Population-based Cohort Research Articles

Increased risk of fracture among patients with iron overload: a population-based matched cohort study

Abstract Introduction Iron overloading disorders are associated with decreased bone mineral density. However, evidence on fracture risk is scarce. Therefore, we evaluated the risk of fracture associated with iron overload disorders, compared to matched controls. Methods Using THIN, a Cegedim database of UK general practice data, we identified patients >18 years with elevated iron (ferritin value >1000 µg/L) or an eligible diagnosis code for iron overloading disorders between 2010-2022. The first date of elevated iron or a diagnosis code defined the index date for iron overload patients, who were matched with to up to 10 controls. Time-varying confounder adjusted Cox proportional hazard models estimated the hazard ratios (HRs) and 95% confidence intervals. Analyses were stratified by osteoporotic fracture site (hip, vertebral, humerus, forearm), evidence of elevated serum ferritin at baseline (ferritin >1000 µg/L), and sex. Results We identified 20,264 eligible patients and 192,956 controls. Overall, there was a 55% increased risk of any fracture among iron overload patients (HR 1.55 [1.42-1.68]). Fracture risk was increased at all sites, with the highest risk observed for vertebral fractures (HR 1.97 [1.63-2.10]). Patients with ferritin >1000µg/L had a 91% increased risk of any fracture (HR 1.91 [1.73-2.16]) and a 2.5-fold increased risk of vertebral fractures (HR 2.51 [2.01-3.12]). There was no increased risk among patients without elevated serum ferritin at any site. Fracture risk was similar between sexes. Discussion This large population-based cohort study found a 55% increased risk of fracture associated with iron overload. The risk was highest among patients with laboratory confirmed iron overload, highlighting the importance for clinicians to consider initiating osteoporosis therapy in patients with serum ferritin >1000 µg/L to minimize fracture risk.

Glycaemic control and adult height: a nationwide Swedish cohort study on childhood type 1 diabetes

Abstract Aims To assess adult height outcomes across levels of glycaemic control in children and adolescents with type 1 diabetes, as well as to investigate the impact of sex, age at disease onset, and timing of glycaemic control in relation to puberty. Methods In this population-based Swedish cohort study, we collected data on glycaemic control and height from specialist healthcare visits of all individuals with childhood-onset type 1 diabetes in the National Diabetes Register. Using linear and logistic regression, we compared suboptimal (HbA1c 53–75 mmol/mol [7.0–9.0%]) and poor (HbA1c >75 mmol/mol [>9.0%]) to optimal (HbA1c <53 mmol/mol [<7.0%]) glycaemic control in relation to final adult height and the risk of short stature. Results Poor glycaemic control was associated with lower final adult height (-2.91 cm [95% CI - 3.48, -2.33] for males, -1.83 cm [-2.42, -1.23] for females) as well as a higher risk of short stature in males (odds ratio 1.90 [1.07, 3.35]) but not in females (0.73 [0.36, 1.51]). For females, adult height was only lower among those with type 1 diabetes since before puberty and if the poor glycaemic control occurred before puberty. For males, adult height was lower irrespective of their age at diabetes onset, but only if they had poor glycaemic control during or after puberty. Conclusions Poor glycaemic control after the onset of type 1 diabetes, compared to optimal control, is associated with lower adult height in males and females. The prepubertal period seems to be more critical for females than males.

Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study

Abstract Objective Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS). Methods All pediatric patients (< 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded. Results Seventy-one pediatric patients with a median age of 9 years were included. Most patients (58%) were females. Chiari 1 was associated with syringomyelia (51%), scoliosis (37%), and hydrocephalus (7%). Perioperative complications occurred in 13 patients (18%) of which two required additional procedures under general anesthesia. On multivariable proportional odds logistic regression, motor deficits (OR: 0.09; CI95%: [0.01–0.62]; p = 0.015), and surgical complications (OR: 0.16; CI95%: [0.41–0.66]; p = 0.011) were significant predictors of worse outcomes. The presence of syringomyelia was identified as a predictor of better outcomes (OR: 4.42 CI95% [1.02–19.35]; p = 0.048). A persistent hydrocephalus during the early postoperative period after posterior fossa decompression was a strong predictor of worse long-term CCOS (OR: 0.026; CI95%: [0.002–0.328]; p = 0.005). Conclusion Results from this study indicate that the existence of motor deficits and syringomyelia prior to surgery, and surgical complications and persistent hydrocephalus despite posterior fossa decompression, were useful predictors of long-term outcome.

Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study

Continuity of primary care and avoidable hospitalization in a young population with asthma: a population-based cohort study

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

AbstractThe aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups. What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology. What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.

Effect of Biological Therapy for Psoriasis on the Development of Psoriatic Arthritis: A Population-Based Cohort Study.

Evidence comparing the impact of various biologics for psoriasis on the progression to psoriatic arthritis (PsA) is limited. We therefore assessed the risk of PsA associated with interleukin (IL)-23 inhibitor, IL-17 inhibitor, or IL-12/23 inhibitor use compared with tumor necrosis factor (TNF) inhibitor use among patients with psoriasis. This population-based cohort study used the nationwide claims database from South Korea (2007-2023). New users of IL or TNF inhibitors with psoriasis who did not have PsA or other inflammatory arthritis were categorized into each class of the IL inhibitors for comparison with TNF inhibitor users. The outcome measured was the development of incident PsA. We calculated multinomial overlap weights to balance predefined covariates. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. We identified 9499 patients with psoriasis (mean age 45.1 years; 33.6% female), of whom 3913 (41.2%), 2126 (22.4%), 2773 (28.8%), and 727 (7.7%) were exposed to IL-23 inhibitor, IL-17 inhibitor, IL-12/23 inhibitor, and TNF inhibitor, respectively. PsA developed in 281 (3.0%) patients during 23,275 person-years. The weighted HR for any IL inhibitors was 0.40 (95% CI 0.25-0.62), with specific HRs of 0.22 (95% CI 0.13-0.37), 0.47 (95% CI 0.28-0.80), and 0.46 (95% CI0.29-0.74) for IL-23 inhibitor, IL-17 inhibitor, and IL-12/23 inhibitor, respectively. IL-23 inhibitors exhibited the greatest rate difference of - 2.61 (95% CI - 3.67 to - 1.55) cases of PsA per 100 person-years. The use of IL inhibitors, particularly IL-23 inhibitors, compared with TNF inhibitors, was associated with a lower risk of developing PsA.

Association of dietary niacin intake with all-cause and cardiovascular mortality: National Health and Nutrition Examination Survey (NHANES) 2003-2018.

The long-term health impacts of niacin are still debated, and the association between dietary niacin and mortality risk in populations hasn't been extensively explored. This study included 26,746 US adults aged 20 years or older from the National Health and Nutrition Examination Survey 2003-2018, with a median follow-up of 9.17 years. During this period, there were 3,551 all-cause deaths, including 1,096 cardiovascular deaths. Cox models were used to compare hazard ratios (HRs) for mortality among participants grouped into different dietary niacin intake quartiles. Participants with the highest dietary niacin intake had a lower risk of all-cause mortality (HR 0.74, 95%CI 0.63-0.86) compared to those in the lowest intake quartile. For cardiovascular mortality, the HR was 0.73 (95%CI 0.57-0.95) in the highest niacin intake quartile. A dose-response relationship was revealed between dietary niacin intake and mortality by restricted cubic spline. Subgroup analysis showed a significant interaction between dietary niacin intake and diabetes concerning all-cause mortality (P = 0.046). In this population-based cohort study, higher dietary niacin intake correlates with lower risk of all-cause and cardiovascular mortality among US adults. The influence of niacin intake on all-cause mortality appears to be more significant in non-diabetic individuals compared to those with diabetes.

Hepatitis C Virus Testing Among Perinatally Exposed Children: 2018 to 2020.

To assess the frequency of hepatitis C virus (HCV) testing among a population-based cohort of perinatally exposed children and identify factors associated with testing. Using a population-based surveillance cohort of perinatally exposed children born from 2018 to 2020 from 4 US jurisdictions (Georgia; Massachusetts; Allegheny County, Pennsylvania; and Los Angeles County, California), we describe the frequency, timing, and type of HCV testing among children and identify characteristics associated with having an HCV test result by the age of 2 to 3 years. Data were obtained from electronic laboratory reporting, vital records, and medical records. Of 803 perinatally exposed children, 7 (1%) died before the age of 24 months. Of 796 children, health departments were unable to find medical records or laboratory reports for 181 (23%). Among those with medical record abstraction at 24 months or testing reported before the age of 3 years (n = 615), 50% had an HCV test. The majority (70% of those tested) were tested for HCV antibodies at the age of 18 months or later, although 9% had an HCV nucleic acid test at ages 2 to <6 months. No characteristics examined were found to be significantly associated with having testing reported. In this surveillance report, we identify the gaps in current testing among children perinatally exposed to hepatitis C. Provider education and resources for health departments for follow-up and linkage to care can improve the identification of children requiring treatment, a vital piece of HCV elimination.

