Population-based Database Research Articles

The Dutch Early-Stage Melanoma (D-ESMEL) study: a discovery set and validation cohort to predict the absolute risk of distant metastases in stage I/II cutaneous melanoma.

Early-stage cutaneous melanoma patients generally have a favorable prognosis, yet a significant proportion of metastatic melanoma cases arise from this group, highlighting the need for improved risk stratification using novel prognostic biomarkers. The Dutch Early-Stage Melanoma (D-ESMEL) study introduces a robust, population-based methodology to develop an absolute risk prediction model for stage I/II melanoma, incorporating clinical, imaging, and multi-omics data to identify patients at increased risk for distant metastases. Utilizing the Netherlands Cancer Registry and Dutch Nationwide Pathology Databank, we collected primary tumor samples from early-stage melanoma patients, with and without distant metastases during follow-up. Our study design includes a discovery set of metastatic cases and matched controls to identify novel prognostic factors, followed by a validation cohort using a nested case-control design to validate these factors and to build a risk prediction model. Tissue sections underwent Hematoxylin & Eosin (H&E) staining, RNA sequencing (RNAseq), DNA sequencing (DNAseq), immunohistochemistry (IHC), and multiplex immunofluorescence (MxIF).The discovery set included 442 primary melanoma samples (221 case-control sets), with 46% stage I and 54% stage II melanomas. The median time to distant metastasis was 3.4years, while controls had a median follow-up time of 9.8years. The validation cohort included 154 cases and 154 controls from a random population-based selection of 5,815 patients. Our approach enabled the collection of a large number of early-stage melanoma samples from population-based databases with extensive follow-up and a sufficient number of metastatic events. This methodology in prognostic cancer research holds the potential to impact clinical decision-making through absolute risk prediction.

Increased respiratory syncytial virus-associated hospitalizations and ambulatory visits in very preterm infants in the first year of life following discontinuation of access to palivizumab.

From 2002 to 2023, palivizumab was the only intervention to reduce RSV-associated hospitalizations in high-risk infants in Canada, but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The national professional pediatric association (Canadian Paediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia (NS) followed these recommendations the next season. To determine if the removal of access to palivizumab in these previously infants was associated with a change in hospital admissions, deaths or ambulatory visits associated with RSV. We identified a retrospective cohort of NS infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking 6 population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization, ambulatory visits or death were identified by International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV- associated diagnostic codes. Of 4835 infants born during the study period, 250 were 30-32 WG were eligible for the cohort. RSV-H increased about 10-fold following restricted access to palivizumab (0/123, to 9.4%; (95% CI 5.0, 15.9, risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7% to 17.3% (risk difference 11.6). Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of healthcare policy change on patient well-being is essential to assess impact and guide future decision making at the population level.

Glucagon-Like Peptide 1 Receptor Agonists and Risk of Thyroid Cancer: An International Multisite Cohort Study.

Introduction: Concerns have been raised that glucagon-like peptide 1 receptor agonists (GLP1-RAs) may increase the risk of thyroid cancer, but evidence remains conflicting. We therefore investigated if GLP1-RA use, compared with use of dipeptidyl peptidase-4 inhibitors (DPP-4is), was associated with thyroid cancer risk in patients with type 2 diabetes. Methods: This multisite cohort study with subsequent meta-analysis included six population-based databases from Canada (Ontario), Denmark, Norway, South Korea, Sweden, and Taiwan. Study populations comprised patients with type 2 diabetes between 2007 and 2023. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CIs) for thyroid cancer among GLP1-RA users compared with DPP-4is. Models were weighted using standardized mortality ratio weights generated from time-specific propensity scores. Site-specific HRs were pooled using a fixed-effects model. Results: We identified 98,147 users of GLP1-RA and 2,488,303 users of DPP-4i, with the median follow-up among users of GLP1-RA ranging from 1.8 to 3.0 years. Overall, use of GLP1-RA relative to use of DPP-4i was not associated with an increased risk of thyroid cancer (pooled weighted HR 0.81, CI 0.59-1.12). Similarly, we observed no increased risk in thyroid cancer with increasing cumulative dose of GLP1-RA among GLP1-RA ever-users. Subgroup analysis of types of thyroid cancer was not possible. Results remained consistent across a range of supplementary analyses. Discussion: In this large multisite study, utilizing data from six population-based databases, we found no evidence that GLP1-RA use is associated with an increased risk of thyroid cancer with follow-up ranging from 1.8 to 3.0 years, providing some reassurance to patients and clinicians about the short-term safety of these drugs. Nevertheless, evidence was insufficient to rule out excess risk with long-term use, due to the short follow-up.

