ward, shifted to critical care unit and in hospital death. Conclusion: According to the observation made our study concludes that qSOFA has 100% sensitivity to detect sepsis at the earliest when applied on patients with suspected infection at emergency department in comparison to SOFA score when applied on patients with suspected infection at critical care units of tertiary care teaching hospital emergency department and critical care unit at Navi Mumbai. The researcher also found that the hurdle to the early detection is the signs and symptoms that are noticed during the normal course of infection leads to the increase of false positive. In spite of that the researcher found it is recommended to detect sepsis at the earliest with pre planned protocols utilizing effective tools and local healthcare policies as it is a global burden with a complex nature. Further research in this arena is highly recommended to generalize the findings. Keywords: Sepsis; qSOFA; SOFA; Predictive tools.

Analysis of Mortality and Morbidity in COVID-19 Patients with Obesity Using Clinical Epidemiological Data from the Korean Center for Disease Control & Prevention.

Previous studies have reported the association of obesity with increased morbidity or mortality due to the coronavirus disease 2019 (COVID-19). This study aims to investigate the relationship of obesity, as defined by the body mass index (BMI), with morbidity and mortality due to COVID-19. Data from 5628 confirmed COVID-19 patients were collected by the Centers for Disease Control and Prevention of Korea. The hazard ratios (HRs) for mortality in the BMI groups were analyzed using the Cox proportional hazard model adjusted for covariates. The odds ratios (ORs) of morbidity and diabetes in the BMI groups were analyzed using logistic regression adjusted for the same covariates. Both underweight and obesity were associated with a higher HR for mortality (adjusted HR = 2.28, 95% confidence intervals [95% CI] = 1.23–4.25, p = 0.009 for underweight and adjusted HR = 1.71, 95% CI = 1.10–2.66, p = 0.017 for obese). Obesity was related to higher odds of morbidity (adjusted OR = 1.71, 95% CI = 1.32–2.21, p < 0.001). Underweight and obesity were associated with high mortality and/or morbidity due to COVID-19 in Korea.

Increased Prevalence of Malignancies in Fibrous Dysplasia/McCune-Albright Syndrome (FD/MAS): Data from a National Referral Center and the Dutch National Pathology Registry (PALGA)

Malignant transformation of fibrous dysplasia lesions has been reported in patients with fibrous dysplasia/McCune-Albright syndrome (FD/MAS). Recently, we have observed an increased risk for breast cancer. In this study, the prevalence of skeletal and extraskeletal malignancies in patients with FD/MAS in the Netherlands was assessed by analyzing data from our cohort of FD/MAS patients, the Dutch Pathology Registry (PALGA), and the Netherlands Cancer Registry (NCR). We extracted data on sex, age at diagnosis of FD/MAS, type of FD/MAS, type of malignancy, and age at diagnosis of malignancy and histology of bone and malignant tissue when available, including GNAS-mutation analysis from patients' medical records. Standardized Morbidity Ratios (SMRs) with 95% confidence intervals were calculated. Twelve malignancies were identified in the LUMC FD/MAS cohort and 100 in the PALGA cohort. In this cohort, SMR was increased for osteosarcoma (19.7, 95% CI 3.5-48.9), cervical cancer (4.93, 95%CI 1.7-8.2), thyroid cancer (3.71, 95% CI 1.1-7.8), prostate cancer (3.08, 95% CI 1.8-4.6), and melanoma (2.01, 95%CI 1.2-3.1). SMRs for pancreatic cancer or hepatocellular carcinoma could not be calculated due to low numbers. The small number of malignancies identified in our FD/MAS cohort precluded the calculation of SMRs for our cohort specifically. Our findings show that patients with FD/MAS appear to have an increased risk for osteosarcoma, cervical, thyroid, and prostate cancer and melanoma. However, these data should be interpreted with caution, as true incidence rates of the identified malignancies may be influenced by the inclusion of only patients with histologically confirmed FD/MAS. The etiology of this increased risk for malignancies still needs to be elucidated.

Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records

Background and aimsThe UK Simon Broome (SB) familial hypercholesterolaemia (FH) register previously reported 3-fold higher standardised mortality ratio for cardiovascular disease (CVD) in women compared to men from 2009 to 2015. Here we examined sex differences in CVD morbidity in FH by national linkage of the SB register with Hospital Episode Statistics (HES). MethodsOf 3553 FH individuals in the SB register (aged 20–79 years at registration), 2988 (52.5% women) had linked HES records. Standardised Morbidity Ratios (SMbR) compared to an age and sex-matched UK general practice population were calculated [95% confidence intervals] for first CVD hospitalisation in HES (a composite of coronary heart disease (CHD), myocardial infarction (MI), stable or unstable angina, stroke, TIA, peripheral vascular disease (PVD), heart failure, coronary revascularisation interventions). ResultsAt registration, men had significantly (p < 0.001) higher prevalence of previous CHD (24.8% vs 17.6%), previous MI (13.2% vs 6.3%), and were commenced on lipid-lowering treatment at a younger age than women (37.5 years vs 42.3 years). The SMbR for composite CVD was 6.83 (6.33–7.37) in men and 7.55 (6.99–8.15) in women. In individuals aged 30–50 years, SMbR in women was 50% higher than in men (15.04 [12.98–17.42] vs 10.03 [9.01–11.17]). In individuals >50 years, SMbR was 33% higher in women than men (6.11 [5.57–6.70] vs 4.59 [4.08–5.15]). ConclusionsExcess CVD morbidity due to FH remains markedly elevated in women at all ages, but especially those aged 30–50 years. This highlights the need for earlier diagnosis and optimisation of lipid-lowering risk factor management for all FH patients, with particular attention to young women with FH.

Comparison of anticarcinogenic properties of Viburnum opulus and its active compound p-coumaric acid on human colorectal carcinoma.

Resistance to therapeutic agents and the highly toxic side effects of synthetic drugs has spurred new research in the treatment of colon cancer, which has high morbidity and mortality ratios. This study aims to clarify the molecular mechanisms of the anticarcinogenic properties of methanol extract of Viburnum opulus L. (EVO)and its main active compound, trans-p -coumaric acid ( p -CA), on human colon cancer cells (DLD-1, HT-29, SW-620, Caco-2) and healthy colon epithelial cells (CCD-18Co). The effects of EVO on controlled cell death (apoptosis) and the cell division cycle were determined by flow cytometry. Alteration in mRNA and protein expressions of switch genes in colorectal carcinoma (APC, MLH1, TP53, SMAD4, KRAS, and BRAF) were determined by qRT-PCR and Western blot, respectively. Our results show that EVO possesses a strong reducing capacity and free-radical scavenging activity. HPLC analyses prove that p -CAis the main compound of EVO. EVO and p -CA inhibit the proliferation of human colon cancer cells DLD-1 and HT-29 in a dose-dependent manner. EVO increases apoptosis of DLD-1 cells and halts the cell cycle in the G2 stage in HT-29 cells. mRNA and protein expressions of p53 and SMAD-4 are upregulated, while BRAFs are downregulated. The results were directly proportional to p -CA. EVO and p -CA up- and downregulate switch genes and protein expressions of DLD-1 cells, which alter the expression of 186 other genes. This is the first study of pharmacological exploration of V.opulus in human colon cancer. Its antiproliferative effects may be due to the presence of p -CA.

