Multicenter Population-based Study Research Articles

Consumption of ultra-processed foods and drinks and colorectal, breast, and prostate cancer

To study whether the consumption of ultra-processed foods and drinks is associated with breast, colorectal, and prostate cancers. Multicentric population-based case-control study (MCC-Spain) conducted in 12 Spanish provinces. Participants were men and women between 20 and 85 years of age with diagnoses of colorectal (n=1852), breast (n=1486), or prostate cancer (n=953), and population-based controls (n=3543) frequency-matched by age, sex, and region. Dietary intake was collected using a validated food frequency questionnaire. Foods and drinks were categorized according to their degree of processing based on the NOVA classification. Unconditional multivariable logistic regression was used to evaluate the association between ultra-processed food and drink consumption and colorectal, breast, and prostate cancer. In multiple adjusted models, consumption of ultra-processed foods and drinks was associated with a higher risk of colorectal cancer (OR for a 10% increase in consumption: 1.11; 95% CI 1.04-1.18). The corresponding odds for breast (OR 1.03; 95% CI 0.96-1.11) and prostate cancer (OR 1.02; 95% CI 0.93-1.12) were indicative of no association. Results of this large population-based case-control study suggest an association between the consumption of ultra-processed foods and drinks and colorectal cancer. Food policy and public health should include a focus on food processing when formulating dietary guidelines.

Prevalence of cervicovaginal human papillomavirus infection and genotypes in the pre-vaccine era in China: A nationwide population-based study

The HPV vaccine has been licensed in mainland China since 2017. This study aimed to assess the epidemiological characteristics of HPV genotypes in the pre-vaccine era in China. We conducted a multicentric population-based study nested in the largest health clinic chain in China. Between January 1, 2017 and December 31, 2017, 427,401women aged 20 years or older with polymerase chain reaction-based HPV genotyping tests were included in the study. The cervicovaginal infection of 14 high-risk HPV genotypes and 9 low-risk genotypes was assessed using adjusted prevalence, multivariable logistic regression, cluster analysis, and heatmap. HPV prevalence was 15.0% (95% confidence interval [CI]: 14.1-15.9%) in China, with high- and low-risk genotypes being 12.1% (95%CI: 11.4-12.7%) and 5.2% (95%CI: 4.8-5.7%), respectively. The prevalence of HPV genotypes corresponding to bivalent, quadrivalent, and nonavalent vaccines were 2.1%, 2.4%, and 8.3%, respectively, whereas the prevalence of non-vaccine high-risk genotypes was 5.7%. The most common high-risk genotypes were HPV-52 (3.5%), HPV-58 (2.1%), and HPV-16 (1.6%), and the prevalence of HPV-18 (0.6%), HPV-6 (0.1%), and HPV-11 (0.2%) were relatively low. Infection with HPV genotypes differed significantly across age groups and geographic locations. HPV prevalence was high in the pre-vaccine era in China, and a population-based HPV vaccination strategy is needed in the future.

Frequency and characteristics of thyroid dysfunction in pregnant women – screening of 547 women in Bulgaria

The Recommendations of the European Thyroid Association’2014 have been widespread among the medical community for many years. In them as well as in the latest Recommendations of the American Thyroid Association’2017 the first recommendation is related to the development of population-based reference limits based on data from the local population. The aim is to study the current functional thyroid status in pregnant Bulgarian women and to carefully assess in the light of modern understandings the specific diagnostic and therapeutic approach for our population. Material and Methods: The study was conducted as a cross-sectional multicenter population-based study, which included 547 pregnant women, mean age 30 ± 5 years. Fasting morning venous blood (TSH, FT4, TPOAb - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration) was taken, ultrasound examination of the thyroid gland was performed. Results: Based on the accepted cut-off for TSH according to the Recommendations of ETA’2014, the studied pregnant women were divided into six groups: Subclinical and Clinical hypothyroidism; Subclinical and Clinical hyperthyroidism; Euthyroid; Low T4 syndrome. Almost 2/3 of pregnant women have TSH < 2.5 mIU / L. Undiagnosed hypothyroidism is present in 121 pregnant women (22%), which is a bad feature of our health system. The data were analyzed in two TSH cut-offs (ETA’2014 and ATA’2017) and it was found that the increase in TSH cut-off for the first trimester did not change the absolute number of undiagnosed and untreated pregnant women with Clinical hypothyroidism, increasing 2.5 times its relative share, from 25.6% reaching 63.3% of all undiagnosed cases of hypothyroidism. Conclusion: Increasing the cut-off of TSH would unrealistically calm and neglect the follow-up of the pregnant women which is very dangerous. Efforts should focus on early screening for verbally identified risk factors. Of course, it is necessary to develop a national standard for TSH, which would serve more accurately to assess the thyroid status of pregnant women in the Bulgarian population.