Different surgical methods for FIGO stage IVB cervical cancer patients receiving chemotherapy: a population-based study.

To assess survival differences between non-extensive surgery (NES) and extensive surgery (ES) in International Federation of Gynecology and Obstetrics (FIGO) stage IVB cervical cancer patients receiving chemotherapy from a population-based database, the Surveillance, Epidemiology and End Results. Propensity matching was conducted to minimize heterogeneity. Survival analysis was performed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards model. A total of 154 patients met screening criteria, among whom 84 patients (84/154) underwent NES while 70 patients (70/154) underwent ES. After matching, no survival advantage was observed in ES group compared with NES group (p=0.066; hazard ratio [HR]=1.54; 95% confidence interval [CI]=0.97-2.42). Stratified analyses suggested ES prolonged overall survival in patients with histology other than squamous cell carcinoma and adenocarcinoma (p=0.028; HR=0.36; 95% CI=0.15-0.89) and American Joint Committee on Cancer (AJCC) T stage T1 (p=0.009; HR=0.18; 95% CI=0.05-0.66). Despite no survival benefit after regional lymph node surgery (p=0.629; HR=0.88; 95% CI=0.53-1.47), subgroup analyses demonstrated that patients younger than 50 (p=0.006; HR=0.21; 95% CI=0.07-0.64), with AJCC T stage T1 (p=0.002; HR=0.09; 95% CI=0.02-0.42), T3 (p=0.001; HR=0.02; 95% CI=0.00-0.21), hematogenous metastasis (p=0.036; HR=0.27; 95% CI=0.08-0.92) and without surgery of other sites (p=0.040; HR=0.01; 95% CI=0.00-0.79) might achieve longer survival after regional lymph node surgery. In conclusion, ES or regional lymph node surgery may provide survival advantage for certain subgroup of FIGO IVB cervical cancer patients receiving chemotherapy. However, it deserves large scale prospective clinical trials to confirm.

Association of community characteristics as measured by social deprivation index score with prenatal care and obstetrical outcomes

Objective We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. Study Design All spontaneously-conceived singleton deliveries of nulliparous gravidae with residence zip code available (n= 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis [Q1 (n=1,342), Q2+3 (n=1,752), and Q4 (n=1,692)] with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method. Results Among our cohort, gravidae in the lowest (least-deprived) SDI quartile (Q1) were older, had lower pre-pregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravidae residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits [mean (standard deviation) 11.17 (2.9)] than those living in Q1 [12.04 (2.3), p < 0.0001]. Gravidae in Q4 were less likely to receive sufficient PNC compared to those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile. Conclusions Outer quartile social deprivation was associated with higher proportions of primigravidae not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravidae are likely important steps toward health equity.

