Personal Identification Number Research Articles

Racing against time: Emergency ambulance dispatches and response times, a register-based study in Region Zealand, Denmark, 2013-2022.

The global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times. This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities. Using administrative data from the Region Zealand emergency medical dispatch center, a register-based study spanning from January 1, 2013, to December 31, 2022, was conducted. Data were linked with nationwide registries and priority A (emergency), or B (urgent) ambulance dispatches were included. Trends were examined overall and stratified by catchment areas corresponding to the hospitals with emergency departments in the region. Poisson and ordinal logistic regressions were used to analyze data. The study encompassed 678,789 emergency ambulance dispatches, with 55.0% priority A and 45.0% priority B. Among these, 667,788 had a valid personal identification number allowing for further analysis. Within the study population, females comprised 48.5%, while 49.1% of patients were 65years or more. Overall, 47.5% of patients had no comorbidities, while 7.7% and 44.8% had mild and severe comorbidities, respectively. Emergency ambulance dispatches increased from 56,867 in 2013 to 81,080 in 2022 (143%). Correspondingly, the dispatch incidence rate per 1,000 residents per year increased from 69.2 to 95.5. Stratification by catchment areas revealed significant disparities. The median response time for priority A dispatches increased from 7min:14s in 2013 to 8min:20s in 2022 and for priority B dispatches from 12min:23s to 15min:6s. From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards.

Long-term outcomes in women diagnosed with heart failure in connection to delivery

Abstract Background Heart failure (HF) among young patients may be from various causes, often triggered by heightened physical demands like pregnancy. Data regarding outcomes of women diagnosed with HF in conjunction to pregnancy and delivery are varied. There remains a notable gap in understanding the outcomes observed in women diagnosed with heart failure in conjunction with delivery. Also, long-term follow-up studies are crucial to elucidate the impact of pregnancy-associated HF on future cardiovascular. Purpose To study the interplay between pregnancy, HF, and subsequent cardiovascular risk. Method Using the personal identification numbers (PINs) that all individuals in Sweden have enables linkage of data between different registers. Data from the National Patient Register (NPR), Swedish Medical Birth Register (MBR) and the Cause of Death Register were also used. All women 18 to 50 years of age registered in the in MBR in the period 1st January 1997 to 31st December 2019 were included. Women with first-time HF in relation to delivery were identified using the international classification code for diseases (ICD-10) I50, I42, I43 and 090.3 together with co-morbidities. Every patient was compared with 5 controls without HF from the Total Population Register matched on age at delivery and calendar year of delivery. Outcomes: all-cause mortality, and any cardiovascular disease (CVD) diagnosed during the observation time. Results A total of 286 cases and 1,430 controls were included. The prevalence of comorbidities at baseline for both patients and controls was low; congenital heart disease (1.4%, vs. 0%), pulmonary hypertension (1.0% vs. 0%), valvular heart disease (5.9% vs. 0%), myocardial infarction 0.7% vs. 0%), arrhythmia (5.9% vs. 0%), hypertension (6.3 % vs. 0.1%), (all p<0.05). Preeclampsia prior to HF diagnosis had 31% of patients vs. 0.2% of controls (p<0.001). Patients exhibited higher mortality rates at 4.9% during median follow up 9.0 (IQR 5.6-13.0) years vs. 0.3%, median follow up 9.4 (6.2-13.5) years and hazard ratios (HR) for all-cause mortality HR (95% CI) of 18.20 (5.99 - 55.31) (p<0.001) compared to controls. During median follow up of 3.2 (0.0-9.2) years 60.1% of patients were diagnosed with CVD both at in-/out-patient settings compared with 4.1% in controls during 9.4 (5.8-13.5) years of follow up. Comparing patients with controls the HR (95% CI) was 22.24 (16.50 - 29.96) p<0.0001 for CVD diagnosis during follow-up, see Figure 1. Conclusion In conjunction with delivery, and in the years thereafter, women with heart failure diagnosis had more than eighteen times higher risk of mortality than women without heart failure. The risk of CVD event in the heart failure group is highest in conjunction with delivery. Figure 1. Cumulative incidence functions for all-cause mortality, CVD in- or out-patient visit adjusted for death as competing risk, comparing cases with controls.

