Population Incidence Rates Research Articles

Assessing the external validity of model-based estimates of the incidence of heart attack in England: a modelling study.

BackgroundThe DisMod II model is designed to estimate epidemiological parameters on diseases where measured data are incomplete and has been used to provide estimates of disease incidence for the Global Burden of Disease study. We assessed the external validity of the DisMod II model by comparing modelled estimates of the incidence of first acute myocardial infarction (AMI) in England in 2010 with estimates derived from a linked dataset of hospital records and death certificates.MethodsInputs for DisMod II were prevalence rates of ever having had an AMI taken from a population health survey, total mortality rates and AMI mortality rates taken from death certificates. By definition, remission rates were zero. We estimated first AMI incidence in an external dataset from England in 2010 using a linked dataset including all hospital admissions and death certificates since 1998. 95 % confidence intervals were derived around estimates from the external dataset and DisMod II estimates based on sampling variance and reported uncertainty in prevalence estimates respectively.ResultsEstimates of the incidence rate for the whole population were higher in the DisMod II results than the external dataset (+54 % for men and +26 % for women). Age-specific results showed that the DisMod II results over-estimated incidence for all but the oldest age groups. Confidence intervals for the DisMod II and external dataset estimates did not overlap for most age groups.ConclusionBy comparison with AMI incidence rates in England, DisMod II did not achieve external validity for age-specific incidence rates, but did provide global estimates of incidence that are of similar magnitude to measured estimates. The model should be used with caution when estimating age-specific incidence rates.

Trends in cancer incidence and survival for Indigenous and non-Indigenous people in the Northern Territory.

To assess trends in cancer incidence and survival for Indigenous and non-Indigenous Australians in the Northern Territory. Retrospective analysis of population-based cancer registration data. New cancer diagnoses in the NT, 1991-2012. Age-adjusted incidence rates; rate ratios comparing incidence in NT Indigenous and non-Indigenous populations with that for other Australians; 5-year survival; multivariable Poisson regression of excess mortality. The incidence of most cancers in the NT non-Indigenous population was similar to that for other Australians. For the NT Indigenous population, the incidence of cancer at several sites was much higher (v other Australians: lung, 84% higher; head and neck, 325% higher; liver, 366% higher; cervix, 120% higher). With the exception of cervical cancer (65% decrease), incidence rates in the Indigenous population did not fall between 1991-1996 and 2007-2012. The incidence of several other cancers (breast, bowel, prostate, melanoma) was much lower in 1991-1996 than for other Australians, but had increased markedly by 2007-2012 (breast, 274% increase; bowel, 120% increase; prostate, 116% increase). Five-year survival was lower for NT Indigenous than for NT non-Indigenous patients, but had increased for both populations between 1991-2000 and 2001-2010. The incidence of several cancers that were formerly less common in NT Indigenous people has increased, without a concomitant reduction in the incidence of higher incidence cancers (several of which are smoking-related). The excess burden of cancer in this population will persist until lifestyle risks are mitigated, particularly by reducing the extraordinarily high prevalence of smoking.

Breast Cancer Risk From Modifiable and Nonmodifiable Risk Factors Among White Women in the United States.