Spatial analysis of hepatobiliary abnormalities in a population at high-risk of cholangiocarcinoma in Thailand

Cholangiocarcinoma (CCA) is a serious health challenge with low survival prognosis. The liver fluke, Opisthorchis viverrini, plays a role in the aetiology of CCA, through hepatobiliary abnormalities: liver mass (LM), bile duct dilation, and periductal fibrosis (PDF). A population-based CCA screening program, the Cholangiocarcinoma Screening and Care Program, operates in Northeast Thailand. Hepatobiliary abnormalities were identified through ultrasonography. A multivariate zero-inflated, Poisson regression model measured associations between hepatobiliary abnormalities and covariates including age, sex, distance to water resource, and history of O. viverrini infection. Geographic distribution was described using Bayesian spatial analysis methods. Hepatobiliary abnormality prevalence was 38.7%; highest in males aged > 60 years (39.8%). PDF was most prevalent (20.1% of males). The Standardized Morbidity Ratio (SMR) for hepatobiliary abnormalities was highest in the lower and upper parts of the Northeast region. Hepatobiliary abnormalities specifically associated with CCA were also more common in males and those aged over 60 years and distributed along the Chi, Mun, and Songkram Rivers. Our findings demonstrated a high risk of hepatobiliary disorders in Northeast Thailand, likely associated with infection caused by O. viverrini. Screening for CCA and improvement of healthcare facilities to provide better treatment for CCA patients should be prioritized in these high-risk areas.

Functional Outcome And Mortality Assessment Following Proximal Femoral Nailing In Inter Trochanteric Fracture

Intertrochanteric fractures constitute one of the most typical fractures of the hip. The incidence of fractures in the trochanteric area has risen with an increase in numbers of the older person with osteoporosis. Mortality, morbidity ratios are increasing in patients with inter-trochanteric fractures. Advanced age and associated co-morbidities are two primary added source for high mortality in trochanteric fracture patients. We conducted this study to assess the mortality rate and the functional outcome in inter-trochanteric fractures after proximal femoral nailing. This is a prospective study, in which 60 Intertrochanteric fractures of femur patients who came to our hospital EMS. Inclusion and Exclusion criteria were included in this study and were done from a period from January 2014 to July 2017. They were evaluated on each follow-up clinically using Harris Hip score and radio-logically using RUST score. The overall mortality rate at the end of the 3-year follow-up in our study is 13.3%. The factor which significantly influenced the mortality rate was Coronary artery disease. Four patients had implant-related complications. One patient developed non-union, which was later revised with Bipolar Hemi-arthroplasty. One patient developed screw back out, and two patients developed screw breakage. Results of our study concluded that elderly patients of age group 75-89 years of age were at higher risk for intertrochanteric fractures. Associated comorbid condition plays a significant role in the mortality of this fractures. In our study, coronary artery disease had a significant influence on the mortality rate for intertrochanteric fractures with a 4.63 fold rise in the mortality rate for these patients.

Reweighting Oranges to Apples: Transported RE-LY Trial Versus Nonexperimental Effect Estimates of Anticoagulation in Atrial Fibrillation.

Results from trials and nonexperimental studies are often directly compared, with little attention paid to differences between study populations. When target and trial population data are available, accounting for these differences through transporting trial results to target populations of interest provides useful perspective. We aimed to compare two-year risk differences (RDs) for ischemic stroke, mortality, and gastrointestinal bleeding in older adults with atrial fibrillation initiating dabigatran and warfarin when using trial transport methods versus nonexperimental methods. We identified Medicare beneficiaries who initiated warfarin or dabigatran from a 20% nationwide sample. To transport treatment effects observed in the randomized evaluation of long-term anticoagulation trial, we applied inverse odds weights to standardize estimates to two Medicare target populations of interest, initiators of: (1) dabigatran and (2) warfarin. Separately, we conducted a nonexperimental study in the Medicare populations using standardized morbidity ratio weighting to control measured confounding. Comparing dabigatran to warfarin, estimated two-year RDs for ischemic stroke were similar with trial transport and nonexperimental methods. However, two-year mortality RDs were closer to the null when using trial transport versus nonexperimental methods for the dabigatran target population (transported RD: -0.57%; nonexperimental RD: -1.9%). Estimated gastrointestinal bleeding RDs from trial transport (dabigatran initiator RD: 1.8%; warfarin initiator RD: 1.9%) appeared more harmful than nonexperimental results (dabigatran initiator RD: 0.14%; warfarin initiator RD: 0.57%). Differences in study populations can and should be considered quantitatively to ensure results are relevant to populations of interest, particularly when comparing trial with nonexperimental findings. See video abstract: http://links.lww.com/EDE/B703.