Impact of body mass index on aortic valve stenosis and its clinical outcomes in early adulthood: a long-term study of young men

Abstract Aims Studies investigating associations between body mass index (BMI), incidence of aortic valve stenosis (AVS), and clinical outcomes in AVS patients are scarce. Purpose To investigate the relationship between BMI in youth and subsequent diagnosis of AVS. A secondary aim was to determine the role of obesity in clinical outcomes in individuals diagnosed with AVS. Methods This was a nationwide, register-based cohort study of 1 701 390 men (mean age, 18.3 ±0.8 years) enrolled in compulsory conscription for military service in Sweden from 1969 through 2005. Anthropometrics, blood pressure, fitness, muscle strength and IQ were recorded at baseline. AVS cases and cardiovascular outcomes were identified according to the International Classification of Diseases (ICD)-10 registered in the National patient register and Cause of Death Register through the Swedish 12-digit personal identification number. BMI (kg/m2) was categorized as <18.5, 18.5–<20, 20–<22.5, 22.5–<25, 25–<27.5, 27.5 <30, 30–<35, and 35–<50 kg/m2. Cox proportional hazard models were used to estimate the association between adolescent BMI and future hospitalization for AVS while adjusting for potential confounders. The BMI reference was set as 20–<22.5. Those who developed AVS formed a subcohort that was followed until a first clinical cardiovascular outcome of death, cardiovascular mortality, Heart failure, Atrial fibrillation, myocardial infarction, or ischaemic stroke. Results During a median follow-up of 32 years (IQR, 24-41 years), 5766 cases (mean age 54.7±9.4 years) of AVS were diagnosed. After adjustment, underweight subjects with a BMI of <18.5 kg/m2, compared to those with a low-normal BMI (20.0–<22.5 kg/m2) showed lower risk (HR 0.70; 95% CI 0.61–0.80) of AVS. The multivariable-adjusted HR for AVS increased from HR 1.28; 95% CI 1.17–1.39 for BMI 22.5–<25 kg/m2 to HR 1.91; 95% CI 1.12–3.25 for those with BMI 35–50 kg/m2. Further on, individuals diagnosed with AVS were followed for a median of ~5.5 years. The multivariable-adjusted HR for all-cause mortality, cardiovascular mortality, and heart failure for obese (BMI 30–50 kg/m2), compared to BMI <20.0 kg/m2 in men diagnosed with AVS, were 4.69 (95% CI 2.61–8.44), 4.09 (95% CI 1.72–9.73), and 2.76 (95% CI, 1.36–5.60), respectively. Conclusions Elevated BMI in youth, even within the normal range, is associated with increased risk of developing AVS, while subnormal BMI was protective. Excess weight in youth diagnosed with AVS is associated with higher risk of subsequent clinical outcomes. These findings are novel, generating new questions as to potential mechanisms and implying more vigilant monitoring of patients with AVS and a history of obesity in youth.Figure 1Figure 2

Use of point-of-care tests in pharyngotonsillitis – a registry-based study in primary health care

Background Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing. Material and methods Retrospective data from 2012–2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing. Results Of 24,237 visits, 68% included RADT and 36% included a CRP test, with 89% of CRP tests performed alongside RADT. CRP testing was more frequent in patients with negative (56%) than positive RADTs (42%) (p < .001). Overall, 66% of RADTs were positive. Median CRP levels were 23 mg/l for positive RADT and 31 mg/l for negative RADT (p < .001). Antibiotics were prescribed for 95% of positive RADTs and 43% of negative RADTs (p < .001). In patients with negative RADTs, CRP testing was associated with higher antibiotic prescribing (57%) compared to no CRP testing (26%) (p < .001). Among these patients, CRP levels were associated with prescribing (aOR 1.032; 95% CI 1.029–1.035; p < .001), with 50% of prescriptions occuring at CRP levels ≤ 20 mg/l. Conclusion The use of RADTs and the proportion of positive test were higher than expected, indicating inappropriate use and diagnostic bias. CRP testing, contrary to guidelines, was common and associated with increased antibiotic prescribing.

Postoperative opioid use in Norway—a population-based observational study on patterns of long-term use

BackgroundThe utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown.MethodsThis study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days.ResultsThe study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age.ConclusionsThe proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain.Trial registrationThe study used national health registry data from the period 2010–2019. A pre-registered analysis plan is available at Open Science Framework.