P100 A systematic review and meta-analysis of the prevalence of comorbidity amongst people with palmoplantar pustulosis

Abstract The treatment landscape for psoriasis vulgaris has been transformed by the introduction of targeted biologic therapies, but these treatments show limited efficacy in palmoplantar pustulosis (PPP). Janus kinase (JAK) inhibitors have emerged as a promising therapeutic option in PPP, but have an evolving side-effect profile, particularly relating to cardiovascular disease and malignancy. PPP is closely associated with smoking, but the wider comorbidity burden is poorly described. The objective of this study was to quantify the prevalence of comorbidities, including cardiovascular risk factors and malignancy, in individuals with PPP (PROSPERO: CRD42024508151). A systematic search of six databases (Embase, Ovid, Pubmed, Web of Science, Cochrane, and Cinahl) was conducted on 29 July 2024. For the systematic review, studies reporting the prevalence of the relevant comorbidities in adults (≥18 years) with PPP were included. No publication date or language restrictions were applied. Conference abstracts, review articles, and case reports were excluded. Records were screened and data extracted by at least two reviewers independently. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. To determine the prevalence of comorbidities in our at-risk PPP population, following quality assessment, we meta-analysed studies conducted in a specialist setting. Population-based studies based on coding and claims databases were excluded. This approach aimed to ensure the inclusion of comparable, tightly-phenotyped populations likely to be considered for JAK inhibitor treatment. Prevalence estimates for comorbidities were pooled using a random-effects model and presented with 95% confidence intervals (95% CI). Of 23 727 references identified, 86 studies met the inclusion criteria for the systematic review, comprising 72 studies conducted in a specialist setting and 14 population-based database studies. Quality assessment identified that only 33/86 (38.4%) studies specified the diagnostic criteria for comorbidities. Following quality assessment, 57 studies were included the meta-analysis. Psoriasis vulgaris [prevalence, 24.4% (95% CI: 18.1–30.6%)] and psoriatic arthritis [19.7% (95% CI: 15.5–24.0)] were common. The most prevalent cardiovascular risk factors were smoking [78.2% (95% CI: 73.6–82.6%)], hypertension [28.6% (95% CI: 24.4–32.8%)], hyperlipidaemia [28.3% (95% CI: 22.3–34.3%)], and obesity [25.2% (95% CI: 17.7–32.7%)]. The prevalence of major adverse cardiovascular events (myocardial infarction/stroke/transient ischaemic attack) and malignancy were 6.9% (95% CI: 3.8–9.9%) and 6.9% (95% CI: 2.6–11.2%), respectively. High heterogeneity was apparent between studies, a common finding in meta-analyses of prevalence. This systematic review and meta-analysis of people with PPP highlights a high prevalence of smoking and cardiovascular risk factors. Our findings underscore the importance of screening for comorbidities to guide treatment decision-making with novel therapeutic agents, such as JAK inhibitors.

Sex Differences in Adverse Liver and Nonliver Outcomes in Steatotic Liver Disease

This cohort study examines the association of sex with liver and nonliver adverse events using data from a US nationwide population-based database of patients with metabolic dysfunction–associated steatotic liver disease.

Proton Pump Inhibitor Use and Worsening Kidney Function: A Retrospective Cohort Study Including 122,606 Acid-Suppressing Users.

The impact of proton pump inhibitors (PPIs) use on worsening renal function is controversial and lacks a solid pathophysiological explanation. To assess the risk of worsening renal function and acute kidney injury (AKI) in PPI initiators as compared with H2-blockers initiators. Retrospective cohort study using longitudinal records from BIGAN, a population-based health database of Aragón (Spain). PPIs (n = 119,520) and H2-blockers (n = 3,086) initiators between 2015 and 2020 with preserved renal function. They were followed until the occurrence of an adverse kidney event, death, lost to follow-up or June 2021. Primary endpoints were worsening kidney function (measured as sCr ≥ 2 times baseline, eGFR < 60ml/min/1.73m2, a decrease in eGFR 30-50% from baseline or end stage renal disease) and AKI (measured by Aberdeen algorithm or hospitalization due to AKI). Incidence rates (IRs) per 1,000 persons-years were reported and Cox regression was used to calculate Hazard ratios (HRs), adjusted for confounders. Crude IRs for worsening kidney function were consistently lower for ranitidine than for PPIs (eGFR < 60ml/min/1.73m2: IR 18.7 95%CI (12.0-27.8) for ranitidine, IR 31.2 95%CI (29.9-32.5) for omeprazole). However, the risk of incident worsening function did not significantly differ in the Cox regression analysis adjusting for confounders (HR 0.99 95%CI (0.66-1.48) for omeprazole, as compared to ranitidine). PPI initiators consistently showed lower IRs of AKI using Aberdeen algorithm (IR 33.8 95%CI (32.4-35.1) for omeprazole, IR 52.8 95%CI (40.9-67.1) for ranitidine) and lower risk of AKI (HR 0.54 95%CI (0.42-0.70) for omeprazole, as compared to ranitidine). No clinically relevant differences were observed for worsening kidney function between PPIs and H2-blockers initiators. PPIs users presented a reduced risk of AKI compared to ranitidine initiators.

