Nationwide Population-based Analysis Research Articles

Cancer risks of patients with Graves' disease who received antithyroid drugs as initial treatment: A nationwide population-based analysis.

Population-based studies that examining the associations between hyperthyroidism and cancer risk have yielded inconsistent results. It remains unclear whether the risks of different cancers increase in patients with Graves' disease (GD) who received antithyroid drugs as initial treatment. We aimed to determine whether cancer risk increases in patients with GD, compared to controls. This nationwide retrospective cohort study utilized data from the National Health Information Database of South Korea. We included 29,502 patients aged >20 years with GD who received antithyroid drugs as initial treatment and 57,173 age and sex matched controls. The primary outcome was the incidence of various types of cancers. Hazard ratios (HR) with 95% confidence intervals (CI) for cancer risk were estimated using Cox proportional hazards models. We also analyzed HR by follow-up period since the diagnosis of GD, accounting for surveillance effect. The risk of biliary tract and pancreatic cancers (HR: 1.41, 95% CI: 1.24-1.60), thyroid cancer (HR: 15.51, 95% CI: 12.29-19.57), prostate cancer (HR: 1.48, 95% CI: 1.28-1.71), and ovarian cancer (HR: 1.31, 95% CI: 1.13-1.52) was elevated in the GD group than in the control group even after the first year of follow-up was excluded. The increased risk of these cancers persisted after a follow-up period of more than 5 years. The risk of thyroid cancer in patients with GD was higher during the initial follow-up period (1 - < 2 years) (HR: 19.35, 95% CI: 7.66-48.87) compared to that in the follow-up period exceeding 2 years. The cancer risk estimates remained significant after excluding patients with GD who underwent subsequent radioactive iodine therapy. In this large-scale population-based study, GD was associated with increased risks of biliary tract and pancreatic, prostate, ovarian, and thyroid cancers. The increased risk of thyroid cancer, particularly during the initial follow-up period, may be a surveillance effect.

Associations between diabetes mellitus and subsequent non-communicable diseases in Indonesia

ObjectiveTo understand how diabetes mellitus (DM) diagnosed at different ages of adulthood are associated with various incident subsequent non-communicable diseases (NCDs).MethodsWe performed a nationwide population-based analysis comparing 212 participants first diagnosed with DM at 20–39, 40–49, 50–59, or 60–69 years of age, with 17,541 participants without DM history, using data from the Indonesian Family Life Survey. Subsequent NCDs that were examined included hypertension, lung diseases, heart diseases, arthritis, liver diseases, kidney diseases, and digestive diseases. We estimated weighted risk ratios and 95% confidence intervals using Poisson regression, adjusting for age, sex, urbanicity, and tobacco use history.ResultsThose diagnosed with DM in all age groups had significantly higher risk of hypertension, compared with those without DM history. Compared with those without DM history, younger individuals with DM diagnosed at 20–39 years of age had significantly higher risks of lung diseases and arthritis, and those with DM diagnosed at 20–49 years of age had significantly higher risk of digestive diseases. Older individuals with DM diagnosed at 40–69 years of age had significantly higher risk of liver diseases, and those with DM diagnosed at 40–59 years of age had significantly higher risk of heart diseases, compared with those without DM history. Participants with DM were diagnosed with subsequent NCDs at younger ages compared with those without DM history.ConclusionOur findings contribute to health surveillance and may promote beneficial lifestyle changes in those with early-onset and later-onset DM, which can help prevent subsequent NCDs and improve public health.

High deductible health plans and survival among cancer survivors.