Finding and Mitigating a Vulnerability of the Color Wheel PIN Protocol

There is an increasing usage in the banking sector of Smartphones enabled with Near Field Communication (NFC), to improve the services offered for the customers. This usage requires a security enhancement of the systems that employ this technology like the Automated Teller Machines (ATMs). One example is the Color Wheel Personal Identification Number (CWPIN) security protocol designed to authenticate users on ATMs using NFC enabled smartphones without typing the PIN code directly. CWPIN has been compared in the literature to several other protocols and was considered easier to use, more cost-effective and more resistant to various attacks on ATMs such as card reader skimming, keylogger injection, shoulder surfing, etc. Nevertheless, we demonstrate in this paper that CWPIN is vulnerable to the multiple video recordings intersection attack. We do so through concrete examples and a thorough analysis that reveals a high theoretical probability of attack success. A malicious party can use one or two hidden cameras to record the ATM and smartphone screens during several authentication sessions, then disclose the user's PIN code by intersecting the information extracted from the video recordings. In a more complex scenario, these video recordings could be obtained by malware injected into the ATM and the user's smartphone to record their screens during CWPIN authentication sessions. Our intersection attack requires a few recordings, usually three or four, to reveal the PIN code and can lead to unauthorized transactions if the user's smartphone is stolen. We also propose a mitigation of the identified attack through several modifications to the CWPIN protocol and discuss its strengths and limitations.

Enhancing cell phone security through finger vein biometric authentication systems

The growing demand for secure mobile devices has led to the widespread adoption of biometric technologies. While personal identification numbers (PINs), passwords, gridlock patterns to safeguard phones and facial recognition have become common, they have certain limitations in terms of security and user convenience. These conventional security measures are riddled with susceptibilities, such as password pilferage, memory lapses in authentication details, and user mistakes in grid pattern creation. Due to the rising occurrence of cell phone incursions and theft, there is an urgent requirement for a strong security system that not only defends data but also shields the device itself. This paper proposes a resilient finger vein biometric security system as a more effective substitute for knowledge-based and password-based authentication techniques. The implementation of finger vein biometrics as a novel approach to enhancing cell phone security. The method employs infrared (IR) light transmission to capture the vein patterns and shadows resulting from the different thicknesses of finger muscles, bones, and tissues. The unique vascular patterns in fingers are difficult to forge, offering a higher level of security compared to other biometric systems. The simulations we conducted indicate an identification accuracy rate of 93.82%, indicating that this technique provides a substantial enhancement in preventing unauthorized access and theft of cell phones. This study examines the technology behind finger vein biometrics, its integration into mobile devices, and the security advantages it offers.

Identifying children at risk in Swedish Child Health Services.

Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver's sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.

ArmSpy++: Enhanced PIN Inference through Video-based Fine-grained Arm Posture Analysis

As one of the most common ways for user authentication, Personal Identification Number (PIN), due to its simplicity and convenience, has suffered from plenty of side-channel attacks, which pose a severe threat to people’s privacy and property. The success of existing attacks is usually built upon the premise of no occlusion between the attacker and the victim’s hand gesture, but it increases the difficulty of launching the attack and the possibility of exposure. To overcome such limitation, we propose ArmSpy++, an improved video-assisted PIN inference attack built upon our previous research, ArmSpy. Specifically, ArmSpy++ employs new modules to leverage more features like the keystroke-induced elbow bending, wrist speed variation, and the spatial relationship between different arm joints, to correctly detect Keystrokes. ArmSpy++ delves into the perspective relationship and natural typing habits to ensure a high success rate of PIN inference. We also re-designed the inferred PIN pattern coordination mechanism to accurately deduce the PINs. By using a pre-trained HigherHRNet model for posture estimation ArmSpy++ eliminates the necessity of additional training. The extensive experiments demonstrate that ArmSpy++ can achieve over \(83.1\% \) average accuracy with 3 attempts and even \(92.5\% \) for some victims, indicating the severity of the threat posed by ArmSpy++.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting

Abstract Background Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. Methods The study population included working-age individuals, aged 22–62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. Results Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. Conclusions Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Executive deficits after SARS-CoV-2 infection: A cross-sectional population study