An improved model for risk stratification can be useful for guiding public health strategies of breast cancer prevention. To evaluate combined risk stratification utility of common low penetrant single nucleotide polymorphisms (SNPs) and epidemiologic risk factors. Using a total of 17 171 cases and 19 862 controls sampled from the Breast and Prostate Cancer Cohort Consortium (BPC3) and 5879 women participating in the 2010 National Health Interview Survey, a model for predicting absolute risk of breast cancer was developed combining information on individual level data on epidemiologic risk factors and 24 genotyped SNPs from prospective cohort studies, published estimate of odds ratios for 68 additional SNPs, population incidence rate from the National Cancer Institute-Surveillance, Epidemiology, and End Results Program cancer registry and data on risk factor distribution from nationally representative health survey. The model is used to project the distribution of absolute risk for the population of white women in the United States after adjustment for competing cause of mortality. Single nucleotide polymorphisms, family history, anthropometric factors, menstrual and/or reproductive factors, and lifestyle factors. Degree of stratification of absolute risk owing to nonmodifiable (SNPs, family history, height, and some components of menstrual and/or reproductive history) and modifiable factors (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], menopausal hormone therapy [MHT], alcohol, and smoking). The average absolute risk for a 30-year-old white woman in the United States developing invasive breast cancer by age 80 years is 11.3%. A model that includes all risk factors provided a range of average absolute risk from 4.4% to 23.5% for women in the bottom and top deciles of the risk distribution, respectively. For women who were at the lowest and highest deciles of nonmodifiable risks, the 5th and 95th percentile range of the risk distribution associated with 4 modifiable factors was 2.9% to 5.0% and 15.5% to 25.0%, respectively. For women in the highest decile of risk owing to nonmodifiable factors, those who had low BMI, did not drink or smoke, and did not use MHT had risks comparable to an average woman in the general population. This model for absolute risk of breast cancer including SNPs can provide stratification for the population of white women in the United States. The model can also identify subsets of the population at an elevated risk that would benefit most from risk-reduction strategies based on altering modifiable factors. The effectiveness of this model for individual risk communication needs further investigation.

Incidence of melanoma in organ transplant recipients in Alberta, Canada.

Many studies have documented the increased risk of non-melanoma skin cancers in organ transplant recipients (OTRs). However, the incidence of melanoma is less well defined. To date, there have been no studies on the incidence of melanoma in Canadian OTRs. Herein, we determine the incidence and clinical features of melanoma in a cohort of OTRs in Southern Alberta, Canada. We used the Southern Alberta Transplant database to identify kidney and liver transplant recipients between the years 2000 and 2012. This population was cross-referenced with the Alberta Cancer Registry for a diagnosis of melanoma. The clinical features of all cases were obtained, and the standardized incidence rate was calculated. We identified 993 OTR patients, representing 5955 person-years. Only one patient developed a melanoma post-transplant, and this was a nodular melanoma. The age-standardized incidence rate was 11 per 100000 (0.6 per 5955), compared to 13.4 per 100000 in the general Alberta population (incidence rate ratio of 1.29, with 95% confidence interval of 0.17 to 9.82). This is the first Canadian study to investigate the association between organ transplantation and melanoma. Our study did not identify an increased risk of developing a de novo melanoma post-transplant.

Cancer-specific incidence rates of tuberculosis

Population-based studies of the incidence of tuberculosis in cancer patients according to the type of cancer are limited. We investigated the cancer-specific incidence of tuberculosis in a nationwide population-based cohort in a country with an intermediate burden of tuberculosis.We used mandatory National Health Insurance claims data to construct a cancer cohort of adults (aged 20–99 years) with newly diagnosed malignancies other than lung cancer, from January 2008 to December 2012. Patients who developed tuberculosis in this period were identified in the cancer cohort and the general population. Standardized incidence ratios (SIRs) of tuberculosis in the cancer cohort according to type of cancer and time after cancer diagnosis were calculated by comparing the observed incidence rates with those inferred from the age- and gender-specific incidence rates in the general population.A total of 855,382 cancer patients and 1589,876 person-years (py) were observed. A total of 5745 patients developed tuberculosis; the mean incidence rate was 361.3 per 100,000 py, and the SIR was 2.22 (95% confidence interval [CI], 2.17–2.27). The incidence rate was highest for hematologic malignancy and lowest for thyroid cancer. It was also highest as 650.1 per 100,000 py, with SIR of 3.70 (CI, 3.57–3.83) for the first 6 months after diagnosis of malignancy and then declined. However, it still remained higher than that of the general population after 24 months (SIR = 1.43, CI, 1.36–1.51).The incidence of tuberculosis increases after diagnosis in patients with malignancies. The risk of tuberculosis differs according to the type of cancer and remains elevated even 24 months after cancer diagnosis. Tuberculosis should be considered an important comorbidity in patients with malignancies.