Methodology for Biological Sample Collection, Processing, and Storage in the Newcastle 1000 Pregnancy Cohort: Protocol for a Longitudinal, Prospective Population-Based Study in Australia.

Research in the developmental origins of health and disease provides compelling evidence that adverse events during the first 1000 days of life from conception can impact life course health. Despite many decades of research, we still lack a complete understanding of the mechanisms underlying some of these associations. The Newcastle 1000 Study (NEW1000) is a comprehensive, prospective population-based pregnancy cohort study based in Newcastle, New South Wales, Australia, that will recruit pregnant women and their partners at 11-14 weeks' gestation, with assessments at 20, 28, and 36 weeks; birth; 6 weeks; and 6 months, in order to provide detailed data about the first 1000 days of life to investigate the developmental origins of noncommunicable diseases. The study aims to provide a longitudinal multisystem approach to phenotyping, supported by robust clinical data and collection of biological samples in NEW1000. This manuscript describes in detail the large variety of samples collected in the study and the method of collection, storage, and utility of the samples in the biobank, with a particular focus on incorporation of the samples into emerging and novel large-scale "-omics" platforms, including the genome, microbiome, epigenome, transcriptome, fragmentome, metabolome, proteome, exposome, and cell-free DNA and RNA. Specifically, this manuscript details the methods used to collect, process, and store biological samples, including maternal, paternal, and fetal blood, microbiome (stool, skin, vaginal, oral), urine, saliva, hair, toenail, placenta, colostrum, and breastmilk. Recruitment for the study began in March 2021. As of July 2024, 1040 women and 684 partners were enrolled, with 922 infants born. The NEW1000 biobank contains 24,357 plasma aliquots from ethylenediaminetetraacetic acid (EDTA) tubes, 5284 buffy coat aliquots, 4000 plasma aliquots from lithium heparin tubes, 15,884 blood serum aliquots, 2977 PAX RNA tubes, 26,595 urine sample aliquots, 2280 fecal swabs, 17,687 microbiome swabs, 2356 saliva sample aliquots, 1195 breastmilk sample aliquots, 4007 placental tissue aliquots, 2680 hair samples, and 2193 nail samples. NEW1000 will generate a multigenerational, deeply phenotyped cohort with a comprehensive biobank of samples relevant to a large variety of analyses, including multiple -omics platforms. DERR1-10.2196/63562.

Health-related quality of life in surgically treated asymptomatic meningioma patients: A population-based matched cohort study

Abstract Background Asymptomatic patients with meningiomas are increasingly detected, where management can be challenging in terms of surgery versus watchful waiting. Health-related quality of life (HRQoL) is an important factor in clinical decision-making, albeit not greatly studied in this patient group. The aim of this paper is to map the HRQoL among patients with surgically removed asymptomatic meningioma as compared to the general population. Methods Patients with first-time surgically treated asymptomatic meningioma between 2007 and 2013 were identified. Patients were invited in 2017 to answer a survey regarding different aspects of quality of life, using EuroQoL (EQ)-5D-3L, perceived health, lifestyle, and occupancy. Data from electronic patient records was obtained. The patients were matched based on age and gender with data from the Stockholm Region Public Health Cohort database. Results There was no difference in EQ-5D-3L or visual analog scale between the patients and their matched controls. Patients and controls experienced ill health to the same extent, but patients felt to a greater extent that this impacted their way of life. In 36% of patients, preoperative occupation was not resumed, mostly due to cognitive symptoms. Additionally, the study suggested social detachment in this cohort, as significantly more patients were living alone and had less emotional support compared to controls. Conclusions Although surgically treated patients with asymptomatic intracranial meningioma have similar overall HRQoL compared to the general population, surgery has an impact on return to work and cognitive function.