ImportanceDespite the major implications of executive deficits in day-to-day functioning, few studies have investigated this in post-acute sequelae of SARS-CoV-2 infection using standardized measures that differentiate between aspects of executive function. ObjectiveExamine whether SARS-CoV-2 infection is associated with deficits in executive functions and if so, investigate the duration of this association. Design, Setting, and ParticipantsThe present research has a cross-sectional design and uses data from the Norwegian Covid-19 Cohort study. The current cohort (n = 8102) completed the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) electronically between April 2021 and September 2021. During the assessment, 4183 of the included participants had a prior positive polymerase chain reaction test (PCR) for SARS-CoV-2 and 3919 were untested or had a confirmed negative PCR test. ExposureLaboratory-confirmed SARS-CoV-2 infection. Main outcomes and measuresExecutive functions were measured using the BRIEF-A, a self-report questionnaire comprising 75 items within nine theoretically and empirically distinct clinical scales. All participants self-reported on demographical variables and comorbidity. Information on sex and age was derived from the personal identification number, and vaccination status was obtained from the Norwegian Immunization Registry (SYSVAK). ResultsParticipants with a positive SARS-CoV-2 status reported executive deficits in everyday life above the clinical threshold (T-score ≥65) more often than non-infected controls (383 vs. 225). Specifically, the SARS-CoV-2 positive status group indicated significantly more deficits related to metacognition, with the greatest difference demonstrated for working memory. This difference remained when adjusting for various demographic factors and comorbidities, with significantly greater odds of reporting above the clinical threshold following SARS-CoV-2 infection, as observed on the global executive composite score 6–12 months after infection (OR 1.97; 95% CI 1.51 to 2.55). ConclusionsOur study confirms more perceived executive deficits following SARS-CoV-2 infection compared to non-infected controls, with metacognitive aspects being the most affected. These findings shed light on the potential functional difficulties that individuals may encounter during the post-acute phase of SARS-CoV-2 infection and may guide further development of targeted interventions addressing metacognitive domains of executive functioning.

ShouldAR: Detecting Shoulder Surfing Attacks Using Multimodal Eye Tracking and Augmented Reality

Shoulder surfing attacks (SSAs) are a type of observation attack designed to illicitly gather sensitive data from "over the shoulder" of victims. This attack can be directed at mobile devices, desktop screens, Personal Identification Number (PIN) pads at an Automated Teller Machine (ATM), or written text. Existing solutions are generally focused on authentication techniques (e.g., logins) and are limited to specific attack scenarios (e.g., mobile devices or PIN Pads). We present ShotjldAR, a mobile and usable system to detect SSAs using multimodal eye gaze information (i.e., from both the potential attacker and victim). ShouldAR uses an augmented reality headset as a platform to incorporate user eye gaze tracking, rear-facing image collection and eye gaze analysis, and user notification of potential attacks. In a 24-participant study, we show that the prototype is capable of detecting 87.28% of SSAs against both physical and digital targets, a two-fold improvement on the baseline solution using a rear-facing mirror, a widely used solution to the SSA problem. The ShouldAR approach provides an AR-based, active SSA defense that applies to both digital and physical information entry in sensitive environments.

Microbe surveillance in the amphibian pet trade: Results from a pilot study

AbstractRegional and global trade of live animals can contribute to the spread and emergence of novel pathogens, including several important pathogens of amphibians. However, understanding the spread or even frequency of infections in large, complex amphibian trade networks has been difficult, in part because businesses tend to be reluctant to participate in surveillance programs. Thus, we developed a novel approach to surveillance in which anonymous participating businesses were sent surveillance kits through a trusted trade advocacy partner, samples were returned to researchers via anonymous prepaid envelopes, and results were provided via a secure website with access regulated by a unique personal identification number (PIN) created by the business. We tested samples for the amphibian pathogens, Batrachochytrium salamandrivorans (Bsal), Batrachochytrium dendrobatidis (Bd), and Ranavirus spp. (Rv), as well as the beneficial microbe, Janthinobacterium lividum (Jliv), using quantitative real‐time polymerase chain reaction (qPCR). Out of 120 businesses invited to complete an anonymous socioeconomic survey, 24 volunteered to participate in pathogen surveillance, of which 14 were sent surveillance kits. Eight of these businesses returned samples consisting of swabs collected from amphibians in 78 terrestrial habitats and water filters from 49 aquatic habitats. Copies of a highly conserved vertebrate gene (EBF3N), quantified using qPCR, were consistently low (&lt;100 copies) in returned samples, but similar to those collected by researchers, indicating comparable sample quality. Three samples (from two facilities) had detectable levels of Bd DNA; Bsal, Rv, and Jliv were not detected. This pilot study provides evidence that information about pathogens in pet trade networks can be acquired by developing partnerships with industry, and business participation might be enhanced by ensuring anonymity and inclusion of a trade advocacy partner.