Differences in cutaneous melanoma survival between the 7th and 8th edition of the American Joint Committee on Cancer (AJCC). A multicentric population-based study.

The 8th edition of the AJCC manual for melanoma includes many changes leading to major substage migrations, which could lead to important clinical reassessments. To evaluate the differences and prognostic value of the 8th AJCC classification in comparison with the 7th edition. Clinical and histopathological data were retrieved from five melanoma referral centers including 7815 melanoma patients diagnosed between January 1998 and December 2018. All patients were reclassified and compared using the 7th and 8th classifications of the AJCC. Sankey plots were used to evaluate the migration of patients between the different versions. The primary outcome was overall survival (OS), and curves based on the Kaplan-Meier method were used to investigate survival differences between the 7th and 8th editions. The number of patients classified as stages IB, IIIA, and IIIB decreased while the patients classified as stages IA and IIIC increased notably. Migration analysis showed that many patients in group I were understaged whereas a significant percentage of patients in group III were upstaged. Indirect OS analysis showed a loss in the linearity in the AJCC 8th edition and the groups tended to overlap. Direct OS analysis between groups and versions of the AJCC showed a better prognosis within the new stage III patients, with no effect on those in stages I and II. The 8th AJCC edition represents an important change in the classification of patients. We observe that the main migratory changes occur in stage I and III, that severity linearity is lost and groups overlap, and that a more advanced stage does not mean a worse prognosis.

A male-ABCD algorithm for hepatocellular carcinoma risk prediction in HBsAg carriers.

ObjectiveHepatocellular carcinoma (HCC) development among hepatitis B surface antigen (HBsAg) carriers shows gender disparity, influenced by underlying liver diseases that display variations in laboratory tests. We aimed to construct a risk-stratified HCC prediction model for HBsAg-positive male adults.MethodsHBsAg-positive males of 35−69 years old (N=6,153) were included from a multi-center population-based liver cancer screening study. Randomly, three centers were set as training, the other three centers as validation. Within 2 years since initiation, we administrated at least two rounds of HCC screening using B-ultrasonography and α-fetoprotein (AFP). We used logistic regression models to determine potential risk factors, built and examined the operating characteristics of a point-based algorithm for HCC risk prediction.ResultsWith 2 years of follow-up, 302 HCC cases were diagnosed. A male-ABCD algorithm was constructed including participant’s age, blood levels of GGT (γ-glutamyl-transpeptidase), counts of platelets, white cells, concentration of DCP (des-γ-carboxy-prothrombin) and AFP, with scores ranging from 0 to 18.3. The area under receiver operating characteristic was 0.91 (0.90−0.93), larger than existing models. At 1.5 points of risk score, 26.10% of the participants in training cohort and 14.94% in validation cohort were recognized at low risk, with sensitivity of identifying HCC remained 100%. At 2.5 points, 46.51% of the participants in training cohort and 33.68% in validation cohort were recognized at low risk with 99.06% and 97.78% of sensitivity, respectively. At 4.5 points, only 20.86% of participants in training cohort and 23.73% in validation cohort were recognized at high risk, with positive prediction value of 22.85% and 12.35%, respectively.ConclusionsMale-ABCD algorithm identified individual’s risk for HCC occurrence within short term for their HCC precision surveillance.

Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A Population-Based Multi-Center Cohort Study.