11005 Background: High deductible health plans (HDHP) enable lower premiums at the expense of potentially high out-of-pocket costs. They are associated with more advanced cancer stage diagnoses and delayed or forgone care among cancer survivors. However, it is unknown how HDHPs are associated with survival among cancer survivors. Methods: Individuals ages 18-84 years with non-Medicaid insurance were identified from the 2011-2018 National Health Interview Survey (NHIS) with linked mortality files from the National Death Index. HDHP status was defined by the NHIS as a yearly deductible ≥$1200-1350 for an individual or ≥2400-$2700 for a family (values depend on survey year with increases over time). Cox proportional hazards models using age as the time scale were utilized to determine: 1) association of HDHP status with overall survival (OS) and cancer survival (CS; i.e., freedom from cancer death) among cancer survivors, and 2) how associations differed for survivors compared to those without a cancer history. Models accounted for the NHIS survey design and survey weights and were adjusted for insurance status, marital status, sex, comorbidities, education, income, national region, and cancer site and time since cancer diagnosis (if applicable). Sensitivity analyses adjusting for age at cancer diagnosis were performed using time since diagnosis as the time scale. Results: A total of 147,254 respondents were identified, 5.9% of whom were cancer survivors. 25.6% of survivors and 28.5% of individuals without a cancer history reported being insured by a HDHP at the time of NHIS participation. HDHP status was associated with worse OS (HR: 1.46, 95% CI = 1.19 - 1.79) and CS (HR: 1.34, 95% CI = 1.01 - 1.77) among cancer survivors overall in the adjusted model. HDHP status was additionally associated with worse OS among the following subgroups of cancer survivors: non-Hispanic White (HR: 1.45, 95% CI = 1.16 - 1.82), income &gt; 400% federal poverty level (HR: 1.65, 95% CI = 1.16 - 2.36), college (HR: 1.47, 95% CI = 1.07 – 2.00) or high school (HR: 1.59, 95% CI = 1.19 - 2.12) education, and multiple cancers (HR: 1.58, 95% CI = 1.06 - 2.36), without clear patterns by sex, comorbidities, insurance, and cancer site. Sensitivity analyses provided similar results. In contrast, among adults without a history of cancer at the time of NHIS participation, HDHP status was not significantly associated with OS (HR: 1.08, 0.96 - 1.21; Pinteraction &lt; .01) or CS (HR: 0.90, 95% CI = 0.70 - 1.14; Pinteraction &lt; .01). Conclusions: This nationwide population-based analysis suggests that HDHPs are associated with both worse overall survival and cancer survival among cancer survivors but are not associated with survival in adults without a history of cancer. HDHPs may financially disincentivize cancer survivors from utilizing necessary medical care to optimize survivorship thereby compromising mortality and cure. Policy changes to limit the proliferation of these plans may improve cancer outcomes.

The impact of the SARS-CoV2 pandemic on the prescription of thyroid medication in Austria – A nationwide population-based registry analysis

BackgroundCase reports indicate a clinical connection between SARS-CoV-2 and thyroid dysfunctions. However, evidence from large population-based registry analyses is sparse, especially in Europe, where iodine deficiency is common. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare provision for thyroid diseases in Austria. MethodsWe performed a retrospective, population-based registry analysis of the Austrian health insurance fund database, covering more than 9 million inhabitants. Data from all patients with prescriptions of thyroid-specific drugs and/or inpatient thyroid-related diagnoses from 2017 to 2019 (pre-pandemic years) were compared to 2020 and 2021 (pandemic years; characterized by high numbers of SARS-CoV2 infections and population-wide vaccination strategy). The incidence rates of thyroid medication prescriptions for hypothyroidism and hyperthyroidism were calculated for every year to evaluate the impact of the pandemic. ResultsThe incidence rate for total thyroid medication prescription was 539.07/100,000 individuals (534.23–543.93 95%CI) in 2018 and declined during the pandemic (2020: 387.19/100,000 (383.12–391.29 95%CI); 2021: 336.90/100,000 (333.11–340.73 95%CI)). Similarly, the incidence rate for levothyroxine prescription was higher pre-pandemic (2018: 465.46/100,000 (460.97–469.98 95%CI) and declined during the pandemic (2020: 348.14/100,000 (344.28–352.03 95%CI); 2021: 300.30/100,000 (296.7–303.91 95%CI). The incidence rates of thiamazole prescriptions (2018: 10.24/100,000 (9.58–10.93 95%CI); 2020: 8.62/100,000 (8.03–9.26 95%CI); 2021: 11.17/100,000 (10.49–11.89 95%CI) were stable. ConclusionsThese findings suggest no clinically significant impact of SARS-CoV2 and/or vaccination on thyroid function at a population level.

Effect of major trauma on the expected number of births in Finnish women: A nationwide population-based public data and register analysis.