Outcomes of Anatomic Lung Resection for Cancer Are Better When Performed by Cardiothoracic Surgeons

Anatomic lung resection (ALR) outcomes are superior for cardiothoracic surgeons (CTSs) by analysis of Medicare; National Inpatient Sample; South Carolina Office of Research and Statistics; and Surveillance, Epidemiology, and End Results databases. Similar findings have been reported for all noncardiac thoracic procedures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Our aim was to further delineate outcome differences between CTSs and general surgeons (GSs) specifically for ALR. A retrospective analysis of 15,574 nonemergent, nonpediatric ALR for lung cancer was conducted using the ACS-NSQIP 2013 to 2017 database. Included procedures were all ALR for lung cancer. Surgeons were classified as CTSs or GSs. Other specialties were excluded. Preoperative characteristics and 30-day outcomes were compared by bivariate (chi-square test) and multivariate analysis. Multivariate analysis was conducted by multiple logistic regression. CTSs performed 14,172 (91.0%) of included procedures, and GSs performed 1402 (9.0%). A thoracoscopic approach was utilized at a similar rate (49.08% for CTSs vs 49.71% for GSs; P= .747). The extent of resection differed in a statistically, but not clinically, significant fashion. CTS patients had a higher rate of preoperative dyspnea (22.66% for CTSs vs 17.62% for GSs; P< .001). Procedures performed by CTSs had a lower risk-adjusted odds ratio of overall morbidity, pulmonary morbidity, sepsis or septic shock, bleeding requiring transfusion, and length of stay greater than the median (5 days). ALR outcomes are superior for CTSs when compared with GSs. This is consistent with prior studies looking at this specific subset of patients and studies looking at a different subset of patients using the ACS-NSQIP database.

Multifaceted Impacts of Pandemics on the Society

The pandemic Corona Virus Disease (COVID-19) which has hampered the globe since December 2019 has endangered the livelihood of human race. Corona Virus Disease is a new strain of coronavirus that twitches with symptoms of fever, sore throat with dry cough, body ache, fatigue, anosmia (loss of sense of smell), dysgeusia (loss of sense of taste) resembling the ailments of common flu within two to fourteen days of exposure. Recently, emesis and diarrhoea are also seen as indicators in most of the patients. When the severity of the disease increases, the pulmonary system is impaired, and the artificial respiratory system support becomes essential for survival. It is not only the ratio of morbidity or mortality that prerequisites insights on discussion about the pandemic, rather there are many other arenas that needs to be pondered. Although, the preventive measures like personal hygiene, social distancing, self-quarantine in case of suspicion, followed by the individuals and the measures implemented by the Government like curfew, have proven effective in reducing the number of victims to coronavirus, the socio-economic dangers caused to human society is at large. Hence, this study aims to review the threats and challenges posed by the pandemics, like Corona Virus Disease on the grounds of education, economic security, food and nutrition security, physical health and psychological health.

A comparative analysis of frequentist and Bayesian approaches to estimate dengue disease transmission in Bandung-Indonesia

Dengue disease is one of the major health concerns in Indonesia because of its high number of cases. There is no specific treatment to cure people infected by this mosquito-borne disease and prevention is the best strategy to avoid infection. A study of dengue disease mapping is essential to depict the high-low risk areas. This study aims to estimate the relative risk of dengue disease in Bandung, West Java, Indonesia, using a frequentist statistics approach i.e. the Standardized Morbidity Ratio (SMR) and the Bayesian statistics approach, i.e. Poisson-gamma and the Besag, York and Mollie (BYM) models. Dengue disease data for Bandung from 2014-2016 are investigated and the results are displayed in graphs and maps. Further, two Bayesian models are compared using the Deviance Information Criterion (DIC) to decide the model which best fits the data. Based on the smallest DIC value, the Poisson-gamma model was found superior to that of the BYM. Further, results show that the most critical areas affected by dengue disease are located in south-west Bandung; and the highest risk of dengue disease in Bandung for the period of 2014-2016 occurred during the rainy season (November-December).