Incidence rate of suicidal behavior stratified by diagnosis among high-risk patients

BackgroundPsychiatric diagnoses are known to increase suicide risk, but whether this risk varies across specific disorders remains unclear. Previous studies have often relied on retrospective designs or population-based databases, limiting comparability due to heterogeneous methodologies and follow-up periods. AimsThis study aimed to compare the incidence rates of unfavorable events (suicide or suicide attempts) among high-risk patients with Major Depressive Disorder (MDD), Bipolar Disorder (BD), and Schizophrenia over a 24-month follow-up period. MethodsThis secondary analysis was conducted as part of a multicenter prospective cohort study involving 324 patients admitted to emergency departments for suicidal ideation or a recent suicide attempt. Clinical evaluations were performed at baseline and every six months to assess for unfavorable events. Additionally, Kaplan-Meier curves were estimated for each diagnosis, and Cox regression models were used to evaluate whether the diagnosis is associated with unfavorable events, adjusted for covariates such as age, history of childhood sexual abuse, and number of previous suicide attempts. ResultsThe incidence rates of suicide attempts were 27,000, 20,400, and 21,100 per 100,000 person-years for patients with MDD, BD, and Schizophrenia, respectively, while suicide rates were 1,600 per 100,000 person-years across all groups. No statistically significant differences were found in the risk of unfavorable events among diagnostic groups (p = 0.653), as confirmed by Kaplan-Meier survival analysis and Cox regression models. ConclusionsOver a 2-year follow-up, psychiatric diagnosis alone did not predict significant differences in unfavorable events rates. Comprehensive suicide risk assessments should prioritize individual risk profiles over diagnostic categories. These findings underscore the importance of integrating biopsychosocial factors in suicide prevention strategies for high-risk psychiatric populations.

Incidence and Risk of Cardiovascular Outcomes in Patients With Anorexia Nervosa

Anorexia nervosa (AN) is commonly associated with cardiovascular complications. To investigate the trajectories of the risk of cardiovascular conditions in a nationwide cohort of patients with AN in Taiwan. From a population-based health insurance database from January 1, 2011, to December 31, 2021, this longitudinal cohort study identified patients with AN and controls through propensity score matching at a 1:10 ratio according to sex, age, urbanization level of residence, socioeconomic status, and year of diagnosis. Data were analyzed from June 27, 2023, to February 23, 2024. First-time diagnosis of AN by psychiatrists during the study period. Incidence and risk of composite cardiovascular conditions. Kaplan-Meier curves were used to estimate the cumulative incidence of major adverse cardiovascular events (MACE) and any cardiovascular condition. With adjustment for psychiatric comorbidities, conditional Cox proportional hazards regression analyses were performed to estimate the risk of cardiovascular events, which were presented as hazard ratios (HRs) and 95% CIs, relative to the comparison group. Risks of individual cardiovascular conditions were calculated during 3 follow-up periods after AN diagnosis. The study population included 2081 patients with AN and 20 810 matched controls, for a total of 22 891 participants (mean [SD] age, 24.9 [9.9] years; 91.3% female). In total, 99 patients with AN (4.8%) had MACE vs 175 (0.8%) in controls, and 124 patients with AN (6.0%) had any cardiovascular condition vs 483 controls (2.3%). At the 5-year follow-up, the cumulative incidence rate of MACE was 4.82% (95% CI, 3.85%-6.02%) and of any cardiovascular condition was 6.19% (95% CI, 5.19%-7.53%). Compared with the control group, the AN group had significantly higher risks of MACE (adjusted HR [AHR], 3.78; 95% CI, 2.83-5.05) and any cardiovascular condition (AHR, 1.93; 95% CI, 1.54-2.41). The significantly increased risks of congestive heart failure, conduction disorder, and structural heart disease occurred in the initial follow-up period and disappeared after 60 months of follow-up. Notably, patients with AN did not have an increased risk of ischemic heart disease until after 60 months of follow-up (AHR, 3.01; 95% CI, 1.48-6.13). In this national matched cohort study, increased risk of cardiovascular conditions was found in different periods after AN diagnosis. Clinicians should monitor comorbid cardiovascular conditions among patients with AN at initial presentation, during treatment, and at follow-up.