Pulmonary Embolism in Portugal: Epidemiology and In-Hospital Mortality

In Portugal, the epidemiology of acute pulmonary embolism is poorly understood. In this study, we sought to characterize the pulmonary embolism from the hospital data and evaluate its in-hospital mortality and respective prognostic factors. The study used diagnostic related groups data from National Health System hospitals from 2003 to 2013 and National Statistics Institute population data to establish the evolution of admissions with the diagnosis of pulmonary embolism, their inhospital mortality rates and the population incidence rates. Diagnosis-related group microdata were used in a logit regression modeling in-hospital mortality as a function of individual characteristics and context variables. Between 2003 and 2013 there were 35,200 episodes of hospitalization in patients with 18 or more years in which one of the diagnoses was pulmonary embolism (primary diagnosis in 67% of cases). The estimated incidence rate in 2013 was 35/100,000 population (≥ 18 years). Between 2003 and 2013, the annual number of episodes kept increasing, but the in-hospital mortality rate decreased (from 31.8% to 17% for all cases and from 25% to 11.2% when pulmonary embolism was the main diagnosis). The probability of death decreases when there is a computerized tomography scan registry or when patients are females and increases with age and the presence of co-morbidities. In the last decade there was an increased incidence of pulmonary embolism likely related to an increased number of dependents and bedridden. However, there was a in-hospital mortality reduction of such size that the actual mortality in the general population was reduced. One possible explanation is that there has been an increase in episodes of pulmonary embolism with incrementally lower levels of severity, due to the greater capacity of diagnosis of less severe cases. Another possible explanation is greater effectiveness of hospital care. According to the logistic regression analysis, improvements in hospital care effectiveness in recent years are primarily responsible for the mortality reduction. About 79% of the reduction of in-hospital mortality of pulmonary embolism between 2003 and 2013 can be attributed to greater effectiveness of hospital care and the rest to the favorable change in patient characteristics associated with risk of death.

Ovarian and tubal cancer in Denmark: an update on incidence and survival.

The Nordic countries are areas with a high-incidence of ovarian cancer; however, differences between the countries exist. We used the Danish Cancer Registry to identify 11 264 cases of ovarian cancer and 363 cases of tubal cancer during 1993-2013. We calculated age-standardized (world standard population) incidence rates for overall and subtype-specific ovarian cancer, and for tubal cancer. We compared age-standardized incidence rates, and 1- and 5-year age-standardized relative survival rates, respectively, for ovarian and tubal cancer combined in four Nordic countries using the NORDCAN database. The incidence rate of ovarian cancer overall in Denmark decreased statistically significantly by approximately 2.3% per year among women aged <70 years, whereas no change was seen among women aged 70+ years. In the <70-year age-group, the incidence of serous tumors was fairly steady, whereas that of other and unspecified epithelial tumors decreased significantly by 6.4% per year. The incidence of tubal cancer was quite stable. In Norway and Finland, the incidence rates of ovarian and tubal cancer combined decreased from 1993 to 2013 in women aged <70 years, whereas in Sweden the incidence rates decreased independently of age. The 1- and 5-year relative survival rates of ovarian and tubal cancer combined increased during the study period in all the Nordic countries. Denmark had the lowest survival; however, the survival rates approached those of the other countries in recent years. In Denmark, the positive development in ovarian cancer has continued during recent years with a lower incidence and an increased survival.

Incidence and etiology of hospitalized acute respiratory infections in the Egyptian Delta.