A geospatial analysis of Type 2 Diabetes Mellitus and the food environment in urban New Zealand

The aim of this research is to analyse the spatial epidemiology of Type 2 Diabetes Mellitus (T2DM) and investigate associations with the built environment in urban New Zealand. Data on T2DM was sourced from the New Zealand Virtual Diabetes Register (2016), and data on environmental variables sourced from the Ministry for Primary Industries and Territorial Authorities (2013–2016). Novel measures of the built environment using an enhanced two-step floating catchment area model were established using data on fast food outlets, takeaways, dairy/convenience stores, supermarkets and fruit/vegetable stores. Rates of T2DM per 1000 population and standardised morbidity ratios were computed and visualised for all urban areas. Getis Ord was used to assess spatial clustering, and Bayesian modelling was used to understand associations between T2DM and environmental variables. Results indicate that T2DM is influenced by demographic factors, spatially clustered and associated with accessibility to environmental exposures. Health-promoting resources, such as fruit/vegetable stores, were shown to have a consistently protective effect on T2DM while those considered detrimental to health showed varying, and largely insignificant, associations. This is the first study in New Zealand to spatially quantify the effects of multiple environmental exposures on population level T2DM for all urban areas using a geospatial approach. It has implications for both policy and future research efforts as a deeper knowledge of local environments forms a basis on which to better understand spatial associations between the built environment and health, as well as formulate policy directed toward environmental influences on chronic health conditions.

Is There an Additional Value in Detecting Anticardiolipin and Anti-β2 glycoprotein I IgA Antibodies in the Antiphospholipid Syndrome?

Anticardiolipin (aCL) and anti-β2 glycoprotein I (aβ2GPI) immunoglobulin A (IgA) antiphospholipid antibodies (aPL) have shown to associate with thrombosis and pregnancy morbidity. However, inclusion of IgA aPL in the classification criteria of the antiphospholipid syndrome (APS) has been debated. We investigated the value of aCL and aβ2GPI IgA aPL in the detection of thrombosis and pregnancy morbidity in addition to the current aPL panel for APS. We included 1,068 patients from eight European medical centers: 259 thrombotic APS patients, 122 obstetric APS patients, 204 non-APS thrombosis patients, 33 non-APS obstetric patients, 60 APS patients with unspecified clinical manifestations, 196 patients with autoimmune diseases, and 194 controls. aCL and aβ2GPI IgG/M/A were detected with four commercial assays and lupus anticoagulant was determined by the local center. Positivity for IgA aPL was found in 17 to 26% of the patients with clinical manifestations of APS and in 6 to 13% of the control population. Both aCL and aβ2GPI IgA were significantly associated with thrombosis and pregnancy morbidity. Isolated IgA positivity was rare in patients with clinical manifestations of APS (0.3-5%) and not associated with thrombosis and/or pregnancy morbidity. Addition of IgA to the current criterion panel did not increase odds ratios for thrombosis nor pregnancy morbidity. aCL and aβ2GPI IgA are associated with clinical manifestations of APS. However, isolated IgA positivity was rare and not associated with thrombosis or pregnancy morbidity. These data do not support testing for aCL and aβ2GPI IgA subsequent to conventional aPL assays in identifying patients with thrombosis or pregnancy morbidity.

Risk of death by age and gender from CoVID-19 in Peru, March-May, 2020.