Association between atherogenic index of plasma and peripheral arterial disease.

Background: Growing body of evidence suggests that the atherogenic dyslipidemia phenotype is a precursor to Peripheral Arterial Disease (PAD). Nonetheless, there is limited research regarding the association between Atherogenic Index of Plasma (AIP) and PAD which utilized a community population-based database in the United States. We sought to fill this knowledge gap. Methods: A total of 3,517 participants from the National Health and Nutrition Examination Survey 1999-2004 cycles were enrolled in our study. AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). Logistic regression models were adopted to reveal the relationship of AIP and PAD. Additionally, stratified and interaction analyses were also undertaken to see if the relationship was stable in different subgroups. Results: Participants in the higher tertile of AIP tended to have higher prevalence of PAD. A positive correlation was identified between AIP increase and PAD after fully multivariate adjustment (OR=1.30, 95% CI: 1.06-1.59). The multivariable-adjusted OR and 95% CI of the highest AIP tertile compared with the lowest tertile was 1.50 (1.07-2.1). Subgroup analysis demonstrated that the positive association between AIP and PAD was persistent across population subgroups. Conclusions: Our findings demonstrate a positive association between AIP and the incidence of PAD among adults in American adults. Specifically, 1 unit increase in AIP led to a 30% greater risk of PAD.

Updated breast cancer costs for women by disease stage and phase of care using population-based databases.

This study assessed health care system costs and resource utilization for adult women with breast cancer in Ontario, Canada. The goal was to update costs by stage, age, and phase of care from a health care system perspective. A retrospective analysis was conducted using linked population-based administrative data. The study included women diagnosed with breast cancer from 2017 to 2021, with follow-up data until 2022. Cases were matched with controls in a 1:5 ratio using birth year, local health integrative network, income quintile, and resource utilization band at baseline. Incremental costs were estimated using linear regression. The modified income quintile was the neighbourhood- or area-level income quintile. Among the 37,133 cases matched with 185,665 controls, the average age at diagnosis was 62 years. For the entire study duration, cases incurred an additional cost of $27,485 per year, compared with controls. Costs rose with disease severity, ranging from $15,588 for stage I to $137,319 for stage IV. The highest incremental costs occurred during the first 12 months after diagnosis (initial: $43,408), followed by the last 12 months before death (terminal: $25,940), and then interim years (continuous: $9,533 per year). Additionally, the incremental cost of breast cancer was higher when diagnosis was before age 70 ($28,415), compared with diagnosis at age 70 and older ($25,254). The findings align with previous studies on breast cancer costs for the health care system. Additionally, variations in costs based on disease severity, care phase, and age were emphasized, highlighting higher costs for metastatic breast cancer cases, women younger than 70 years, and the initial 12 months following diagnosis.