Social inequity in chiropractic utilisation – a cross-sectional study in Denmark, 2010 and 2017

BackgroundInequity in healthcare utilisation refers to differences between groups that remain after adjustment for need for health care. To our knowledge, no previous studies have aimed to assess social inequity in chiropractic utilisation in a general population. Therefore, the objective of this study was to evaluate social inequity in chiropractic utilisation in the general Danish population adjusted for health status as a proxy of need for chiropractic care.MethodsA population-based repeated cross-sectional study design was used based on the Danish National Health Survey in 2010 and 2017. Overall, we included 288,099 individuals aged 30 years or older in 2010 or 2017. For each individual, information on chiropractic utilisation, socioeconomic status, and health status as a proxy of need for chiropractic care was retrieved from nationwide registers using the unique personal identification number. Measures of health status included demographics, poor self-rated physical health, activity limitations, musculoskeletal pain, number of musculoskeletal conditions, and number of chronic diseases.We investigated social inequity in chiropractic utilisation (yes, no) using logistic regression adjusted for health status, stratified by sex and year. Three characteristics of socioeconomic status (educational level, employment status and income) were investigated. To further quantify the degree of social inequity in chiropractic utilisation, we estimated the concentration index of inequity for each of the three characteristics of socioeconomic status.ResultsWe found significantly higher odds of chiropractic utilisation among individuals with short or medium/long education compared with individuals with elementary education, and among employed individuals compared with individuals who were unemployed, receiving disability pension or retired. Furthermore, the odds of chiropractic utilisation increased with higher income. The concentration index indicated social inequity in chiropractic utilisation in favour of individuals with higher socioeconomic status, with income and employment status contributing more to inequity than educational level.ConclusionThe study demonstrated social inequity in chiropractic utilisation in Denmark beyond differences in health status as a proxy of need for chiropractic care in the general population. The results suggest that new strategies are required if equal treatment for equal need is the goal.

O-158 Social disparities in achieving a live birth after initiating ART treatment: a national register-based study among women in Denmark

Abstract Study question How are educational level, labor market attachment and income associated with achieving a live birth after initiating ART treatment among women in Denmark? Summary answer Higher educational level, labor market attachment and higher income were strongly associated with achieving a live birth after initiating ART treatment among women in Denmark. What is known already Infertility is increasing in populations worldwide with an estimated lifetime prevalence of 17.5%. Approaches to this issue differs between societies and healthcare systems. In the public Danish healthcare system, three fresh ART treatments are currently offered free of charge. Additional ART treatments are self-financed in the private healthcare sector. Socioeconomic disparities in health are widely recognized. Previous studies have indicated that higher socioeconomic position (SEP) is associated with a greater probability of achieving a live birth after initiating ART treatment. However, there is limited knowledge about SEP and its relation to outcomes of ART treatment. Study design, size, duration This is a national, register-based study based on the DANAC II Cohort. Women undergoing ART treatment during 1994–2017 registered in the Danish IVF register were individually linked with data from sociodemographic registries and the Medical Birth Registry using the Danish Personal Identification number. The study population consisted of 68,738 women treated with ART. The outcome was a live birth. The women were followed until outcome, death, migration, or end of study (31/12/2017). Participants/materials, setting, methods Women included in the analyses were aged 18–45 years. Overall associations between achieving a live birth after initiating ART treatment and educational level, labor market attachment and income were examined and further stratified by nulliparity at baseline and age group. Hazard ratios (HRs) with confidence intervals (CIs) were estimated by Cox proportional hazards regression, and with adjustment for potential confounders age and ethnicity. Death was incorporated as a competing risk in all analyses. Main results and the role of chance Adjusted results showed that educational level, labour market attachment and income significantly determined the probability of achieving a live birth after initiating ART treatment. HRs of achieving a first live birth after initiating ART treatment increased stepwise with higher education and income level, respectively. Compared with primary school education the highest HR was found among women with a research education (HR = 3.02 [95% CI 2.71; 3.35]). Unemployed women had the lowest HR of achieving a live birth after initiating ART treatment (HR = 0.67 [95% CI 0.64; 0.69]) compared to employed women. Women in the highest income group had two times higher HR of achieving a live birth after initiating ART compared to women in the lowest income group. Analyses of different age groups showed that higher SEP was associated with a live birth after ART treatment in all ages. The same consistency was found for both childless women and women who had a child or children prior to ART treatment. Subanalyses showed that women with higher SEP were more likely to continue ART treatment after unsuccessful attempts, which could explain the observed social inequality in achieving a live birth after ART treatment. Limitations, reasons for caution The Danish IVF register did not register non-ART treatments (intrauterine inseminations) before 2007, thus these treatments are not included. Whether severity of infertility/prognosis differs among SEP groups is unclear. Also, geographical distance to fertility clinics could have provided additional perspectives. Wider implications of the findings Free access to fertility treatment in public healthcare should ideally provide equal access. Patients encounter barriers during treatment and, as shown, treatment success differs based on socio-economic background. Difficulties encountered during treatment that challenge certain patients more than others based on their socio-economic background needs to be addressed. Trial registration number Not applicable