Background:Early hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs.Objective:To determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients.Design:Population-based cohort study using linked, administrative health care databases.Setting:Ontario, Canada.Patients:We included 5437 kidney transplant recipients from 2002 to 2015.Measurements:Risk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission.Methods:We used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model.Results:In all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to <0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40).Limitations:We were not able to identify which readmissions could have been preventable and there is a potential for residual confounding.Conclusions:Results can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs.Trial registration:This is not applicable as this is a population-based cohort study and not a clinical trial.

Hyperglycemia During Pregnancy Depends on Numerous Factors (Hypertension During Pregnancy, Previous Birth of a Fetus over 4 kg, Hirsutism - Bulgarian Screening, 2019)

Gestational diabetes mellitus (GDM) starts during pregnancy and can increase the risk of adverse pregnancy outcomes, as well as be the cause of a number of diseases in the years after birth in both the mother and the fetus. The aim is to study in the Bulgarian population of pregnant women the relationship between hyperglycemia during pregnancy and some factors – arterial hypertension (AH), previous macrosomic baby weighing 4.5 kg or above, hirsutism. Material: A cross-sectional multicenter population-based study which included 547 pregnant women, with average age 30.49±5,12 years was conducted in 84 settlements in Bulgaria. Methods: A questionnaire was completed, blood pressure was measured (Guideline of ESC/ESH, 2018), BMI was calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas e501 analyzer. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: The incidence of Hyperglycemia for the whole group of pregnant women was 14.4% (79/547), up to 24 gestational week (g.w.) it was 5.3% (29/547) and after 24 g.w. - 9.1% (50/547), P < 0.01. Of all screened pregnant women, 2.4% (13/547) developed AH during the current pregnancy. Hyperglycemia was found in 38.5% (5/13) of the women with AH and in 13.9% (74/534) of the women without AH, P < 0.028. In 3.29% of the pregnant women (18/547) a macrosomic baby weighing 4.5 kg or above was found in a previous pregnancy. Hyperglycemia was present in 38.9% (7/18) of women who gave birth to a large fetus against 13.6% (72/529) of women who gave birth to a fetus under 4 kg, P < 0.008. Hirsutism was reported in 7.9% (43/547) of the studied pregnant women. Hirsutism is twice as common in pregnant women with Hyperglycemia - 13.9% (11/79) versus hirsutism in those with Normoglycemia - 6.8% (32/468), P < 0.049. There was a significant correlation between Hyperglycemia and gestational age (P < 0.006), previous fetal birth over 4 kg (P < 0.03), AH during the current pregnancy (P < 0.01), presence of hirsutism (P < 0.03). Conclusion: A good knowledge of all risk factors associated with the development of glucose intolerance and GDM could play an important role in the early diagnosis of this common disorder during pregnancy.

Cross-sectional Study of Glucose Disturbances of Pregnant Women in Bulgaria

Hyperglycemia is one of the most common conditions during pregnancy. The International Diabetes Federation (IDF) estimates that one in six live births (16.8%) are in women with some form of Hyperglycemia during pregnancy. The aim is to analyze the frequency of Hyperglycemia during pregnancy through a cross-sectional multicenter population-based study in 84 settlements in Bulgaria, as well as to study the dynamics of this frequency during pregnancy. Material: We studied 547 pregnant women with a mean age of 30±5 years, divided into two groups - up to 24 gestational week – g.w. (n-386, 70.6%) and after 24 g.w. (n-161, 29.4%). Methods: BMI before pregnancy and the current one at the time of the study were calculated. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. Plasma glucose was quantitatively determined using enzymatic reference method with hexokinase (Roche reagent) on Cobas е501 analyzer, in one Central laboratory on the day of the blood sampling. The results were in mmol / l. The statistical analysis was performed using standard SPSS 13.0 for Windows. Results: Hyperglycemia was observed in 79 (14.4%) pregnant women after fasting state or in the course of classic OGTT, according to the criteria of WHO’2019, FIGO’2015, NICE’2015, and in the remaining 468 (85.6%) pregnant women - Normoglycemia. There was no significant difference in the level of glycemia between the three trimesters for each of the points of OGTT (0, 60, 120 minutes) in the subgroups of pregnant women with Hyperglycemia (up to 12 g.w, 13-24 g.w, after 24 g.w.). It turned out that the number and frequency of pregnant women with Hyperglycemia in the period up to 24 g.w. is 7.5% (29/386) and increases in the period after 24 g.w. reaching 31% (50/161), P < 0.01. According to the generally accepted population diagnostic criteria for diabetes in non-pregnant women, we found that 8.9% (7/79) of pregnant women with Hyperglycemia had Diabetes in Pregnancy (DIP), all of whom had a risk factor for Diabetes (two of them even 3 risk factors). Conclusion: As soon as pregnancy is established, verbal screening for diabetes risk factors should be performed as a first step in selecting pregnant women for glucose tolerance screening with classic OGTT to determine the glucose status of the pregnant woman.