Abstract 4120332: RISING TRENDS IN ISCHEMIC HEART DISEASE RELATED MORTALITY AMONG OLDER ADULTS WITH SLEEP APNEA IN THE UNITED STATES FROM 1999 TO 2021

Introduction: Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database. Methods: We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population &gt;65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time. Results: Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1). Conclusion: In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

Association Between Atopic Dermatitis and Meniere's Disease: Nationwide Cohort Study.

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by relapsing and remitting episodes. Although AD is well-known for its association with other allergic conditions, its relationship with Meniere's disease has not been thoroughly investigated. This study aimed to explore the potential correlation between AD and Meniere's disease. This study utilized data from the National Health Insurance Service-National Sample Cohort, a nationwide population-based database. The AD group was selected from a cohort of 1 million individuals randomly extracted from database. A non-AD group was obtained through Propensity Score Matching. The AD group comprised 84,579 individuals, with an equal number of individuals in the non-AD (control) group. The overall hazard ratio (HR) for Meniere's disease in the AD group was 1.44 (95% confidence interval (CI): 1.31-1.6). Subgroup analysis showed an adjusted HR of 0.42 (95% CI: 0.38-0.48) for Meniere's disease in males, 4.99 (95% CI: 4.45-5.62) in the middle-aged group (40-59 years), and 8.21 (95% CI: 7.21-9.35) in the older age group (≥60 years). Additionally, the adjusted HRs for developing Meniere's disease were higher in patients with comorbidities, including allergic rhinitis (1.18 [95% CI, 1.07-1.32]), allergic contact dermatitis (1.32 [95% CI, 1.19-1.48]), and allergic conjunctivitis (1.54 [95% CI, 1.32-1.82]). Long-term follow-up revealed that the prevalence of Meniere's disease was 1.44 times higher in the AD group compared to the control group. Moreover, older age, female sex, allergic rhinitis, allergic contact dermatitis, and allergic conjunctivitis were identified as factors that increase the risk of developing Meniere's disease. 3 Laryngoscope, 2024.

Clinical profile of herpes zoster-related hospitalizations and complications: A French population-based database study

To estimate the incidence of hospitalization with a diagnosis of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in France between 2013 and 2020, overall and stratified by age-group and immune status. Retrospective observational, database study, using the French hospital discharge database, which includes private and public data for all day-care and inpatient stays. Adults aged ≥18 years, hospitalized between January 1, 2013, and December 31, 2020, with a diagnosis of HZ or PHN, were included. Overall, 62 077 adults had a first hospitalization with a diagnosis of HZ or PHN during the observation period. HZ and/or PHN incidence ranged between 14.6 and 16.3 hospitalizations/100 000 persons and was highest in people aged ≥80 years (97.6 hospitalizations/100 000 persons). The immunocompromised (IC) population accounted for 22% of the overall study population. IC patients had longer lengths of stay for HZ per episode compared with non-IC patients (15.5±19.4 days vs 12.2±13.5 days) and higher in-patient mortality (8% vs 4%). Average annual hospitalization costs per patient were higher in the IC vs non-IC population (€8018 vs €5603). Older age increases hospitalization rates up to 6-fold and IC status increases in-patient mortality up to two-fold. The study was conducted by HEVA and data were provided by ATIH according to French regulatory and data protection procedures.

Survival Outcomes of Radiofrequency Ablation for Intrahepatic Cholangiocarcinoma from the Surveillance, Epidemiology, and End Results Database: Comparison with Radiotherapy and Resection