P-779 GLP-1 receptor agonist treatment in early pregnancy and risk of pregnancy complications - A nationwide cohort study

Abstract Study question Does periconceptionally exposure to GLP-1 receptor agonist (GLP-1 RA) treatment increase the risk of pregnancy complications? Summary answer Perconceptionally exposure to GLP-1 RA had no association with pregnancy complications when compared to a control group with balanced covariates. What is known already The prevalence of obesity continues to increase globally, affecting half the adult population in Western countries, increasing the risk of infertility and obstetric and neonatal complications. Weight loss might improve risks, leading to an interest in effective weight loss methods such as GLP-1 RAs. However, none of the GLP-1 RAs are approved for use during pregnancy and at least two months before to avoid fetal toxicity. The current recommendations are based on a fetal safety principle and data from animal studies, clearly underscoring the need for more human evidence about the effect of GLP-1 RA use in the periconceptional period. Study design, size, duration A Danish nationwide observational cohort study of 522,209 pregnancies from October 2009 until June 2019 with data from health and socioeconomic registries at Statistics Denmark: the National Prescription Register, National Patient Register, Birth Register, Residential Register, and the National Diabetes Registry. All registries had complete information until June 2019, except the National Prescription Register which was until December 2018. The unique personal identification number used in Denmark enables direct linkage of individual-level information across registries. Participants/materials, setting, methods Exposure was defined as the redemption of GLP-1 RA prescription, liraglutide, +/- eight weeks from last menstruation. Primary outcome: any complication (pre-eclampsia, gestational diabetes (GDM), preterm birth (&amp;lt;37 + 0), low-birth-weight (&amp;lt;2500g), small-for-gestational-age, or large-for-gestational-age (LGA)). Evaluated risk of individual outcomes, and effect on gestational age, birth weight, and placenta weight. Outcomes were compared to an unexposed control group, weighted using fast generalized matching on propensity score estimated from relevant confounders. Risk ratio, 95% confidence interval (CI). Main results and the role of chance Within the study population of 522,209 pregnant women, we identified 93 pregnancies exposed to liraglutide in early pregnancy. The exposed women were on average older, had a higher BMI (on average 40% higher), and had a sixty times higher frequency of diabetes (DM1 or DM2) compared to unexposed women giving birth in the same period (p &amp;lt; 0.001). We found that liraglutide exposure was associated with a higher risk of obstetrical complications, pre-eclampsia, GDM, and preterm birth. There was no difference in the birth weight, but those exposed were more likely to give birth to an LGA child (liraglutide, p &amp;lt; 0.01). However, we did not find any evidence of increased risk when utilizing a propensity score matching method (liraglutid, p &amp;gt; 0.1). This indicates that liraglutide, in itself, is not driving the increased risk, but the indication for a GLP-1 RA prescription (e.g. diabetes or obesity) is the causal factor. The finding did not depend on the choice of method for propensity score matching. Findings pertaining to liraglutide and semaglutide, encompassing the period from 2009 to 2023, will be showcased at the primary conference. Limitations, reasons for caution Weight loss treatment was off-label for most of the study time. Wider implications of the findings The study is important for counseling women periconceptionally exposed to GLP-1 RA, that there is no evidence of an increased risk of pregnancy complications. It calls for studies on the safety profile for GLP-1 RA treatment in women, enabling early weight management for the benefit of the mother and child. Trial registration number not applicable