IntroductionAcute Respiratory Infections (ARI) are responsible for nearly two million childhood deaths worldwide. A limited number of studies have been published on the epidemiology of viral respiratory pathogens in Egypt.MethodsA total of 6113 hospitalized patients >1 month of age with suspected ARI were enrolled between June 23, 2009 and December 31, 2013. Naso‐ and oropharyngeal specimens were collected and tested for influenza A and B, respiratory syncytial virus, human metapneumovirus, adenovirus, and parainfluenza viruses 1–3. Blood specimens from children 1–11 months were cultured and bacterial growth was identified by polymerase chain reaction. Results from a healthcare utilization survey on the proportion of persons seeking care for ARI was used to calculate adjusted ARI incidence rates in the surveillance population.ResultsThe proportion of patients with a viral pathogen detected decreased with age from 67% in patients age 1–11 months to 19% in patients ≥65 years of age. Influenza was the dominant viral pathogen detected in patients ≥1 year of age (13.9%). The highest incidence rates for hospitalized ARI were observed in children 1–11 months (1757.9–5537.5/100 000 population) and RSV was the most commonly detected pathogen in this age group.ConclusionIn this study population, influenza is the largest viral contributor to hospitalized ARIs and children 1–11 months of age experience a high rate of ARI hospitalizations. This study highlights a need for surveillance of additional viral pathogens and alternative detection methods for bacterial pathogens, which may reveal a substantial proportion of as yet unidentified etiologies in adults.

Modeling the prevention of colorectal cancer from the combined impact of host and behavioral risk factors

Purpose:This study investigated the utility of modeling modifiable lifestyle risk factors in addition to genetic variation in colorectal cancer (CRC) screening/prevention.Methods:We derived a polygenic risk score for CRC susceptibility variants in combination with the established nongenetic risk factors of inflammatory bowel disease (IBD), adiposity, alcohol, red meat, fruit, vegetables, smoking, physical activity, and aspirin. We used the 37 known risk variants and 50 and 100% of all risk variants as calculated from a heritability estimate. We derived absolute risk from UK population age structure, incidence, and mortality rate data.Results:Taking into account all risk factors (known variants), 42.2% of 55- to 59-year-old men with CRC have a risk at least as high as that of an average 60-year-old, the minimum eligible age for the UK NHS National Bowel Cancer Screening Program. If the male population is stratified by known variants and IBD status, then risk-difference estimates imply that for 10,000 50-year-old men in the 99th percentile, 760 cases could be prevented over a 25-year period through the modifiable risk factors, but in the lowest percentile, only 90 could be prevented.Conclusion:CRC screening and prevention centered on modifiable risk factors could be optimized if targeted at individuals at higher polygenic risk.Genet Med19 3, 314–321.

Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population

BackgroundMammography screening programs (MSPs) aim to detect early-stage breast cancers in order to decrease the incidence of advanced-stage breast cancers and to reduce breast cancer mortality. We analyzed the time trends of advanced-stage breast cancer incidence rates in the target population before and after implementation of the MSP in a region of northwestern Germany. MethodsThe MSP in the Münster district started in October 2005. A total of 13,874 women with an incident invasive breast cancer (BC) was identified by the population-based epidemiological cancer registry between 2000 and 2013 in the target group 50–69 years. Multiple imputation methods were used to replace missing data on tumor stages (10.4%). The incidence rates for early-stage (UICC I) and advanced-stage (UICC II+) BC were determined, and Poisson regression analyses were performed to assess trends over time. ResultsThe incidence rates for UICC I breast cancers increased during the step-up introduction of the MSP and remained elevated thereafter. By contrast, after increasing from 2006 to 2008, the incidence rates of UICC II+ breast cancers decreased to levels below the pre-screening period. Significantly decreasing UICC II+ incidence rates were limited to the age group 55–69 years and reached levels that were significantly lower than incidence rates in the pre-screening period. DiscussionThe incidence rates of advanced-stage breast cancers decreased in the age groups from 55 years to the upper age limit for screening eligibility, but not in the adjacent age groups. The findings are consistent with MSP lead time effects and seem to indicate that the MSP lowers advanced-stage breast cancer rates in the target population.