PurposeTo determine effectiveness of radiofrequency ablation for treatment of intrahepatic cholangiocarcinoma (iCCA) using a population-based database. Materials and MethodsData were extracted from Surveillance, Epidemiology, and End Results database from 2000 to 2020 to include 194 patients who underwent ablation for iCCA. Data on patient demographics, overall survival (OS), and cancer-specific survival were retrieved. Factors associated with survival were evaluated. Comparison between ablation and surgical resection (n = 2,653) or external beam radiotherapy (n = 1,068) was performed. ResultsIn the ablation group, patients diagnosed and treated after 2010 demonstrated improved OS than that in the 2000–2009 subgroup (median OS, 32 vs 21 months; hazard ratio, 0.50; 95% CI, 0.33–0.75; P = .001). Additional factors associated with OS included tumor size (≤3 cm vs >3 cm; P = .049) and tumor stage (P < .001). For patients diagnosed after 2010, the 1-, 3-, and 5-year OS were 82.8% (95% CI, 74.8%–88.4%), 43.5% (95% CI, 33.5%–53.1%), and 23.7% (95% CI, 15.3%–33.5%), respectively. Patients with local disease (1-year OS, 87.8%; 95% CI, 78.6%–93.3%) demonstrated improved OS compared with patients with regional (1-year OS, 81.3%; 95% CI, 52.5%–93.5%) and distant disease (50.2%; 95% CI, 34.0%–78.8%; P < .001). For tumors ≤3 cm, ablation and surgical resection offered comparable survival benefits (P = .561), although both were better than radiotherapy (P < .0001). ConclusionsSurvival of patients with iCCA who underwent thermal ablation has improved over the last 10 years. For tumors ≤3 cm, ablation could be as effective as resection with careful candidate selection, and may be considered front-line compared with radiotherapy in certain patient populations. Patient selection based on tumor size and disease stage could improve survival outcomes.

Sex-Based Differences in Long-Term Outcomes Following Transcatheter Closure of Patent Foramen Ovale for Cryptogenic Stroke.

Evidence from trials suggests that patent foramen ovale closure is superior to medical therapy alone in reducing stroke recurrence in men but not in women. Evidence from real-world data on the impact of sex on outcomes after patent foramen ovale closure, however, remains scarce. Therefore, the present study aimed to assess sex-based differences in long-term outcomes after transcatheter closure of patent foramen ovale. This was a single-center, retrospective cohort study enrolling patients who underwent transcatheter patent foramen ovale closure to prevent recurrent cerebrovascular events. Detailed information from medical charts was entered into a clinical registry, which has been linked to population-based administrative health databases in Ontario. Procedural, short, and long-term outcomes have been compared by sex. Of the 783 patients included in the sample, 349 (44.5%) were women and 434 (55.5%) were men. Women were younger and had a higher rate of migraine, while men had a higher prevalence of cardiovascular risk factors. No differences were observed in procedural and 30-day outcomes by sex. At a median follow-up of 14 years, the event rates of recurrent cerebrovascular events, survival, and new-onset atrial fibrillation were not different by sex. In adjusted analysis, men experienced higher rates of pacemaker implantation (hazard ratio, 5.62 [95% CI, 1.57-20.1]). No sex-based differences in recurrent cerebrovascular events, survival, or new-onset atrial fibrillation were observed in this study, suggesting equal benefits for both sexes. Future studies should report outcomes by sex to enhance the reproducibility of our findings and help support guideline development.

Impact of zero coronary artery calcium scoring on downstream cardiac testing and cardiac outcomes in comparison to no testing