Peru implemented strict social distancing measures during the early phase of the epidemic and is now experiencing one of the largest CoVID-19 epidemics in Latin America. Estimates of disease severity are an essential indicator to inform policy decisions about the intensity and duration of interventions needed to mitigate the outbreak. Here we derive delay-adjusted case fatality risks (aCFR) of CoVID-19 in a middle-income country in South America.We utilize government-reported time series of CoVID-19 cases and deaths in Peru stratified by age group and gender.As of May 25, 2020, we estimate the aCFR for men and women at 10.8% (95%CrI: 10.5-11.1%) and 6.5% (95%CrI: 6.2-6.8%), respectively, whereas the overall aCFR was estimated at 9.1% (95%CrI: 8.9-9.3%). Our results show that senior individuals have been the most severely affected by CoVID-19, particularly men, with an aCFR of nearly 60% for those aged 80- years. We also found that men have a significantly higher cumulative morbidity ratio across most age groups (proportion test, p-value< 0.001), with the exception of those aged 0-9 years.The ongoing CoVID-19 pandemic is generating a substantial mortality burden in Peru. Senior individuals, especially those older than 70 years, are being disproportionately affected by the CoVID-19 pandemic.

Real-world on-treatment and initial treatment absolute risk differences for dabigatran vs warfarin in older US adults.

Trials and past observational work compared dabigatran and warfarin in patients with atrial fibrillation, but few reported estimates of absolute harm and benefit under real-world adherence patterns, particularly in older adults that may have differing benefit-harm profiles. We aimed to estimate risk differences for ischemic stroke, death, and gastrointestinal bleeding after initiating dabigatran and warfarin in older adults (a) when patients adhere to treatment and (b) under real-world adherence patterns. In a 20% sample of nationwide Medicare claims from 2010 to 2015, we identified beneficiaries aged 66 years and older initiating warfarin and dabigatran. We followed individuals from initiation until death or October 2015 (initial treatment, IT) and separately censored individuals' follow-up after drug switches and gaps in supply (on-treatment, OT). We applied inverse probability of treatment and standardized morbidity ratio weights, as well as inverse probability of censoring weights, to estimate two-year risk differences (RDs) for dabigatran vs warfarin. We identified 10,717 dabigatran and 74,891 warfarin initiators. Weighted OT RDs suggested decreased ischemic stroke risk for dabigatran vs warfarin; IT RDs indicated increased or no change in ischemic stroke risk. Regardless of follow-up approach and weighting strategy, risk of death appeared lower and risk of gastrointestinal bleeding appeared higher when comparing dabigatran vs warfarin. Dabigatran use was associated with lower risks of mortality and ischemic stroke in routine care when older adults stayed on treatment. IT analyses suggested that these benefits may be diminished under real-world patterns of switching and discontinuation.

Patient-reported physical and mental health of socioeconomically disadvantaged cancer patients.

e19041 Background: Patient-reported outcomes (PROs) are extensively described for cancer patients with access to care, but little information is available about PROs for socioeconomically disadvantaged cancer patients with barriers to care. Therefore, we aimed to compare patient-reported mental and physical health between newly diagnosed cancer patients at an urban safety-net cancer center and the general population. Methods: We used data collected during implementation of a quality improvement pilot initiative to integrate PROs into clinical care at the JPS Oncology and Infusion Center (Fort Worth, TX), which is a Comprehensive Community Cancer Program. The Patient-Reported Outcomes Measurement Information System (PROMIS) 10-item Global Health Survey was used to ascertain mental, physical, and social health for newly diagnosed cancer patients between August and December 2019. Our outcomes of interest were the mental and physical health subdomains. We computed T-scores, where a score of 50 represents the mean for the U.S. general population with a standard deviation (SD) of 10. We defined severely impaired health as subdomain scores ≥2 SDs below the mean. In addition, we estimated standardized morbidity ratios (SMR) and corresponding 95% confidence limits (CL) to compare the observed number of patients with severe impairment of mental or physical health with the expected number of patients with severe impairment. For example, an SMR = 1.0 implies that the observed number of severely impaired individuals in the study population is equal to the expected number in the general population. Results: Our study population comprised 59 patients, of whom 73% were aged &lt; 65 years, 51% were female, and 54% were racial/ethnic minorities. Breast (21%) and lung (21%) cancers were the most common diagnoses. The frequency of severely impaired physical health for our population was 4.4 times higher than the general population (SMR = 4.4, 95% CL: 1.6, 9.6), whereas no patients in our study population reported severely impaired mental health (SMR = 0, 95% CL: 0, 2.2). Conclusions: Our results suggest that socioeconomically disadvantaged cancer patients have substantially impaired physical health but not mental health at diagnosis. These findings may be useful for raising awareness about the importance of systematically ascertaining PROs and using the results to allocate resources for delivering care to safety-net cancer patients.