The effect of major trauma on subsequent fertility is poorly described. If women have lower fertility after trauma, they would have a lower risk of anti-D mediated hemolytic disease of the fetus and newborn in a future pregnancy following the transfusion of RhD-positive blood to RhD-negative women during their resuscitation. Data was obtained from the Care Register for Health Care, National Medical Birth Register, and open access data from Statistic Finland to evaluate the effect of major trauma (traumatic brain injuries, spine, pelvic, hip/thigh fractures) on the age-specific number of births during years 1998-2018. The total number of births before a specific maternal age for different trauma populations was calculated and these were compared to the corresponding number of births in the general population. There were 50,923 injured women in this study. All injured women, including when analyzed by the nature of their injury, demonstrated lower expected numbers of births starting at approximately 28 years of age compared to the general population of women in Finland. At age 49, the expected number of births in the general population was approximately 1.8, whereas for all injured women 0.6, women with TBIs and spine fractures 0.6, women with pelvic fractures 0.5, and women with hip or thigh fractures 0.3. Injured women are predicted to have lower fertility rates compared to the general population of Finnish women. The lower fertility rate should be considered when planning a blood product resuscitation strategy for injured women.

479 Differences in time of birth between spontaneous and operative vaginal births: a nationwide population-based analysis

479 Differences in time of birth between spontaneous and operative vaginal births: a nationwide population-based analysis

Epidemiological characterization of ischemic heart disease at different altitudes: A nationwide population-based analysis from 2011 to 2021 in Ecuador.

Cardiovascular diseases, including ischemic heart disease, are the leading cause of premature death and disability worldwide. While traditional risk factors such as smoking, obesity, and diabetes have been thoroughly investigated, non-traditional risk factors like high-altitude exposure remain underexplored. This study aims to examine the incidence and mortality rates of ischemic heart disease over the past decade in Ecuador, a country with a diverse altitude profile spanning from 0 to 4,300 meters. We conducted a geographic distribution analysis of ischemic heart disease in Ecuador, utilizing hospital discharge and mortality data from the National Institute of Census and Statistics for the years 2011-2021. Altitude exposure was categorized according to two distinct classifications: the traditional division into low (< 2,500 m) and high (> 2,500 m) altitudes, as well as the classification proposed by the International Society of Mountain Medicine, which delineates low (< 1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m), and very high (3,500-5,800 m) altitudes. From 2011-2021, we analyzed 49,765 IHD-related hospital admissions and 62,620 deaths. Men had an age-adjusted incidence rate of 55.08/100,000 and a mortality rate of 47.2/100,000, compared to 20.77/100,000 and 34.8/100,000 in women. Incidence and mortality surged in 2020 by 83% in men and 75% in women. Altitudinal stratification revealed higher IHD rates at lower altitudes (<2500 m), averaging 61.65 and 121.8 per 100,000 for incidence and mortality, which declined to 25.9 and 38.5 at elevations >2500 m. Men had more pronounced rates across altitudes, exhibiting 138.7% and 150.0% higher incidence at low and high altitudes respectively, and mortality rates increased by 48.3% at low altitudes and 23.2% at high altitudes relative to women. Ecuador bears a significant burden of ischemic heart disease (IHD), with men being more affected than women in terms of incidence. However, women have a higher percentage of mortality post-hospital admission. Regarding elevation, our analysis, using two different altitude cutoff points, reveals higher mortality rates in low-altitude regions compared to high-altitude areas, suggesting a potential protective effect of high elevation on IHD risk. Nevertheless, a definitive dose-response relationship between high altitude and reduced IHD risk could not be conclusively established.

Postoperative survival after lumbar instrumented surgery for metastatic spinal tumors: a nationwide population-based cohort analysis.

It is difficult to predict the expected survival after lumbar instrumented surgery for metastases owing to the difference among different cancer origins and the relatively short survival after surgery. The aim of this study is to analyze the postoperative survival period of lumbar spinal metastasis patients who underwent lumbar instrumented surgery. Data were collected from the Korean National Health Insurance Review and Assessment Service database. Patients who underwent lumbar spinal surgery with instrumentation between January 2011 and December 2015 for metastatic lumbar diseases were reviewed. The mean postoperative survival period of patients with metastatic lumbar cancer according to each primary cancer type was evaluated. A total of 628 patients were enrolled and categorized according to primary cancer type. The overall median survival rate was 1.11±1.30 years. The three most prevalent primary cancer groups were lung, hepatobiliary, and colorectal cancers, presenting relatively short postoperative survival rates (0.93±1.25, 0.74±0.75 and 0.74±0.88 years, respectively). The best postoperative survival period was observed in breast cancer (2.23±1.83 years), while urinary tract cancer showed the shortest postoperative survival period (0.59±0.69 years). The postoperative survival period of patients with lumbar metastatic spinal tumors according to different primary cancers after instrumented fusion was ˃1 year overall, with differences according to different primary origins. This result may provide information regarding the expected postoperative survival after instrumented surgery for lumbar spinal metastases.