Diabetes and Hypothyroidism Alone and Simultaneously in Bulgarian Pregnant Women - Frequency and Features of Various Risk Factors

Gestational hypothyroidism affects the maturation and function of the beta cell, which can influence glucose metabolism. The aim of the study is to investigate the relationship between Hypothyroidism and Hyperglycemia in Bulgarian pregnant women and to look for the influence of various factors on the manifestation of each of these diseases separately, as well as their role in cases of simultaneous combination of the two diseases. Маterial: We studied 547 pregnant women, mean 30±5 years. The cross-sectional population-based multicenter study was conducted in 84 Bulgarian towns and villages. Pregnant women were divided into 4 groups according to the presence or absence of Diabetes (Diab) resp. Hypothyroidism (Thyr): Group 0 – 62.7% (n-343) – without Thyr or Diab; Group 1 – 22.9% (n-125) – Thyr; Group 2 – 11% (n-60) – Diab; Group 3 – 3.5% (n-19) – with Thyr and Diab. Methods: Fasting morning venous blood (TSH, FT4 - determined by ECLIA method) and fresh morning urine sample (to determine urine iodine concentration - UIC) was taken. A two-hour, 75 g oral glucose tolerance test (OGTT) was performed. The peripheral levels of 25(OH)D were tested using a standard assay in a central laboratory on the day of the sampling. The statistical analysis was conducted using standard SPSS 13.0 for Windows. Results: Group 2 were the oldest and Group 1 - the youngest, P 500 µg / L), compared with the Group with Normoglycemia (n-368). Conclusion: All international guidelines specifically emphasize the main risk factors when pregnant women should be screened for early detection of major endocrine diseases. However, the role of some additional factors, such as deficiency of 25(OH)D and iodine, should not be underestimated.

Second-line Chemotherapy Prolongs Survival in Real World Patients With Advanced Biliary Tract and Gallbladder Cancers: A Multicenter Retrospective Population-based Cohort Study.

Limited evidence is available regarding the survival benefit of second-line therapy in real world patients with advanced biliary tract and gallbladder cancer. Until very recently, there was a lack of randomized clinical trials to address this important question. In this multicenter population-based cohort study, the authors evaluated whether second-line therapy improves the survival of real world patients with advanced biliary tract and gallbladder cancer. Patients with biopsy-proven advanced biliary tract and gallbladder cancer who were diagnosed during the period of 2006 to 2015 and had received first-line chemotherapy were assessed. Cox proportional multivariate analysis was performed to determine the survival benefit of second-line therapy. One hundred thirty-six eligible patients with a median age of 66 years and male:female ratio of 1:1.34 were identified. Sixty-eight percent of patients had metastatic disease. Primary tumor sites were as follows: gallbladder 31%, intrahepatic cholangiocarcinoma 36%, extrahepatic bile duct 23%, and ampullary cancer 10%. Overall, 37% of patients received second-line therapy. The median overall survival of the treatment group was 17 months (95% confidence interval [CI]: 12.5-21.5) compared with 7 months (95% CI: 5.3-8.7) in the control (P<0.0001). Patients who received combination chemotherapy had a median overall survival of 20 months (14.0-26.1) compared with 17 months (13.5-20.5) if they received single-agent second-line therapy (P=0.73). Multivariate analysis of second-line therapy, hazard ratio: 0.55 (95% CI: 0.36-0.83) and neutrophil to lymphocyte ratio >2, HR: 1.10 (1.05-1.15) showed a significant correlation with survival. This well-designed population-based retrospective cohort study suggests that second-line chemotherapy improves survival of real world patients with advanced biliary tract and gallbladder cancers and should be offered to the patients who are potential candidates for chemotherapy.