Risk of colorectal cancer following CT-verified acute diverticulitis: a nationwide population-based cohort study.

Routine colonoscopy to exclude colorectal cancer (CRC) after CT-verified acute diverticulitis is controversial. This study aimed to compare the incidence of CRC in patients with acute diverticulitis with that in the general population. Patients with an emergency admission for diverticular disease to any Norwegian hospital between 1 January 2008 and 31 December 2010 were included through identification in the Norwegian Patient Registry using International Classification of Diseases (ICD-10) codes K57.1-9. To estimate the age-specific distribution of CT-verified acute uncomplicated diverticulitis (AUD) and acute complicated diverticulitis (ACD) in this nationwide study population, numbers from the largest Norwegian emergency hospital were used. Patients diagnosed with CRC within 1year following their admission for acute diverticulitis were detected through cross-matching with the Cancer Registry of Norway. Based on both Norwegian age-specific incidence of CRC and estimated age-specific distribution of CT-verified diverticulitis, standard morbidity ratios (SMRs) were calculated. A total of 7473 patients with emergency admissions for diverticular disease were identified (estimated CT-verified AUD n=3523, ACD n=1206); of these 155 patients were diagnosed with CRC within 1year. Eighty had a CT-verified diverticulitis at index admission [41 AUD (51.3%); 39 ACD (49.7%)]. Compared with the general population, the SMR was 6.6 following CT-verified AUD and 16.3 following ACD, respectively. In the first year after CT-verified acute diverticulitis, especially after ACD, the risk of CRC is higher than in the general population. This probably represents misdiagnosis of CRC as acute diverticulitis. Follow-up colonoscopy should be recommended to all patients admitted with acute diverticulitis.

Morbilidad materna extrema en mujeres peruanas atendidas en una institución especializada. 2012-2016

Introducción: La morbilidad materna extrema genera indicadores para evaluar y controlar el riesgo de muerte materna. Objetivo: Describir la morbilidad materna extrema en mujeres peruanas atendidas en una institución especializa de Perú, 2012-2016. Material y Método: Estudio observacional, descriptivo y transversal. Se incluyeron las pacientes atendidas en el Instituto Nacional Materno Perinatal de Perú, entre el 2012 y 2016. Los casos de morbilidad materna extrema fueron incluidos según criterios de la Federación Latinoamericana de Sociedades de Obstetricia y Ginecología. Se describieron características maternas y se evaluaron indicadores de resultado. Se aplicó estadística descriptiva e inferencial bajo intervalos de confianza al 95%, utilizando el programa Stata versión 14. Resultados: La población de estudio fue 1245 casos. La multiparidad estuvo presente en el 63,7% de casos, presentaron en promedio 4 controles prenatales y el 60% de los casos tuvo por lo menos una cesárea previa. La razón de morbilidad materna extrema varío entre 10,7 y 17,6 por cada 1,000 recién nacidos vivos, el Índice de Mortalidad fue 3%, la relación morbilidad materna extrema / muerte materna fue de 32,8 casos. Conclusiones: La prevalencia promedio de morbilidad materna extrema fue de 13 casos por cada mil nacidos vivos con tendencia al incrementó en los últimos tres años de estudio, siendo principalmente causado por trastornos hipertensivos, sepsis y hemorragias. Los índices de resultado de morbilidad materna extrema demuestran una mejora progresiva en la calidad de atención de las pacientes con una tendencia a la disminución de muerte materna.