Effects of the COVID-19 Pandemic on H&N SCCa Incidence: A Population-based Analysis.

The LaryngoscopeEarly View Rapid Communication Effects of the COVID-19 Pandemic on H&N SCCa Incidence: A Population-based Analysis Neel R. Sangal MD, Corresponding Author Neel R. Sangal MD [email protected] orcid.org/0000-0002-8221-8438 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Send correspondence to Neel R. Sangal, MD, Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19107, USA. Email: [email protected]Search for more papers by this authorPraneet Kaki BS, Praneet Kaki BS Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USASearch for more papers by this authorJason Brant MD, Jason Brant MD orcid.org/0000-0002-3492-0679 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USASearch for more papers by this authorRobert M. Brody MD, Robert M. Brody MD orcid.org/0000-0001-6639-8830 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USASearch for more papers by this author Neel R. Sangal MD, Corresponding Author Neel R. Sangal MD [email protected] orcid.org/0000-0002-8221-8438 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Send correspondence to Neel R. Sangal, MD, Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19107, USA. Email: [email protected]Search for more papers by this authorPraneet Kaki BS, Praneet Kaki BS Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USASearch for more papers by this authorJason Brant MD, Jason Brant MD orcid.org/0000-0002-3492-0679 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USASearch for more papers by this authorRobert M. Brody MD, Robert M. Brody MD orcid.org/0000-0001-6639-8830 Department of Otolaryngology – Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USASearch for more papers by this author First published: 05 June 2023 https://doi.org/10.1002/lary.30804 Editor's Note: This Manuscript was accepted for publication on May 21, 2023 The authors have no other funding, financial relationships, or conflicts of interest to disclose. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. BIBLIOGRAPHY 1Pujolar G, Oliver-Angles A, Vargas I, Vazquez ML. Changes in access to health services during the COVID-19 pandemic: a scoping review. Int J Environ Res Public Health. 2022; 19(3): 1749. 2Rygalski CJ, Zhao S, Eskander A, et al. Time to surgery and survival in head and neck cancer. Ann Surg Oncol. 2021; 28(2): 877- 885. 3Flynn W, Maqsood R, Maseland T, Montgomery J, Douglas C. Advancing head and neck cancer following the coronavirus disease 2019 pandemic. J Laryngol Otol. 2022; 136(11): 1118- 1124. 4Doll KM, Rademaker A, Sosa JA. Practical guide to surgical data sets: surveillance, epidemiology, and end results (SEER) database. JAMA Surg. 2018; 153(6): 588- 589. 5Schoonbeek RC, de Jel DVC, van Dijk BAC, et al. Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: a nationwide population-based analysis. Radiother Oncol. 2022; 167: 42- 48. 6Okuyama A, Watabe M, Makoshi R, Takahashi H, Tsukada Y, Higashi T. Impact of the COVID-19 pandemic on the diagnosis of cancer in Japan: analysis of hospital-based cancer registries. Jpn J Clin Oncol. 2022; 52(10): 1215- 1224. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Prevalence and risk of type 2 myocardial infarction (T2MI) in adults with depression and its impact on in-hospital outcomes: a nationwide population-based analysis in the USA (2019)

Abstract Funding Acknowledgements Type of funding sources: None. Background Type 2 myocardial infarction (T2MI) is an ischaemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with T1MI, data remains non-existent to evaluate the association with T2MI. Therefore, we aim to identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes. Methods We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using ICD-10 codes in hospitalized adults ( ≥18 years). In addition, we compared sociodemographics and comorbidities in the T2MI cohort with vs. without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs. without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke); adjusting for confounders. Statistical significance was achieved with p-value of &amp;lt;0.05. Results There were 331,145 adult T2MI hospitalizations after excluding T1MI (median age 73 years, 52.8% male, 69.9% white); 41,405 (12.5%) had depression, the remainder; 289,740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression vs without (aOR 0.88, 95% CI 0.86-0.90, p= 0.001).There was equal prevalence of prior MI with any revascularization and similar prevalence of peripheral vascular disease in cohort with depression vs without depression. There is a greater prevalence of stroke in patients with depression 10.1% vs those without 8.6 %. There was a slightly higher prevalence of hyperlipidaemia in patients with depression vs without depression; (56.5% vs 48.9%), as well as obesity (21.3% vs 17.9%) There was generally equal prevalence of HTN and T2DM in both cohorts. There was no significant difference in the frequency of elective and non-elective admissions between cohorts. Patients with depression vs without depression also showed a lower risk of all-cause mortality (aOR 0.75, 95%CI 0.67-0.83, p= 0.001), Cardiogenic shock (aOR 0.65, 95%CI 0.56-0.76, p= 0.001), Cardiac arrest (aOR 0.77, 95%CI 0.67-0.89, p= 0.001) as well as Stroke (aOR 0.79, 95%CI 0.70-0.89, p= 0.001). Conclusions This study revealed a significantly lower risk of T2MI in patients with depression vs. without depression. The data also showed a significant decrease in adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest and stroke in patients with depression vs. without depression. Further prospective studies are warranted to assess the impact of depression on other in-hospital outcomes as well as the impact of medication, its duration and serotonin levels on T2MI.