Abstract 2590: Development and validation of a breast cancer risk prediction model for black women: findings from the Nigerian breast cancer study

Abstract Background: Breast cancer (BC) risk prediction models, such as the Gail model, have been developed and widely used to identify women at higher risk of having breast cancer in developed countries. However, no model exists for Black women of sub-Saharan Africa (SSA). Because African women have different risk profiles, it is of public health importance to develop a Black women-specific model. Methods: A total of 1,880 hospital-based cases and 2,166 population-based controls from the Nigerian Breast Cancer Study (NBCS, 1998∼2015) were included in the analysis. Subjects were randomly divided into the training (2/3 of the data) and validation sets (1/3 of the data), and multivariate logistic regressions were used to derive the model. Risk factors were selected based on previous NBCS findings and literature review. Calibration and discrimination performances were assessed using the observed/expected ratio (O/E) and concordance statistic (C-index), respectively. Results: The final model included age, age at menarche, parity, duration of breast feeding, family history of BC in first degree relatives, height, body mass index, benign breast diseases, oral contraceptive use, and alcohol drinking. The model performed well in the validation set with an O/E of 1.01 (95% CI: 0.93∼1.09) and C-index of 0.694 (95% CI: 0.666∼0.722). The odds ratios for developing BC by percentiles of the predicted chance of cases, relative to women in the middle quintile, showed a monotonic increasing trend. Conclusion: In Nigeria, the most populous country in SSA with 175 million people, this study developed and validated a risk prediction model for BC that is specific to Black women. It can be used to identify individuals at high risk of BC for cancer prevention. Using the population incidence rates in Nigeria, an absolute risk prediction model will be further developed. Table 1Validation analyses in both training set and validation setPercentile of predicted chance being casesTraining set (n = 2699) OR (95%CI)Validation set (n = 1347) OR (95%CI)&amp;lt;5%0.18(0.10-0.30)0.24 (0.11-0.55)5%∼20%0.31(0.23-0.41)0.53(0.36-0.78)20%∼40%0.62(0.48-0.79)0.83(0.60-1.16)40%∼60%1.00(referent)1.00(referent)60%∼80%1.50(1.18-1.90)1.74(1.25-2.44)80%∼95%2.76(2.10-3.62)3.68(2.48-5.44)95%∼8.53(4.93-14.77)7.43(3.76-14.69)C-index0.724(0.705-0.742)0.694(0.666-0.722) Citation Format: Shengfeng Wang, Temidayo Ogundiran, Adeyinka Ademola, Oluwasola A. Olayiwola, Adewunmi Adeoye, Adenike Adeniji-Sofoluwe, Imran Morhason-Bello, Stella Odedina, Imaria Agwai, Clement Adebamowo, Millicent Obajimi, Oladosu Ojengbede, Olufunmilayo I. Olopade, Dezheng Huo. Development and validation of a breast cancer risk prediction model for black women: findings from the Nigerian breast cancer study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2590.

Incidence of Gastrointestinal Perforations in Patients with Rheumatoid Arthritis Treated with Tocilizumab from Clinical Trial, Postmarketing, and Real-World Data Sources.