Gender-specific physical activity-related injuries and risk factors among university students in China: a multicentre population-based cross-sectional study

ObjectivesData on the problem of physical activity-related injury (PARI) in university students and the risk factors for PARI among different genders are rare. We conducted a multicentre population-based study to...

Prevalence of depression, anxiety, and their associations among end-stage renal disease patients on maintenance hemodialysis: a multi-center population-based study

ABSTRACT Depression and anxiety are the most common mood disorder among end-stage renal disease (ESRD) patients, which can negatively affect quality-of-life and treatment outcomes. This study aimed to estimate the prevalence of depression and anxiety symptoms among ESRD patients undergoing hemodialysis (HD) and test associations with several covariates. In across-sectional study, we collected data from 457 patients using Hospital Anxiety and Depression Scale (HADS). We used multinomial logistic regression to model the associations between depression/anxiety symptoms and several covariates. The prevalence of depression (anxiety) symptoms was 21.7%(21.4%). About 12.6% had both depression and anxiety. Males were significantly less likely to have anxiety (depression) compared to females. Married with children were significantly less likely to have anxiety compared to divorced/widowed. Patients with Glomerulonephritis were significantly more likely to have anxiety (depression) compared to other causes of dialysis. Depression and anxiety are prevalent among HD patients with their HADS scores significantly positively correlated. This requires regular screening for symptoms of anxiety/depression. Future interventions should target females, those on dialysis between one and three years, and those with glomerulonephritis as ESRD cause. Finally, HADS is ascreening tool for symptoms of anxiety and depression for which aspecialist should assess the definitive diagnosis clinically.

PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese Prostate Cancer Consortium.

We performed this study to investigate the diagnostic performance of prostate-specific antigen density (PSAD) in a multicenter cohort of the Chinese Prostate Cancer Consortium. Outpatients with prostate-specific antigen (PSA) levels ≥4.0 ng ml−1 regardless of digital rectal examination (DRE) results or PSA levels <4.0 ng ml−1 and abnormal DRE results were included from 18 large referral hospitals in China. The diagnostic performance of PSAD and the sensitivity and specificity for the diagnosis of prostate cancer (PCa) and high-grade prostate cancer (HGPCa) at different cutoff values were evaluated. A total of 5220 patients were included in the study, and 2014 (38.6%) of them were diagnosed with PCa. In patients with PSA levels ranging from 4.0 to 10.0 ng ml−1, PSAD was associated with PCa and HGPCa in both univariate (odds ratio [OR] = 45.15, P < 0.0001 and OR = 25.38, P < 0.0001, respectively) and multivariate analyses (OR = 52.55, P < 0.0001 and OR = 26.05, P < 0.0001, respectively). The areas under the receiver operating characteristic curves (AUCs) of PSAD in predicting PCa and HGPCa were 0.627 and 0.630, respectively. With the PSAD cutoff of 0.10 ng ml−2, we obtained a sensitivity of 88.7% for PCa, and nearly all (89.9%) HGPCa cases could be detected and biopsies could be avoided in 20.2% of the patients (359/1776 cases). Among these patients who avoided biopsies, only 30 cases had HGPCa. We recommend 0.10 ng ml−2 as the proper cutoff value of PSAD, which will obtain a sensitivity of nearly 90% for both PCa and HGPCa. The results of this study should be validated in prospective, population-based multicenter studies.

