Prevalence Of Other Comorbidities Research Articles

Association of baseline hypertension and hyperlipidemia with the clinical characteristics and outcomes in patients with colorectal cancer: A single institution experience.

e15522 Background: Hypertension (HTN) and hyperlipidemia (HLD) are widely prevalent diseases, but their effect on colorectal cancer (CRC) outcomes is limited. We aimed to study the effects of baseline HTN and HLD on CRC survival. Methods: We identified patients with stage 1-4 colorectal cancer diagnosed between 2011 and 2017 from tumor registry of a large safety-net hospital and NCI-designated Comprehensive Cancer Center. Patients with a diagnosis of HTN (ICD-9/10: I10, 401.9) and HLD (ICD 9/10: E78.0-E78.5, 272.0-272.4) at CRC diagnosis were compared with patients who did not have these comorbidities. Chi-square tests were used to compare categorical differences between groups. Multivariable logistic regression was used to identify factors associated with HTN and HLD. Overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazards model with an index date of tumor diagnosis until death. Patients who did not meet endpoint of interest were censored at the date of last clinical contact. Results: We identified 1,921 patients - 627 (33%) had HTN, 403 (21%) had HLD and 309 (16%) had HTN and HLD. The median age of diagnosis of CRC was 61 (IQR: 54-68) for HTN patients and 61 (IQR: 53-69) for HLD patients. Compared to patients without HTN or HLD, patients with HTN or HLD were more likely to be non-Hispanic Blacks (HTN: 39% vs 19%; HLD: 30% vs 24%), uninsured (HTN: 33% vs 17%; HLD: 36% vs 18%) and treated at safety-net hospital (HTN: 53% vs 24%; HLD: 55% vs 27%). These patients had a higher prevalence of other comorbidities including diabetes mellitus (HTN: 39% vs 7%; HLD: 50% vs 9%), anxiety (HTN:12% vs 3%; HLD: 14% vs 4%), and tobacco use (HTN: 16% vs 5%; HLD: 14% vs 7%). On multivariable analysis, HTN and HLD patients were older (HTN-OR: 1.05, 95CI: 1.04-1.06; HLD-OR: 1.03, 95CI: 1.02-1.05), had concurrent diabetes mellitus (HTN-OR: 4.2, 95CI: 2.9-6.3; HLD-OR: 4.5, 95CI: 3.2 - 6.4), depression (HTN-OR: 2.0, 95CI: 1.3-3.2; HLD-OR: 1.9, 95CI: 1.2-3.0), and cirrhosis (HTN-OR: 2.6, 95CI: 1.3-5.2; HLD-OR: 2.1, 95CI: 1.1-3.9) and treated at safety-net hospital (HTN-OR: 2.7, 95CI: 1.7-4.3; HLD-OR: 1.4, 95CI: 0.9-2.2). Compared to patients without HTN or HLD, OS was improved for HLD alone patients (HR: 0.58; 95CI: 0.38-0.89; P: 0.01), while it was not different for patients with HTN without HLD (HR: 0.99; 95CI: 0.81-1.2; P: 0.55) or HTN and HLD (HR: 0.92; 95CI: 0.75-1.13; P: 0.34). The 5-year yr OS for these groups were 65%, 77%, 66%, and 69% respectively. Conclusions: In this single institution cohort that includes a safety-net hospital, the prevalence of HTN or HLD at CRC diagnosis was higher among older and non-Hispanic Black CRC patients and associated with coexisting diabetes mellitus, anxiety, and tobacco use. CRC patients with HLD alone had a significantly better 5-yr OS compared to those without HTN or HLD, with HTN alone, and with HTN and HLD.

Bleeds and resource use in hemophilia B: retrospective observational study.