A260 PYOGENIC LIVER ABSCESS FORMATION SIX MONTHS AFTER PERFORATED APPENDICITIS IN AN OTHERWISE HEALTHY CHILD

Abstract Background Pyogenic liver abscesses (PLA) in children are uncommon in the developed world. When they are diagnosed, it is often in patients with hepatobiliary cancers, biliary diseases and liver transplants. PLA post perforated appendicitis has been reported as an aetiology in non-immunocompromised children. Reported cases of PLA’s developing as a late complication of perforated appendicitis are rare. The longest time from appendicitis to PLA diagnosis previously reported was four months. Purpose To report a rare case of liver abscess formation, post ruptured appendicitis, in a previously healthy and review the recent literature relevant to this topic. Method Retrospective chart review through electronic patient records was conducted for our reported case. Literature review of the relevant medical literature was performed. Result(s) Patient is an 11-year-old female with no significant past medical history apart from a perforated appendix requiring laparotomy for washout and 10 days of antibiotics, 6 months prior to presentation. The patient presented to her local emergency room with 6-week history of right flank pain and 10 days of fever. Abdominal ultrasound (US) identified a 3cm x 3cm x 3cm mass in the right lobe of the liver consistent with an abscess which was confirmed with magnetic resonance imaging (MRI). She was transferred to Toronto Hospital for Sick Children for management and investigation. At the Hospital for Sick Children she was started on Intravenous (IV) cefotaxime and metronidazole. After a repeat US on transfer it was determined the liver abscess was not amenable to drainage. Echinococcosis and Entamoeba serology were negative and neutrophil oxidative burst test (NOBT) test was within normal limits. Liver enzymes never exceeded 2x the upper limit of normal and synthetic function remained intact. After 7 days of IV antibiotics the patient’s inflammatory markers had improved and she had remained afebrile, but repeat US and MRI showed little to no change in abscess size. The decision was made for a prolonged course of IV antibiotics. After another two weeks of IV antibiotics her repeat US showed reduction in abscess size by roughly one third, and she was switched to oral antibiotics, after a total of 28 days, for a further four weeks with ongoing improvement. Conclusion(s) A review of the literature identified one nationwide population-based analysis in the United States reporting 4075 cases of PLAs, as well as three single centre reviews, from Iran, Tailand and the United Kingdom, reporting 18, 15 and 38 cases of liver abscesses, respectively. Common underlying aetiologies included primary immunodeficiency’s, liver transplantation, hepatobiliary cancers and non-PLA intra-abdominal infections. Managements included IV antibiotics plus/minus drainage when amenable. No cases of liver failure or death were reported. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

The Timing of Pregnancies After Bariatric Surgery has No Impact on Children’s Health—a Nationwide Population-based Registry Analysis

PurposeBariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children’s outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12–24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied.Materials and MethodsA nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring’s data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months.ResultsOverall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval.ConclusionPregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.Graphical

1523P Incidence and geographic distribution of bone and soft tissue sarcoma in Japan using a nationwide population-based analysis: 69,734 cases

Bone and soft tissue sarcomas are rare and heterogenetic diseases. Each subtype has unique epidemiology, etiology, molecular profile, and prognosis. According to previous studies, genetic predisposition causes some sarcoma. Additionally, studies have identified environmental and occupational factors, such as chemicals and pesticides. However, these results need further validation. This study analyzed the incidence and geographic distribution of bone and soft tissue sarcoma cases in Japan. It aimed to determine the risk factors and develop strategies for prevention and early detection of sarcoma.