IntroductionThe aim of this study was to use multiple data sources to update information on gastrointestinal perforations (GIPs) during tocilizumab (TCZ) treatment in patients with rheumatoid arthritis (RA).MethodsReporting rates of GIP events were estimated from three distinct patient data sets: a TCZ-IV RA clinical trial all-exposure population, a global TCZ postmarketing safety database population, and a US healthcare claims database population of patients with RA, including patients who received TCZ, anti-tumor necrosis factor (aTNF) agents, or abatacept.ResultsThe clinical trial, global postmarketing, and healthcare claims populations provided 17,906, 382,621, and 3268 patient-years (PYs) of TCZ exposure, respectively. GIP incidence rates [95% confidence interval (CI)] were 1.9 (1.3–2.7), 1.2 (1.1–1.3), and 1.8 (0.7–4.0; specific definition) to 2.8 (1.3–5.2; sensitive definition) per 1000 PYs for the clinical trial, postmarketing, and healthcare claims populations, respectively. The GIP incidence rate (95% CI) for the comparator aTNF healthcare claims population ranged from 0.6 (0.3–1.2) to 0.9 (0.5–1.5) per 1000 PYs, for an absolute rate difference between TCZ and aTNFs of 1.2 (−0.3 to 2.5) to 1.9 (0.0–3.7) per 1000 PYs, corresponding to a number needed to harm between 533 and 828.ConclusionThe TCZ GIP event rates from multiple data sources were consistent with previously reported rates, did not increase over time, and were significantly associated with the number of prior biologics. Comparison of GIP incidence rates among patients with prior biologic exposure suggests that, for every 1000 patients treated with TCZ per year, an additional 1–2 GIP events might occur compared with patients treated with aTNFs.FundingRoche.

Identification of a Potential Molecular Diagnostic Biomarker in Keloid Disease: Syndecan-1 (CD138) Is Overexpressed in Keloid Scar Tissue

first year that cutaneous warts on the hands were assessed, were included in this analysis (Melski et al., 1977; Stern et al., 1979). The Mann-Whitney (Wilcoxon) twosample test for medians and Student t test for means were used to test for statistical significant differences between groups. Poisson regression was used to calculate the association of developing subsequent SCCs or BCCs with the presence of cutaneous hand warts in 1985e1986 and other risk factors. Age, sex, geographic location, and population incidence rates were used to calculate expected number of tumors (Scotto et al., 1974; Stern et al., 1979). We performed a univariate analysis of the association of cutaneous warts with previous history of SCC or BCC, level of exposure to PUVA up to the year 1985, high UVB exposure (300 treatments or more), high doses of methotrexate (if given for 36 or more months), and high doses of cyclosporine (if given for 2 or more years). Factors significant on univariate analysis were included in the multivariable model.

In memoriam: Dr. Andrew Czeizel.

In memoriam: Dr. Andrew Czeizel.

Epidemiology of intussusception in New Zealand pre rotavirus vaccination

To describe the epidemiology of intussusception in New Zealand children aged 0-36 months prior to the introduction of routine rotavirus vaccination.ICD-10 coding data from the New Zealand National Minimum Data Set (NMDS) was used to identify all cases of intussusception in children aged 0-36 months between January 1998 and December 2013. These data were linked with birth data from the New Zealand census. Population incidence rates of intussusception were calculated, and demographic characteristics described.Over the 16-year study period, there were 794 cases of intussusception. The majority (56%) occurred in the first year of life (age adjusted incidence rate 56.1/100,000 child-years, 95% confidence interval (CI) 41.7-71.2). Intussusception occurred more frequently in males (36.4/100,000 (95% CI 24.6-48.2) versus 19.5/100,000 (95% CI 10.8-28.1, p<0.001)). There was no difference in intussusception incidence between ethnic groups, although cases occurred at a younger age in Māori and Pacific infants compared to Asian and other ethnicities (Pacific median 7.5 months (interquartile range 5.9-11.6), Māori 7.8 months (IQR 5.5-12.3), European 9.2 months (IQR 5.8-15.8), Other Ethnicity 10.2 months (IQR 8.2-12.3), Asian 10.5 months (IQR 7.0-17.1 )). There was a weak seasonal trend with incidence troughs in January and July, and corresponding peaks in March and September. There was wide variation in presentation rates across District Health Board (DHB) regions, with a national average of 18.0/100,000 child-years (95% CI 9.7-26.3). Most patients were admitted on a single occasion to a single hospital for treatment (81%).This study updates background incidence rates of intussusception prior to the introduction of a national rotavirus vaccination programme in July 2014. It identifies a trend of earlier intussusception in Māori and Pacific infants; the relationship between earlier intussusception and the risk of vaccine-associated events is unknown.