Socioeconomic status and risk of cardiovascular diseases in patients with retinal vein occlusion: A Danish nationwide cohort study

PurposeThis study examines the association between socioeconomic status and the occurrence of both cardiovascular diseases and mortality following retinal vein occlusion (RVO), a condition known to elevate the risk of cardiovascular health issues. Despite recognition of the impact socioeconomic factors might have on a patient's course through the healthcare system, its association with cardiovascular outcomes post-RVO has not previously been thoroughly explored. DesignNationwide cohort study. MethodsWe included all subjects with RVO from the Danish nationwide registries diagnosed between 2000 and 2018. Information was combined using a personal identification number each Danish resident is given at birth or upon immigration. We categorized participants by their socioeconomic levels to evaluate the five-year incidence rate of cardiovascular conditions and overall mortality. The analysis was further refined by sex and age groups to elucidate any differential impacts. Furthermore, the cumulative incidence was estimated using the Aalen-Johansen estimator and the differences between the socioeconomic groups were quantified using a cox proportional hazard model. Key quantitative results were summarized, including hazard rate ratios (HR), confidence intervals (CI), and p-values ResultsThe cohort was comprised of 14,041 individuals with RVO. Our analysis revealed a relationship between educational attainment and cardiovascular health outcomes. Lower education levels were consistently linked with heightened risks of mortality, diabetes, ischemic heart disease, myocardial infarction, and peripheral artery disease following RVO. Individuals with a middle educational level also exhibited a higher prevalence of peripheral artery disease when compared to those with the highest education levels. In terms of income, the lowest earners faced increased risks across several categories, including mortality, diabetes, heart failure, ischemic heart disease, myocardial infarction, and peripheral artery disease, when compared to the highest-income earners. The middle-income group also showed elevated risks for mortality, heart failure, and peripheral artery disease. Being unmarried was additionally associated with higher risks of mortality and heart failure compared to being married. ConclusionSocioeconomic status was significantly associated with clinically relevant differences in post-RVO risk of cardiovascular diseases and death. Our data suggests that socioeconomic factors should be considered in the attempt to reduce the risk of cardiovascular disease and death in patients with RVO.

#1923 Anticoagulation and risk of stroke in patients with incident atrial fibrillation and CKD stages 4-5—results from the nationwide FinACAF study

Abstract Background and Aims Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD). It is well known that CKD in AF patients increases the risk of thromboembolic complications, and also bleeding. However, there is lack of safety and efficacy data of oral anticoagulation (OAC) in patients with advanced CKD. Method The FinACAF study includes data from 411 000 patients covering all Finnish AF patients from 2004 to 2018. Using national unique personal identification numbers, individual patients’ data from several registries and laboratory databases were linked together. The inclusion criteria of this study were all patients 20 years or older with a new-onset, non-valvular AF between 2010 and 2018 and a measured estimated glomerular filtration rate (eGFR) within the proximity of the AF diagnosis. Risk of stroke in patients with CKD stages 4-5 (eGFR &amp;lt; 30 ml/min/1.73 m2) was evaluated. Patients on dialysis and those with functioning graft were excluded. Participants were followed for the occurrence of ischemic stroke (IS) until December 31st 2018 or until death or until the OAC exposure reached a maximum duration of 730 days, whichever came first. The follow-up period was capped at 730 days due to the limited number of patients with direct oral anticoagulation (DOAC) exposure exceeding 730 days. Hazard ratios [95% confidence intervals (CI)] comparing different OACs or no OAC were derived from the Cox regression model. Results The study cohort included 4148 patients. The mean (SD) eGFR was 21.5 (6.7) ml/min/1.73 m2. 1940 patients had no OAC, 1658 patients had warfarin and 550 patients had any DOAC (396 apixaban, 121 rivaroxaban, 17 dabigatran and 16 edoxaban). During the follow-up 146 patients (3.5%) had ischemic stroke. Compared to patients with no OAC (reference) HRs were 0.42 [95% CI 0.30-0.59)] for the patients with warfarin and 0.28 [95% CI 0.01-0.52)] for the patients with DOACs. Cumulative hazards for ischemic stroke are shown in the Figure. Conclusion Among patients with incident AF and advanced CKD, the risk of stroke was lowest in patients with DOACs and the worst in patients with no OAC. Warfarin users were positioned in between these two groups. Further analysis is needed to evaluate also the safety of different OACs in our cohort.