1633P The correlation between the geographical distribution of asbestos-exposed workplaces and the increased risk of developing malignant mesothelioma, lung cancer, laryngeal cancer, and ovarian cancer: A nationwide population-based analysis in Japan

Asbestos exposure causes some malignancies. Several studies and financial aids for mesothelioma patients are available but are limited for other malignancies. This study aimed to determine the distribution of incidence and the association of malignancies with asbestos exposure.

Hypertension and diabetes including their earlier stage are associated with increased risk of sudden cardiac arrest

Sudden cardiac arrest (SCA) is a medical disaster for both the victim and the society. Despite intrinsic limitations in the management of SCA, primary prevention has been overlooked and risk factors for SCA are not fully understood. We aimed to evaluate whether hypertension and diabetes mellitus (DM), including pre-hypertension and impaired fasting glucose (IFG), are associated with increased risk of SCA. We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 were enrolled. The risk of SCA was evaluated in people with hypertension and DM with a clinical follow-up through December 2018. A total of 4,056,423 people with 33,345,378 person-years of follow-up and 16,352 SCA events were examined. People with hypertension had 65.4% increased risk of SCA (adjusted hazard ratio [HR] = 1.654 [1.572–1.739]; p < 0.001). Pre-hypertension was also associated with 21.3% increased risk of SCA (adjusted HR = 1.213 [1.158–1.272]; p < 0.001). People who had IFG and DM showed 7.5% (adjusted HR = 1.075 [1.035–1.117]; p < 0.001) and 80.1% (adjusted HR = 1.801 [1.731–1.875]; p < 0.001) increased risk of SCA, respectively. People with DM who took anti-diabetic medication showed significantly lower risk of SCA compared with uncontrolled DM patients (fasting glucose ≥ 200 mg/dL) (adjusted HR = 0.625 [0.533–0.733]; p < 0.001). Coexistence of hypertension and DM was associated with an even higher risk of SCA (adjusted HR = 3.078 [2.877–3.293]; p < 0.001). In conclusion, the risk of SCA is significantly higher in people with hypertension and DM, including pre-hypertension and IFG. Adequate control of blood pressure and serum glucose can have a profound impact for the primary prevention of SCA in the general population.

Radioactive Iodine Treatment for Thyroid Cancer Patients Increases the Risk of Long-Term Gastrointestinal Disorders: A Nationwide Population-Based Cohort Analysis.

Simple SummaryThe standard treatment for well-differentiated thyroid cancer is thyroidectomy followed by radioactive iodine (RAI) treatment or active surveillance. Despite adequate documentation of acute gastrointestinal adverse effects after RAI treatment, whether the gastrointestinal exposure causes long-term comorbidity or not remained unclear. We conducted a nationwide, population-based retrospective cohort study using the data from the Taiwan National Health Insurance Research Database (NHIRD) to clarify the association between long-term gastrointestinal disorders (including ulcers, atrophic gastritis, and secondary stomach malignancy) and RAI treatment in thyroid cancer patients. We found that patients with RAI treatment were at a significantly higher risk of developing gastric and duodenal ulcers than those without. In addition, a higher cumulative dose is associated with higher risk. Therefore, follow-ups at gastrointestinal clinics might be of great importance for patients presenting with chronic gastrointestinal discomforts, after receiving a single RAI dose of more than 1.11 GBq, and undergoing repeated treatment due to recurrent or residual thyroid cancer.(1) Background: The study aimed to investigate the association between radioactive iodine (RAI) treatment and long-term gastrointestinal disorders including ulcers, atrophic gastritis, and secondary malignant neoplasm of the stomach in patients with thyroid cancer. (2) Methods: The data of the study were extracted from the National Health Insurance Database (NHIRD) of Taiwan between 2000 to 2015. Patients of ages older than 20 with thyroid cancer after thyroidectomy were included and divided into groups with RAI (study cohort) and without RAI (comparison cohort). Multivariate Cox proportional hazards regression analysis and the Kaplan–Meier method were used for statistical analysis. (3) Results: A total of 7250 (with RAI: 5800, without RAI: 1450) patients were included. The Kaplan-Meier analysis revealed a significantly higher cumulative risk for overall gastrointestinal disorders in the group with RAI (log-rank p = 0.034). The risk for gastrointestinal disorders was higher when receiving a cumulative RAI dose higher than 1.11 GBq in the Cox regression analysis. In the subgroup analysis, the risks of gastric and duodenal ulcers are significantly higher in the group with RAI treatment. (4) Conclusions: This study revealed that RAI was associated with an increased risk for long-term gastrointestinal disorders, specifically gastric and duodenal ulcers, in thyroid cancer, especially when the cumulative dose exceeds 1.11 GBq.