Improved survival boosts the prevalence of chronic myeloid leukemia: predictions from a population-based study.

Due to prolonged survival, there will be many more chronic myeloid leukemia (CML) patients alive in the future. The aims of this work were to estimate the current prevalence of CML by using routine data and to project future patient numbers in Germany. Data were available for about 10.5 million people in the statutory health insurance system in Bavaria for the years 2008-2013. Survival rates were adapted from two recent publications. The mean estimated age-standardized (Old European Standard Population) incidence rates per 100,000 inhabitants were 1.300 and 1.768 for women and men. Based on the population data, we estimated a total number of about 9000 CML patients in Germany for 2012. We expect the number of CML patients to increase further until at least 2040-2050 with a maximum of more than 20,000 CML patients as the most probable scenario. Using a restrictive definition for case patients, we do not think that there is much overestimation. As a consequence of this considerable increase of the prevalence of CML the burden for the health care system will increase with respect to costs and medical care needed. The procedure presented here allows to estimate the expected number of CML patients in other countries, too.

Incidence and In-Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis-Requiring AKI (AKI-D) After Cardiac Catheterization in the National Inpatient Sample.

BackgroundAcute kidney injury (AKI) and dialysis‐requiring AKI (AKI‐D) are common, serious complications of cardiac procedures.Methods and ResultsWe evaluated 3 633 762 (17 765 214 weighted population) cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI‐D in the United States from 2001 to 2011. Odds ratios for both conditions and associated in‐hospital mortality were calculated for each year in the study period using multiple logistic regression. The number of cardiac catheterization or PCI cases resulting in AKI rose almost 3‐fold from 2001 to 2011. The adjusted odds of AKI and AKI‐D per year among cardiac catheterization and PCI patients were 1.11 (95% CI: 1.10–1.12) and 1.01 (95% CI: 0.99–1.02), respectively. Most importantly, in‐hospital mortality significantly decreased from 2001 to 2011 for AKI (19.6–9.2%) and AKI‐D (28.3–19.9%), whereas odds of associated in‐hospital mortality were 0.50 (95% CI: 0.45–0.56) and 0.70 (95% CI: 0.55–0.93) in 2011 versus 2001, respectively. The population‐attributable risk of mortality for AKI and AKI‐D was 25.8% and 3.8% in 2001 and 41.1% and 6.5% in 2011, respectively. Males and females had similar patterns of AKI increase, although males outpaced females.ConclusionsThe Incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States, and this should be addressed by implementing prevention strategies. However, mortality has significantly declined, suggesting that efforts to manage AKI and AKI‐D after cardiac catheterization and PCI have reduced mortality.

Implications of polygenic risk for personalised colorectal cancer screening

We modelled the utility of applying a personalised screening approach for colorectal cancer (CRC) when compared with standard age-based screening. In this personalised screening approach, eligibility is determined by absolute risk which is calculated from age and polygenic risk score (PRS), where the PRS is relative risk attributable to common genetic variation. In contrast, eligibility in age-based screening is determined only by age. We calculated absolute risks of CRC from UK population age structure, incidence and mortality rate data, and a PRS distribution which we derived for the 37 known CRC susceptibility variants. We compared the number of CRC cases potentially detectable by personalised and age-based screening. Using Genome-Wide Complex Trait Analysis to calculate the heritability attributable to common variation, we repeated the analysis assuming all common CRC risk variants were known. Based on the known CRC variants, individuals with a PRS in the top 1% have a 2.9-fold increased CRC risk over the population median. Compared with age-based screening (aged 60: 10-year absolute risk 1.96% in men, 1.19% in women, as per the UK NHS National Bowel Screening Programme), personalised screening of individuals aged 55-69 at the same risk would lead to 16% fewer men and 17% fewer women being eligible for screening with 10% and 8%, respectively, fewer screen-detected cases. If all susceptibility variants were known, individuals with a PRS in the top 1% would have an estimated 7.7-fold increased risk. Personalised screening would then result in 26% fewer men and women being eligible for screening with 7% and 5% fewer screen-detected cases. Personalised screening using PRS has the potential to optimise population screening for CRC and to define those likely to maximally benefit from chemoprevention. There are however significant technical and operational details to be addressed before any such programme is introduced.