#1000 Living alone and prognosis in elderly patients with chronic kidney disease: a nationwide study from Denmark

Abstract Background and Aims Patient care is increasingly relying upon involvement of patient relatives, including for patients with chronic kidney disease (CKD). However, patients living alone may be disadvantaged due to a lack of support. We aimed to assess the difference in prognosis after incident CKD in elderly patients between patients living alone versus living with others in a nationwide cohort study. Method We identified all patients aged 65 years or older with incident CKD from January 1, 2016, to December 31, 2020, with follow-up until December 31, 2021. We used data from national registries to identify CKD from out-patient creatinine measurements and linked these data to hospital treatment procedures and information from the Civil Person Registration system by the universal and unique personal identification number assigned to all Danish residents at birth or immigration. We defined incident CKD as having two or more estimated glomerular filtration rate (eGFR) values below 60 ml/min/1.73 m2 registered at least 90 days apart. We categorized eGFR according to “Kidney Disease: Improving Global Outcomes” (KDIGO) CKD stages into 45-59 ml/min/1.73 m2 (mildly/moderately decreased), 30-44 ml/min/1.73 m2 (moderately/severely decreased), 15-29 ml/min/1.73 m2 (severely decreased), &amp;lt;15 ml/min/1.73 m2 (kidney failure). We assessed cohabitation (living alone, or living with others), also in national registry data. We described the population by age group, sex and stage of CKD. Analyzing mortality, we followed patients from date of CKD to death or end of follow-up, whichever came first. We calculated the median time to death, using age as the time scale and reported these by cohabitation status with 95% confidence intervals (CIs). In further analyses, we will estimate the cumulated proportion who experienced a rapid decline in kidney function, as a measure of prognosis, and model the association between cohabitation and prognosis/mortality in regression models. Results We identified 204 662 elderly patients with CKD from 2016 to 2020, with 55% women and 38% 80 years or older. For severity, 84% had mildly/moderately decreased kidney function, 13% had moderately/severely decreased kidney function, 2% had severely decreased kidney function and only less than 1% (457 patients) presented with kidney failure. At index, 55% lived with others and 45% lived alone. Overall, 53 715 died during follow-up, and median age at death was 82 (95% CI: 82;82) for CKD patients living together with someone, but 78 (95% CI: 77;78) for those living alone. Conclusion The results are preliminary, and further analyses, including age adjustment, mortality estimates and information on adult children, will be available for presentation at the ERA conference 2024.

Gout and Gout-Related Comorbidities: Insight and Limitations from Population-Based Registers in Sweden

Population-based databases in Nordic countries offer unique opportunities for large-scale population-based epidemiological studies. The personal identity number enables researchers to link different registers at the individual level, which can be used for large-scale epidemiological population-based studies. This review outlines how these opportunities have been used so far in the field of gout research, as well as the potential challenges and limitations. Their major advantage is that they cover the entire population, minimizing problems such as selection bias and loss to follow-up. This has enabled us to provide information on gout regarding risk factors; occurrence; association with comorbidities in relation to gout onset; treatment patterns; as well as its effect on other outcomes, such as sick leave and mortality. Validity issues, missing data, and legal issues are some of the challenges that researchers need to deal with. Choosing the most appropriate combination of databases to use for a specific question is crucial in order to maximize validity and adjust for confounders. Despite challenges and potential limitations, the Swedish registers have provided valuable epidemiological results and will continue to play an important role in the years to come.