Risk of adverse fetal outcomes following nonobstetric surgery during gestation: a nationwide population-based analysis

BackgroundLiterature suggests that nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion, prematurity, and a higher cesarean section rate, but the direct impact on fetal outcomes is still unclear. In this study, we aimed to investigate whether nonobstetric surgery during pregnancy is associated with negative fetal outcomes by analysing a nation-wide database in Taiwan.MethodsThis population-based retrospective observational case–control study was based on the linkage of Taiwan’s National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database between 2004 and 2014. For every pregnancy with nonobstetric surgery during gestation, four controls were randomly matched according to maternal age and delivery year. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of adverse fetal outcomes with the non-surgery group as the reference. The primary outcomes involved stillbirth, prematurity, low birth weight, low Apgar scores, and neonatal and infant death.ResultsAmong 23,721 identified pregnancies, 4,747 underwent nonobstetric surgery. Pregnancies with nonobstetric surgery had significantly higher risks of prematurity (aOR: 1.46; 95% CI: 1.31–1.62), lower birth weight (aOR: 1.49; 95% CI: 1.33–1.67), Apgar scores < 7 (1 min, aOR: 1.58; 95% CI: 1.33–1.86; 5 min, aOR: 1.34; 95% CI: 1.03–1.74), neonatal death (aOR: 2.01; 95% CI: 1.18–3.42), and infant death (aOR: 1.69; 95% CI: 1.12–2.54) than those without nonobstetric surgery after adjustment for socioeconomic deprivation, hospital level, and other comorbidities. Surgery performed in the third trimester was associated with a significantly increased rate of prematurity (aOR: 1.38; 95% CI: 1.03–1.85), but lower rates of stillbirth (aOR: 0.1; 95% CI: 0.01–0.75) and Apgar score < 7 at the 5th minute (aOR: 0.2; 95% CI: 0.05–0.82), than surgery performed in the first trimester.ConclusionsPregnancies with nonobstetric surgery during gestation were associated with increased risks of prematurity, low birth weight, low Apgar scores, neonatal and infant death, longer admission, and higher medical expenses than those without surgery. Furthermore, surgery in the third trimester was associated with a higher rate of prematurity than surgery performed in the first trimester.Trial registrationNot applicable.

Frequency, risk and predictors of type 2 myocardial infarction hospitalizations in young obese patients: A nationwide population-based analysis in the United States

Abstract Funding Acknowledgements Type of funding sources: None. Background Obesity in the young population is emerging as a challenging health concern. Though there is a rising prevalence of obesity and its potential association with demand ischemia-related myocardial infarction, data remains non-existent to evaluate the association of obesity or higher body mass index (BMI) with type 2 myocardial infarction (T2MI). We aim to identify the frequency, risk and predictors of T2MI in young hospitalized obese patients compared to non-obese patients in this population-based study. Methods We used National Inpatient Sample (2018, ICD-10 codes) to identify T2MI in young (18-44 years) hospitalized patients. Obesity was identified from comorbidities or using diagnostic codes for BMI&amp;gt;30 kg/m2. We performed multivariable regression analysis for the primary outcome of odds of T2MI in young obese patients compared to non-obese patients. The frequency of T2MI was compared between obese vs non-obese patients in overall and subgroup populations. Sociodemographic characteristics and comorbidities in T2MI-obese vs. T2MI-non-obese cohorts were also compared. A p&amp;lt;0.05 was considered a threshold for statistical significance. Results Out of 1,268,255 young hospitalized patients with obesity, 555 had T2MI. T2MI was significantly higher in young obese than non-obese (44 T2MI/100000 hospitalizations in young obese patients vs. 17 T2MI/100000 hospitalizations in young non-obese patients, overall 0.04% in obese vs. 0.02% in non-obese, p&amp;lt;0.001). Multivariate analysis revealed higher odds of T2MI in obese than nonobese when adjusted for demographics (aOR 2.65, 95% CI:2.42-2.90, p&amp;lt;0.001) and social demographics with comorbidities (aOR 1.60, 95% CI:1.24-2.07, p&amp;lt;0.001). In young obese, higher risk was found with advancing age (OR 1.07, 95% CI 1.03-1.11, p=0.001), in males than females (aOR 2.70, p&amp;lt;0.001), and blacks (aOR 2.22, p=0.011) and Native Americans (OR 3.91, 95% CI: 1.13-13.49, p=0.011) vs whites. Comorbidities including chronic obstructive pulmonary disease (OR 1.86), chronic kidney disease (CKD, OR 2.36), rheumatoid arthritis/collagen vascular disease (RA/CVD, OR 3.04) Iin young obese patients independently increased the risk of T2MI hospitalizations [Table 1]. The T2MI-obese cohort had a significantly higher rate of hyperlipidemia, hypertension, diabetes, COPD, and prior history of MI and TIA/stroke compared to the T2MI-nonobese cohort [Table 2]. Conclusion This nationwide analysis revealed a significantly higher risk of T2MI in young obese patients compared to nonobese after excluding patients with concomitant diagnoses of T1MI. Males, blacks compared to females and whites, and comorbidities including COPD, CKD and RA/CVD predicted a higher risk of T2MI in young obese patients. Future studies are warranted to evaluate the role of higher body mass index in myocardial oxygen demand-supply mismatch and short-term/long-term risk and outcomes of T2MI.