Peripheral Arterial Disease Incidence and Associated Risk Factors in a Mediterranean Population-based Cohort. The REGICOR Study

The reported incidence of lower extremity peripheral arterial disease (PAD) in Western countries ranges between 530 and 2,380 per 100,000 person years. The aims of this study were to determine the incidence of PAD and identify associated risk factors in a Mediterranean population. Cardiovascular risk factors, the Edinburgh questionnaire, and ankle brachial index (ABI) were collected from 5,434 individuals, aged 35-79 years, from a population based cohort study at baseline and after a mean of 5.7 years follow up. PAD was defined as ABI <0.9 or a clinical diagnosis during follow up. Logistic and regression tree analyses were used to identify factors associated with PAD. In total, 118 new cases of confirmed PAD were identified. The cumulative population incidence rate of PAD was 377 cases per 100,000 person years. For symptomatic PAD, this figure was 102 per 100,000 person years. The most important risk factors for PAD were current (OR 2.30; 95% CI 1.27-4.16) or former smoking (OR 2.02; 95% CI 1.19-3.43), diabetes (OR 1.78; 95% CI 1.17-2.72), age (OR 1.04; 95% CI 1.02-1.07), history of cardiovascular disease (OR 2.06; 95% CI 1.22-3.51), triglycerides level (OR 1.56; 95% CI 1.07-2.29), and systolic blood pressure (OR 1.02; 95% CI 1.01-1.03). In the population ≤65 years the most relevant risk factor was diabetes, whereas in those >65 years smoking was the leading factor. Long-term uncontrolled diabetes was the strongest risk factor for PAD (OR 10.14; 95% CI 3.57-28.79). The incidence of lower extremity PAD is lower in the Mediterranean area than has been reported for other areas. The data suggest that patients with long-term uncontrolled diabetes and former and current smokers older than 65 years should be considered for PAD screening.

Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations.

Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale. To estimate the worldwide incidence and mortality of sepsis and identify knowledge gaps based on available evidence from observational studies. We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus criteria and published in the last 36 years. The search yielded 1,553 reports from 1979 to 2015, of which 45 met our criteria. A total of 27 studies from seven high-income countries provided data for metaanalysis. For these countries, the population incidence rate was 288 (95% confidence interval [CI], 215-386; τ = 0.55) for hospital-treated sepsis cases and 148 (95% CI, 98-226; τ = 0.99) for hospital-treated severe sepsis cases per 100,000 person-years. Restricted to the last decade, the incidence rate was 437 (95% CI, 334-571; τ = 0.38) for sepsis and 270 (95% CI, 176-412; τ = 0.60) for severe sepsis cases per 100,000 person-years. Hospital mortality was 17% for sepsis and 26% for severe sepsis during this period. There were no population-level sepsis incidence estimates from lower-income countries, which limits the prediction of global cases and deaths. However, a tentative extrapolation from high-income country data suggests global estimates of 31.5 million sepsis and 19.4 million severe sepsis cases, with potentially 5.3 million deaths annually. Population-level epidemiologic data for sepsis are scarce and nonexistent for low- and middle-income countries. Our analyses underline the urgent need to implement global strategies to measure sepsis morbidity and mortality, particularly in low- and middle-income countries.