Aplastic Anemia in Thailand: Incidence and Treatment Outcome from a Prospective Nationwide Population-Based Study

Background: Incidence of Aplastic Anemia (AA) in Asia tends to be higher than in western countries, but contemporary real-world incidence and outcomes of AA in Asia remain limited. This study aimed to explore the incidence across the country regions and to evaluate the patient outcomes according to age, the severity of disease, and treatment modalities. Method: This is a prospective multicenter nationwide population-based observational study of patients with AA aged over 15 years old, diagnosed between August 1st, 2014 to July 31st, 2016, with a longitudinal follow-up period over 2 years, from 30 medical centers. Patients with suspected hypocellular MDS and congenital bone marrow failure syndrome were excluded. Results: During the study period of 2 years, there were 348 newly diagnosed patients with aplastic anemia, giving the annual incidence of 4.6 per million inhabitants. There was a higher annual incidence of severe (SAA) and very severe aplastic anemia (VSAA) (3.8 per million) than non-severe aplastic anemia (NSAA) (0.8 per million). The incidence was greater among older patients with a peak incidence in patients aged 60-89 years old. (Figure 1) There was a high variation in the geographic incidences across country regions, ranging from 2.6 to 6.6 per million per year. (Figure 2) The 2-year overall survival (OS) for NSAA, SAA, and VSAA were 65.5%, 49.3%, and 20.1%, respectively (P &amp;lt; 0.001). Patients aged older than 60 years had the worst OS (42.6% as compared with 47.7% for the age 41-60 years and 64.5% for the age 15-40 years, P = 0.002). Among patients with SAA and VSAA (n = 280), the overall response rate (ORR) among patients treated with rabbit anti-thymocyte globulin and/or cyclosporin A (rATG±CsA) was significantly superior than those treated with CsA-based therapy and those treated with anabolic steroid (44.4% vs. 36.4% and 31.2%, respectively, P &amp;lt; 0.001). Among evaluable patients, ORR after the 1st treatment with rATG±CsA at 3, 6, 12 and 24 months were 23.9%, 43.8%, 68.4% and 89.2%, respectively. The 2-year OS among SAA/VSAA patients treated with rATG±CsA, CsA-based therapy, and anabolic steroid were 54.8%, 54.5%, and 37.6% (P = 0.037), respectively (Figure 3). From multivariate analysis, age &amp;gt; 60 years (HR 1.63, 95%CI, 1.14-2.33, P = 0.007), VSAA (HR 2.24, 95% CI, 1.45-3.46, P &amp;lt; 0.001) and not receiving immunosuppressive therapy or anabolic steroid (HR 4.96, 95%CI, 2.88-8.54, P &amp;lt;0.001), were independently associated with inferior OS among patients with SAA/VSAA. Conclusion: The incidence rate of AA in Thailand from this contemporary nationwide population-based study is high, especially in the elderly. Patients treated with rATG±CsA had superior survival than those receiving anabolic steroid. The real-world outcome of patients with SAA/VSAA, especially in those aged over 60 years, is substantially poor. Figure 1 Disclosures No relevant conflicts of interest to declare.

Sex-specific prevalence and outcomes of frailty in critically ill patients

BackgroundThe prevalence of frailty, an important risk factor for short- and long-term outcomes in hospitalized adults, differs by sex. Studies in critically ill adults have also found differences in mortality and organ support rates in males and females. The objective of this study was to determine if these observed differences in mortality and organ support rates can be explained by sex and frailty alone, or if the interaction between sex and frailty is an important risk factor.MethodsThis is a retrospective multi-centre population-based cohort study of all adult patients (≥ 18 years) admitted to the seventeen intensive care units (ICUs) across Alberta, Canada, between 2016 and 2017. On admission, physicians assigned a Clinical Frailty Scale (CFS) score (1 = very fit, 9 = terminally ill) to all patients. Patients with missing CFS scores or who died within 24 h of ICU admission were excluded. Frailty was defined as CFS ≥ 5. Outcomes included all-cause hospital mortality, ICU mortality, and organ support rates. A propensity score for female sex was generated and 1:1 matching on sex was performed. Multivariable Cox regression or logistic regression, as appropriate, was performed to evaluate the association between sex, frailty, and the sex-frailty interaction term with outcomes.ResultsOf 15,238 patients included in the cohort, after propensity score matching 11,816 patients remained (mean [standard deviation] age 57.3 [16.9]). In the matched cohort, females had a higher prevalence of frailty than males (32% vs. 27%, respectively) and higher odds of frailty (odds ratio [95% confidence interval (CI)] 1.29 [1.20–1.40]). Though females were less likely to receive invasive mechanical ventilation (hazard ratio [95% CI] 0.78 [0.71–0.86]), the interaction between sex and frailty (i.e., males and females with and without frailty) was not associated with differences in organ support rates. Receipt of dialysis and vasoactive support, as well as hospital mortality and ICU mortality were associated with frailty but were not associated with female sex or the interaction between sex and frailty.ConclusionsAlthough frailty and sex were individually associated with mortality and differences in organ support in the ICU, there does not appear to be a significant interaction between sex and frailty with regards to these outcomes.