Non-fermented tea consumption protects against osteoporosis among Chinese male elders using the Taiwan biobank database.

Few studies compared the effects of non-fermented and fermented tea among the general population. We aimed to compare the risk of incident osteoporosis (OP) between non-fermented tea and fermented tea drinkers by this retrospective nationwide population-based analysis from the Taiwan Biobank. Participants ≥ 40 years who drink fermented tea (n = 2205) were compared with those who drink non-fermented tea (n = 1034) from 2008 to 2015 with a mean follow-up period of 3.64 years. OP was defined by T-score ≤ − 2.5. Multivariate Cox proportional hazards regression models were performed to estimate the risk of developing OP between the two groups. Separate models were used to determine the relationship between tea consumption and OP stratified by sex and age. There was a significant interaction between sex, age, and type of tea consumed. In men aged ≥ 60 years, the risk of developing OP decreased by 79% for those who drank non-fermented tea (hazard ratio, 0.21; 95% confidence level, 0.05–0.94) than those who drank fermented tea. Additionally, those with a family history of OP had a higher risk of developing osteoporosis. This study suggests that male elderly who consume non-fermented tea have a lower risk of OP. Drinking non-fermented tea, such as green tea, could be suggested, especially for those with a family history of osteoporosis.

Survival among people hospitalized with COVID-19 in Switzerland: a nationwide population-based analysis

BackgroundIncreasing age, male sex, and pre-existing comorbidities are associated with lower survival from SARS-CoV-2 infection. The interplay between different comorbidities, age, and sex is not fully understood, and it remains unclear if survival decreases linearly with higher ICU occupancy or if there is a threshold beyond which survival falls.MethodThis national population-based study included 22,648 people who tested positive for SARS-CoV-2 infection and were hospitalized in Switzerland between February 24, 2020, and March 01, 2021. Bayesian survival models were used to estimate survival after positive SARS-CoV-2 test among people hospitalized with COVID-19 by epidemic wave, age, sex, comorbidities, and ICU occupancy. Two-way interactions between age, sex, and comorbidities were included to assess the differential risk of death across strata. ICU occupancy was modeled using restricted cubic splines to allow for a non-linear association with survival.ResultsOf 22,648 people hospitalized with COVID-19, 4785 (21.1%) died. The survival was lower during the first epidemic wave than in the second (predicted survival at 40 days after positive test 76.1 versus 80.5%). During the second epidemic wave, occupancy among all available ICU beds in Switzerland varied between 51.7 and 78.8%. The estimated survival was stable at approximately 81.5% when ICU occupancy was below 70%, but worse when ICU occupancy exceeded this threshold (survival at 80% ICU occupancy: 78.2%; 95% credible interval [CrI] 76.1 to 80.1%). Periods with higher ICU occupancy (>70 vs 70%) were associated with an estimated number of 137 (95% CrI 27 to 242) excess deaths. Comorbid conditions reduced survival more in younger people than in older people. Among comorbid conditions, hypertension and obesity were not associated with poorer survival. Hypertension appeared to decrease survival in combination with cardiovascular disease.ConclusionsSurvival after hospitalization with COVID-19 has improved over time, consistent with improved management of severe COVID-19. The decreased survival above 70% national ICU occupancy supports the need to introduce measures for prevention and control of SARS-CoV-2 transmission in the population well before ICUs are full.