To describe people with hemophilia B (PWHB) in the US who experience bleeds despite factor replacement therapy and to quantify the associated burden from the third-party payer perspective. Observational study of adult male PWHB treated with factor IX replacement therapy identified from the PharMetrics Plus claims data from 2010 to 2019. Patients with medically recorded bleeds (MRBs) were identified using diagnostic codes. Rates and rate ratios of inpatient admissions, emergency department (ED) visits, and outpatient visits among PWHB with and without MRBs were estimated. The presence of comorbidities was identified using diagnostic codes, and the analysis was stratified by age group. There were 345 PWHB with MRBs and 252without MRBs. More than half of PWHB with MRBs (56.8%) had 1 or more comorbidity vs 39.3% of PWHB without MRBs. The prevalence of anxiety and depression was high in PWHB, regardless of bleed status and age group, whereas the prevalence of other comorbidities increased with age group. The rate of all-cause inpatient admissions for PWHB with MRBs was 14.8 per 100 person-years (95%CI, 12.8-17.1), 2.5 times higher than for PWHB without MRBs. The rate of all-cause ED visits for PWHB with MRBs was 67.6per 100 person-years (95% CI, 63.2-72.3), 2.7 times higher than for those without MRBs. This study reports significant resource use and clinical burden among PWHB who seek medical care. PWHB with MRBs had considerable all-cause resource use compared with PWHB without MRBs. The prevalence of mental illness was consistently high across all age groups.

Exploring the Relationship Between Diabetes and Breast Cancer in the United Arab Emirates.

Introduction This study delves into the complex interplay between diabetes and breast cancer within the United Arab Emirates (UAE), a subject of considerable global health concern. Given the increasing incidence of both diseases worldwide, this research investigates explicitly the potential influence of diabetes on the staging of breast cancer. The UAE, mirroring global trends, has experienced a surge in both conditions attributed to a blend of genetic, environmental, and lifestyle factors. The core objective of this investigation is to explore the link between diabetes and the stage at which breast cancer is diagnosed in UAE patients. Material and method To conduct this study, data were extracted from an extensive medical database consisting of anonymized records about breast cancer patients and their comorbid conditions. The research encompassed adult patients of all genders, all of whom had been definitively diagnosed with breast cancer. The data was analyzed using a suite of Python libraries, including Pandas, NumPy, SciPy, Scikit-learn, Matplotlib, and Seaborn. Descriptive and inferential statistical methods were employed, focusing on the Chi-Square test and logistic regression analysis to evaluate the relationship between diabetes and the stages of breast cancer, considering other comorbidities as well. Results The analysis included 131 breast cancer patients, predominantly female (98.47%), with an average age of 54.2 years. Among these patients, 22.14% were diabetic. The prevalence of other comorbidities, such as dyslipidemia, hypertension, and hypothyroidism, was also recorded. The Chi-Square test indicated no significant correlation between diabetes and the stages of breast cancer (χ² = 3.07, p = 0.381). Stage II was the most frequently diagnosed, irrespective of the presence or absence of diabetes. Conclusion In conclusion, this study finds no substantial link between diabetes and the stage of breast cancer diagnosis among patients in the UAE after adjusting for age and other comorbid conditions. These results underscore the need for early breast cancer detection approaches that are not exclusively dependent on the diabetic status of the patients. However, limitations such as the retrospective cohort design and the relatively small sample size highlight the necessity for further comprehensive studies. Such research would deepen the understanding of the relationship between diabetes and breast cancer and contribute to the advancement of breast cancer healthcare in the UAE.

Prevalence and Socioeconomic Impact of Allergic Rhinitis Among Ear, Nose, and Throat Patients of a Tertiary Hospital.