Epidemiology of Uveitis in a Spanish Region: Prevalence and Etiology

ABSTRACT Objective To estimate the prevalence of uveitis and to describe its etiologic and anatomical patterns based on a population study carried out in a Spanish region. Material and methods A cross-sectional, descriptive, population-based multicenter study was conducted. The selection criteria consisted of having a diagnosis of uveitis. All data were collected from existing information in medical records. Clinical information was collected in all cases that had a diagnosis of uveitis, regardless of its etiology, in participating centers from the date of the study to the end of the following year. All patients underwent a complete ophthalmological examination, which included assessment of their visual acuity, biomicroscopy, applanation tonometry, and indirect ophthalmoscopy. Results During the study, 389 cases of uveitis were registered. The prevalence was 58.7 (95% confidence interval [CI] 53.0–64.9). The mean age was 47.0 ± 20.6 years and 57.8% were women. The most prevalent anatomical pattern was anterior uveitis (54.2; 95% CI 48.1–60.8). For adults, the idiopathic group constituted the highest prevalence (31.7; 95% CI: 27.1–36.9), while autoimmune etiology was most frequent for children (10.6; 95% CI: 5.8–17.7). Conclusion The results of this population-based study offer a representative estimate of the magnitude of uveitis in this area of Spain.

Benefit of adjuvant chemotherapy in high-risk colon cancer: A 17-year population-based analysis of 6131 patients with Union for International Cancer Control stage II T4N0M0 colon cancer

BackgroundThe benefit of adjuvant chemotherapy in Union for International Cancer Control (UICC) stage III colon cancer has been demonstrated in numerous studies. While adjuvant chemotherapy is generally not recommended in stage II patients, its role in high-risk UICC stage II disease (e.g. T4 tumours) remains controversial. MethodsThe present population-based multicenter cohort study investigated the influence of adjuvant chemotherapy on survival and recurrence rates in high-risk UICC stage II T4N0M0 tumours. Based on an anonymised nationwide ADT data set from 31 clinical cancer registries, we identified a total of 6651 patients with a T4 tumour of the colon, of whom 6131 were eligible for survival analysis. A matched-pair analysis based on propensity scores (PSM) was performed with a subset of 3986 patients. ResultsMultivariable analyses demonstrated a significant benefit of adjuvant chemotherapy for overall survival (OS) (hazard ratio [HR]: 0.711, 95% confidence interval [CI]: 0.643–0.785, p < 0.001), cumulative recurrence rate (HR: 0.780, 95% CI: 0.681–0.893, p < 0.001), and recurrence-free survival (HR: 0.715, 95% CI: 0.652–0.785, p < 0.001) further confirmed by the matched-pair cohort. ConclusionThis large and representative study demonstrated a significant advantage of adjuvant chemotherapy for patients with T4 UICC stage II colon cancer in terms of OS, recurrence rate, and relapse-free survival. Based on these results, adjuvant chemotherapy should be recommended for these patients.

Lymph node ratio as a predictor for outcome in oral squamous cell carcinoma: a multicenter population-based cohort study