Do Time-Dependent Repeated Measures of Anthropometric and Body Composition Indices Improve the Prediction of Incident Diabetes in the Cohort Study? Findings from a Community-Based Korean Genome and Epidemiology Study.

Cumulative evidence consistently shows that anthropometric and body composition measurements are strongly linked to the risk of incident diabetes, typically based on baseline measurements. This study aims to assess whether repeated measurements enhance the prediction of diabetes risk beyond baseline assessments alone. We utilized data from a 16-year population-based follow-up cohort within the Korean Genome and Epidemiology Study, comprising 6,030 individuals aged 40 to 69 years at baseline. We included eight indices: a body shape index (ABSI), body adiposity index (BAI), waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), weight-adjusted skeletal muscle index (SMI), percent body fat, and fat-to-muscle ratio. The effect of these measurements for incident diabetes was estimated using Harrell's C-indexes and hazard ratios with 95% confidence intervals, employing time-dependent Cox proportional hazard models. Over the 16-year follow-up, 939 new diabetes cases were identified (cumulative incidence, 15.6%). The median number of indicator measurements per participant was eight. The basic model, including 10 features (sex, age, education levels, physical activity, alcohol intake, current smoking, total energy intake, dietary diversity score, and log-transformed C-reactive protein levels, and quartiles of unweighted genetic risk score at baseline), yielded a Harrell's C-index of 0.610. The highest C-index in repeated measurements was for WC (0.668) across the general population, weight-adjusted SMI in men, and WHR in women. However, except for ABSI and BAI, the diabetes predictive power of the other indicators was comparable. Additionally, repeated measurements of WC, BMI, and WHR in women were found to contribute to improved discrimination compared to baseline measurements, but not in men. Utilizing repeated measurements of general and central adiposity to predict diabetes may be helpful in predicting hidden risks, especially in women.

Psychotropic-induced weight gain and telomere length: results from a one-year longitudinal study and a large population-based cohort.

Weight-inducing psychotropic treatments are risk factors for age-related diseases such as cardiovascular disorders, which are associated with both inflammation and telomere length shortening. With a longitudinal design, the present study evaluates telomere length trajectories after 1 year of weight-inducing psychotropic medication, accounting for weight changes and the inflammatory biomarker high-sensitivity C-Reactive Protein (CRP). Among 200 patients, an overall median telomere shortening of -41.2 bp was observed (p = 0.014), which is comparable with the general population's yearly telomere attrition. Linear regression showed on average -93.1 and -58.9 bp of further telomere shortening per five units of BMI for BMI values < or ≥30 kg/m2, respectively (p = 0.003 and p = 0.009, respectively). Importantly, the overall telomere shortening was predicted to be increased four-fold among patients with low baseline weight (i.e., 50 kg) and with clinically relevant weight gain (≥ 7%) after 1 year of treatment (interaction term between relevant weight gain and baseline weight: +6.3 bp, p = 0.016). Patients with relevant weight gain showed greater CRP levels (+ 49%; p = 0.016), and a telomere shortening of -36.2 bp (p = 0.010) was estimated whenever CRP level doubled. Mendelian randomization using UKBiobank data showed a causal effect of BMI on telomere shortening, notably stronger among patients receiving weight-inducing psychotropic treatments (n = 9798) than among psychiatric patients without such drugs (n = 16228) and non-psychiatric controls (n = 252932) (beta: -0.37, -0.12, -0.06, respectively; p = 0.004, p < 0.001, p < 0.001, respectively). Ultimately, telomere trajectories were associated with 1 year weight gain and increases in CRP levels, with telomere shortening strongly enhanced by BMI increments among patients receiving weight-inducing psychotropic treatments.

SARS-CoV-2 testing, test positivity and vaccination in social housing residents compared with the general population: a retrospective population-based cohort study

BackgroundThe consideration of unique social housing needs has largely been absent from the COVID-19 response, particularly in tailoring strategies to improve access to testing and vaccine uptake among vulnerable and...

Trends in Peripheral Artery Disease, Lower Extremity Revascularization, and Lower Extremity Amputation in Incident Type 2 Diabetes: A Danish Population-Based Cohort Study.