BackgroundThe impact of coronary artery calcium (CAC) scoring on downstream resource utilization and outcomes remains unclear, especially in those with zero CAC. MethodsConsecutive CAC scores from two academic hospitals in Toronto, Canada were linked to population-based databases. Subjects with zero calcium without previous cardiovascular disease were propensity score-matched with a non-CAC-tested control group for age, sex, cardiovascular risk factors and other comorbidities. Downstream cardiac testing, acute myocardial infarction (AMI), heart failure (HF) hospitalizations, and HF ED visits were compared between the two groups. Results4,884 patients underwent CAC scoring, of whom 2,709 had zero CAC (mean 52.9y, standard deviation (SD) 10.6), 55.4% women. At 3.4 years, graded-stress testing (hazard ratio (HR) 1.24, 95% confidence interval 1.14 – 1.35), stress echocardiography (HR 1.80, 1.59 – 2.05) and cardiac magnetic resonance imaging (HR 3.40, 2.55 – 4.53) use was higher in the zero CAC group, whereas myocardial perfusion imaging (HR 1.08, 0.97 – 1.21) and catheterization (HR 1.14, 0.91 – 1.44) were similar and percutaneous coronary intervention (PCI) (HR 0.58, 0.35 – 0.98) and coronary artery bypass grafting (CABG) (HR 0.14, 0.03 – 0.61) were lower. There was an approximately 5-fold lower rate of myocardial infarction (AMI) (HR 0.22, 0.10 – 0.51) in the zero CAC group and no difference in HF hospitalizations (HR 1.15, 0.53 – 2.48) or ED admissions (HR 1.21, 0.58 – 2.52). ConclusionOur results support the utility of zero CAC in limiting interventional cardiovascular procedures while maintaining an association with reduced downstream cardiovascular events.

Racial and Ethnic Differences in Liver Transplantation and Post-Liver Transplant Survival Among Patients With Hepatocellular Carcinoma.

Racial and ethnic disparities in diagnosis and overall outcomes for HCC are well known. We present updated real-world data on racial or ethnic differences in LT and post-LT survival among patients with HCC in a large population-based database. We used the TriNetX database to retrospectively identify patients who had HCC (ICD-10 C22.0, C22.8) and underwent LT (CPT codes 47,135, 47,140, 47,140, 47,141, 47,142) from 2012 to 2022 and compared outcomes across racial and ethnic subgroups. Majority of the patients were Caucasians (2403/2901, 84.8%), followed by African Americans (267/2901, 9.2%) Hispanic/Asian (231/2901, 7.9%). At follow up of 5 years, we noted no significant difference in mortality between AA and Caucasian patients [HR = 1.087 (95% CI 0.76, 1.56, p = 0.59)] as well as Hispanic/Asian and Caucasian patients [HR = 1.14 (95% CI 0.73, 1.78, p = 0.10)]. These results indicate that stringent implementation of policies aimed at ensuring equitable access to LT may contribute to bridging disparities in overall outcomes in HCC.

Regional Comparison in Cerebral Performance Outcome of Out-of-Hospital Cardiac Arrest: The All-Japan Utstein Registry.

Past studies have reported regional differences in the prognosis of out-of-hospital cardiopulmonary arrest (OHCA) in Japan, but there is a lack of sufficient information to explain the changes in neurological prognosis over time. Using the All-Japan Utstein Registry, a nationwide population-based OHCA database, we included non-traumatic OHCA patients resuscitated by emergency responders across all seven regions from January 1, 2011, to December 31, 2017. The primary endpoint was a favorable neurological outcome one month after cardiac arrest, compared among these seven regions. The secondary endpoint was one-month survival after OHCA. There were 880,043 OHCA patients, of whom 721,455 (82.0%) were included in the analysis. Overall, a total of 17,685 (2.45%) patients survived with favorable neurological outcomes. Unadjusted neurological favorable outcomes varied regionally, ranging from 1.64% to 3.37% (rate difference: 1.73%; 95%CI: 1.57-1.89%). The East and Northeast had a significantly lower rate compared to the Midwest region (unadjusted rate ratio: 0.73; 95%CI: 0.70-0.76; p<0.001, 0.63; 95%CI: 0.59-0.67; p<0.001, respectively). The significant difference remained after adjustment for patient factors and prehospital factors (adjusted rate ratio: 0.68; 95%CI: 0.64-0.72, p<0.01, 0.70; 95%CI: 0.67-0.73, p<0.01, respectively). The secondary outcome, survival at one month, also showed similar regional differences. In this post-hoc analysis, nationwide, population-based study in Japan, we found that regional differences in the neurologic prognosis of OHCA patients persist. The difference has narrowed from previous years, but the causes still need to be investigated and improved in the future.