ObjectivesRecently, multiple studies addressed the importance of lymph node ratio (LNR) in specifying patients’ risk of disease recurrence in various malignancies. The present study examines the prognostic significance of LNR in predicting outcome of oral squamous cell carcinoma (OSCC) patients after surgical treatment with curative intent.MethodsHere, we describe a retrospective population-based cohort with 717 patients previously diagnosed with OSCC. Histopathologically verified lymph node metastasis was diagnosed in 290 patients. Among these patients, we evaluated the impact of LNR on overall survival (OAS) and recurrence-free survival (RFS) in uni- as well as multivariate analysis.ResultsA median cutoff (0.055) in LNR was found to significantly predict outcome in OSCC patients. Five-year OAS was 54.1% in patients with a low LNR, whereas a high LNR was associated with a 5-year OAS of 33.3% (p < 0.001). Similar results were detected for RFS with a 5-year survival rate of 49.8% (LNR low) and 30.3% (LNR high) (p = 0.002). Results were confirmed in multivariate Cox regression which substantiated the importance of LNR in predicting survival in OSCC patients.ConclusionsLNR was shown to be an independent prognostic factor for outcome of OSCC in a population-based cohort in uni- as well as multivariate analysis. Hereby, a LNR ≥ 0.055 predicted a shorter OAS and RFS in our cohort.Clinical relevanceBesides established histopathological factors, LNR can be used as a reliable predictor of outcome in OSCC and might therefore be further applied in evaluating adjuvant treatment after resection in curative intention.

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults

Rapid eye movement (REM) sleep has been linked with health outcomes, but little is known about the relationship between REM sleep and mortality. To investigate whether REM sleep is associated with greater risk of mortality in 2 independent cohorts and to explore whether another sleep stage could be driving the findings. This multicenter population-based cross-sectional study used data from the Outcomes of Sleep Disorders in Older Men (MrOS) Sleep Study and Wisconsin Sleep Cohort (WSC). MrOS participants were recruited from December 2003 to March 2005, and WSC began in 1988. MrOS and WSC participants who had REM sleep and mortality data were included. Analysis began May 2018 and ended December 2019. All-cause and cause-specific mortality confirmed with death certificates. The MrOS cohort included 2675 individuals (2675 men [100%]; mean [SD] age, 76.3 [5.5] years) and was followed up for a median (interquartile range) of 12.1 (7.8-13.2) years. The WSC cohort included 1386 individuals (753 men [54.3%]; mean [SD] age, 51.5 [8.5] years) and was followed up for a median (interquartile range) of 20.8 (17.9-22.4) years. MrOS participants had a 13% higher mortality rate for every 5% reduction in REM sleep (percentage REM sleep SD = 6.6%) after adjusting for multiple demographic, sleep, and health covariates (age-adjusted hazard ratio, 1.12; fully adjusted hazard ratio, 1.13; 95% CI, 1.08-1.19). Results were similar for cardiovascular and other causes of death. Possible threshold effects were seen on the Kaplan-Meier curves, particularly for cancer; individuals with less than 15% REM sleep had a higher mortality rate compared with individuals with 15% or more for each mortality outcome with odds ratios ranging from 1.20 to 1.35. Findings were replicated in the WSC cohort despite younger age, inclusion of women, and longer follow-up (hazard ratio, 1.17; 95% CI, 1.03-1.34). A random forest model identified REM sleep as the most important sleep stage associated with survival. Decreased percentage REM sleep was associated with greater risk of all-cause, cardiovascular, and other noncancer-related mortality in 2 independent cohorts.

Prevalence of Sj\xf6gren\u2019s syndrome in the general adult population in Spain: estimating the proportion of undiagnosed cases

To estimate the prevalence of Sjögren’s syndrome (SS) in the adult Spanish population we performed a population-based multicenter cross-sectional study. Cases were defined by the American-European Consensus Group criteria proposed in 2002. A total of 4,916 subjects aged 20 years or over were included. The estimated prevalence of SS (including primary and secondary forms) in the adult population in Spain was 0.33% (95% CI 0.21–0.53). Extrapolating to the total population of the country aged ≥ 20 years (around 37.7 million persons), there would be around 125,000 cases of SS in Spain. Considering only primary SS, the estimated prevalence was 0.25% (95% CI 0.15–0.43) or 1 person in 400. The prevalence of primary SS in Spain is comparable to that reported in other European studies with a similar design and diagnostic criteria. Based on these results, primary SS could not be considered a rare (orphan) disease. Only 50% of cases had already been diagnosed with SS prior EPISER 2016 study, confirming the existence of a non-negligible proportion of undiagnosed cases in the general population.