To examine trends in peripheral artery disease (PAD), lower-extremity (LE) revascularization, and LE amputation in patients with incident type 2 diabetes. This cohort study included patients in Denmark diagnosed with type 2 diabetes in 1996-2015 and followed until 2020. Patients were age and sex matched with as many as three general population individuals. Outcomes comprised 5-year cumulative incidences of first-time PAD, LE revascularization, and LE amputation. Age- and sex-adjusted hazard ratios (aHRs) were computed using Cox regression. The cohort comprised 349,454 patients with incident type 2 diabetes (53% male; median age 62 years) and 1,025,054 general population individuals. Among patients with diabetes, decreases in 5-year cumulative incidence of PAD (from 6.2 to 3.4%; aHR 0.55 [95% CI 0.52-0.57]), LE revascularization (from 0.8 to 0.6%; aHR 0.80 [95% CI 0.71-0.90]), and LE amputation (from 1.0 to 0.4%; aHR 0.45 [95% CI 0.40-0.51]) occurred from 1996-2000 to 2011-2015. LE amputation decreased at all amputation levels (hip/thigh, knee/lower leg, and ankle/foot/toe) during the study period. In the general population, 5-year cumulative incidence remained stable (1.2-1.5% for PAD, ∼0.4% for LE revascularization, and ∼0.2% for LE amputation). However, the relative rates of all outcomes were two- to threefold higher in patients with diabetes than matched individuals in 2011-2015. In recent decades, the cumulative incidence of LE complications substantially decreased in patients with incident type 2 diabetes while remaining stable in the general population.

Exploring the Impact of Parkinson's Disease on Driving: A Population-Based Survey.

Persons with Parkinson's disease (PD) experience progressive motor and non-motor symptoms which may influence their ability to drive a car. This is experienced as a massive challenge by many affected individuals, for whom being able to drive a car is vital to maintain functional independence. We assessed how the diagnosis of PD affected the possession of a driving license, how people with PD had adapted their driving style, and to what extent they had communicated about their driving ability with their healthcare professionals. We also evaluated their knowledge on insurance- and Driver and Vehicle Licensing Agency (DVLA)-related implications. A cross-sectional 10-item survey was completed by 540 participants of a population-based cohort of persons with PD in the Netherlands (PRIME-NL study). Participants had a mean age of 70 years and disease duration of 7.3 years. 84% possessed a valid driving license. Of those who gave up their license, this was done mostly (78%) on a voluntarily basis. Forty percent of those with a driving license adjusted their driving style. Over 50% of respondents had not discussed the impact of PD on their driving ability with their healthcare professionals. Although not compulsory by Dutch law, 52% of the respondents had informed the DVLA about their diagnosis. This study highlights the need for information and support from healthcare professionals to proactively address driving in their clinical practice. This will help persons with PD in their efforts to maintain their driving license for as long as possible.

MRI-Based Phenotyping for Osteosarcopenic Adiposity in Subjects from a Population-Based Cohort

Objective: Imaging biomarkers of bone, muscle, and fat by magnetic resonance imaging (MRI) may depict osteopenia, sarcopenia, and adiposity as the three different conditions of osteosarcopenic adiposity (OSA). Methods: Subjects from a prospective, population-based case–control study underwent a health assessment and 3 Tesla whole-body MRI scan. Imaging biomarkers of bone (bone marrow fat-fraction (BMFF)), skeletal muscle (skeletal muscle FF (SMFF)), and fat (total adipose tissue (TAT)) were determined. Participants were allocated to one phenotype according to the OSA complex. Results: Among 363 participants forming the study cohort, 81 (22.3%, 48.1% males, 62.4 ± 6.9 years) were allocated into the OSA subgroup. Participants with an OSA phenotype were significantly older compared to all remaining subjects and showed the highest grades of SMFF (all p &lt; 0.005). Together with subjects from the osteopenic sarcopenia group, OSA subjects exhibited the highest amounts of BMFF and together with the three other adiposity-containing subgroups also exhibited the highest BMIs. The highest prevalence of an impaired glucose tolerance as well as significantly higher blood pressure, blood dyslipidemia, and hepatic steatosis was found in the OSA subgroup (all p &lt; 0.005). Conclusions: MR biomarkers of bone, skeletal muscle and fat are feasible for body composition phenotyping and may allow for targeted risk stratification in suspected OSA syndrome.

Incidence of and risk of mortality after hip fractures in Rheumatoid Arthritis relative to the general population.

Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in RA patients treated with contemporary treatment strategies are lacking. The objectives were 1) to estimate age- and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age and sex-matched general population controls, and 2) to compare the risk of all-cause mortality in RA and general population controls after hip fracture. A longitudinal study of a population-based incident cohort of RA patients diagnosed between 1997 and 2009, followed until 2014, with age- and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (ICD9-CM codes 820.0 or 820.2; ICD10-CA code S72.0 to S72.2) and mortality at pre-defined intervals after fracture (in-hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRR) were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA vs. controls; logistic regression compared in-hospital mortality risk. Overall, 1314 hip fractures over 360,521 person-years were identified in 37,616 RA individuals and 2083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95%CI, 1.20;1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 + 10.8 vs. 81.6 + 9.3 yrs). Post-fracture mortality risk at 1- and 5-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only RA individuals who received disease-modifying antirheumatic drugs (DMARDs). People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.

Fertility treatment and risk of ovarian cancer in a large nationwide cohort of infertile Danish women.

Whether fertility treatment increases the risk of ovarian cancer has been a concern for many decades, but previous research has yielded conflicting findings. We therefore investigated this association within a large population-based cohort study of infertile women aged 20-45 years and living in Denmark between 1995 and 2017, as identified in the Danish Infertility Cohort (n = 146,110). The study cohort was linked to nationwide registers to obtain information on fertility drug use, cancer diagnoses, covariates, emigration, and vital status was. Hazard ratios (HR) and 95% confidence intervals (CI) with adjustment for potential confounders for ovarian cancer overall and for serous ovarian cancer were estimated using Cox proportional hazard models. During a median 10.3 years of follow-up, 114 women were diagnosed with ovarian cancer of which 65 had serous ovarian cancer. Our results showed that the rate of serous ovarian cancer (HR 1.92; 95% CI 1.16-3.17) was increased after every use of progesterone but the association was not affected by increased follow-up time since first use or with increased cumulative dose. We performed a secondary analysis adding less extensive data from 1971 through 1994 from the Danish Infertility Cohort. In this study cohort, 332 women developed ovarian cancer of which 192 had serous ovarian cancer. The overall results were similar, including the association between every use of progesterone and serous ovarian cancer (HR 2.05: 95% CI: 1.31-3.21). In conclusion, the novel finding that use of progesterone is associated with an increased rate of serous ovarian cancer warrants further investigation.

Population-based cohort study investigating the association between weight loss and pyogenic liver abscesses

Population-based cohort study investigating the association between weight loss and pyogenic liver abscesses

Parent-child interaction frequency: associations with age, sibling presence, and child health.

Parent-child interaction plays a crucial role in child development. This study investigated associations between the frequency of parent-child-interactions and sociodemographic characteristics (age, sex, socio-economic status, family structure, number and age of siblings), physical and psychological symptoms in children, and mental health of parents. The frequencies of 11 different parent-child interactions (shared reading, singing, moving, painting, building, puzzle, playing ball, role games, language games, number games and talking about problems) were assessed in 739 children aged 2-6.5 years-old using a standardised parental questionnaire, within a population-based cohort study in Leipzig, Germany. Physical and psychological symptoms were investigated using the HBSC Symptom-Checklist and parental depression symptoms using the Patient Health Questionnaire. We applied regression analyses to assess associations between variables. Shared reading was the parent-child interaction reported most frequently, with an average occurrence of several times a week. Number games were reported least frequently, with an average occurrency of every two weeks. Fewer parent-child interactions were significantly associated with higher child age, higher number of siblings, presence of older siblings and a lower level of physical and psychological symptoms. The other variables (sex, SES, living situation, presence of younger siblings or both (younger and older), depression symptoms of parents) were not significantly associated with the frequency of parent-child interactions. The findings show that age of children and number as well as age of siblings at home may shape the frequency of parent-child interaction in preschool children. In addition, the findings suggest that parent-child interaction might be related to the health of children rather than the (mental) health of parents. This study assessed the associations between the frequency of different types of parent-child interactions and sociodemographic as well as health-related parameters in a large sample of children. There still exist sex-specific differences in the frequency of parent-child interactions related to traditional role models of girls and boys. A higher frequency of parent-child interactions is associated with more physical and psychological symptoms in children. Parent-child interactions are less frequent in families with more children, especially when older siblings are present.