The objectives of this study were to establish the demographic factors of allergic rhinitis patients taking part in the study, to gain insight into the common symptoms experienced by patients with allergic rhinitis, to know the common allergens or triggers that lead to the symptoms of allergic rhinitis and to determine the prevalence of other comorbidities associated with allergic rhinitis. The study was a cross-sectional hospital-based study encompassing both quantitative and qualitative features of the participants involved. The quantitative study involved collecting data on allergic rhinitis clients visiting our tertiary hospital, over the period of March 1, 2021, to June 25, 2021. The quantitative data included the gender and age groups commonly affected, the most common symptom, and the trigger identified. Whilst, the qualitative aspect of the study involved the socioeconomic impact of allergic rhinitis on the clients. The prevalence of allergic rhinitis is 10% at the ENT clinic of our hospital. It was most common in the age group (19-35). Urban residents suffered more from allergic rhinitis than the rural residents. The main presenting complaint was sneezing and the commonest comorbid condition and trigger associated with allergic rhinitis were sinusitis and dust mites respectively. Twenty-nine percent of respondents had experienced reduced productivity at their workplace and in school. Twenty-one percent had experienced depression while 26% perceived the cost of treatment to be greatly expensive. The use of face masks was found not to be beneficial in reducing the symptoms of allergic rhinitis in most clients. The conclusions reached at the end of this study were that the public must be educated on allergic rhinitis and to look out for the triggers, signs, and symptoms of it and then report early to the hospital for appropriate management.

Abstract 16217: Characteristics and Short-Term Outcomes of Patients With Cardiogenic Shock Secondary to Myocarditis

Background: The clinical profile and short-term prognosis of patients with cardiogenic shock (CS) secondary to myocarditis remains poorly defined. Methods: All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1 st , 2010, to Dec 31 st , 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records. Patients were further categorized into those with CS secondary to myocarditis (myocarditis-CS) or other etiologies (non-myocarditis-CS). Only patients with confirmed myocarditis with an endomyocardial biopsy or cardiac MRI were included. Descriptive characteristics and short-term outcomes of this group were explored. Results: A total of 2775 patients were admitted to our CICU with CS of which, 26 patients (1%) had CS secondary to confirmed myocarditis. Compared to patients with non-myocarditis CS, patients with myocarditis-CS were significantly younger (median age of 49 vs 65, p<0.001), had lower prevalence of known coronary artery disease (23% vs 62%, p<0.001), and significantly lower prevalence of other comorbidities (diabetes- 12% vs 42%, dyslipidemia- 23% vs 49%, and hypertension- 31% vs 62, all p<0.05). Amongst patients with myocarditis-CS, 23% (n=6) patients received a heart transplant during the same admission whereas 8% (n=2) were discharged on an LVAD. Viral myocarditis was the most common etiology (35%, n=9), followed by idiopathic myocarditis (23%, n=6), and lymphocytic (15%, n=4). The 30-day all-cause mortality of patients with CS-myocarditis was 8% compared to 22% for those with non-myocarditis CS (p=0.1). Conclusion: Myocarditis continues to remain an infrequent cause of CS in the contemporary era accounting for around 1% of all CS admissions. A third of these patients would require advanced therapies and so early consideration of a destination mechanical therapy or transplant is vital to ensure optimal care of these patients.

Reclassification of moderate aortic stenosis based on data-driven phenotyping of hemodynamic progression

The management and follow-up of moderate aortic stenosis (AS) lacks consensus as the progression patterns are not well understood. This study aimed to identify the hemodynamic progression of AS, and associated risk factors and outcomes. We included patients with moderate AS with at least three transthoracic echocardiography (TTE) studies performed between 2010 and 2021. Latent class trajectory modeling was used to classify AS groups with distinctive hemodynamic trajectories, which were determined by serial systolic mean pressure gradient (MPG) measurements. Outcomes were defined as all-cause mortality and aortic valve replacement (AVR). A total of 686 patients with 3093 TTE studies were included in the analysis. Latent class model identified two distinct AS trajectory groups based on their MPG: a slow progression group (44.6%) and a rapid progression group (55.4%). Initial MPG was significantly higher in the rapid progression group (28.2 ± 5.6 mmHg vs. 22.9 ± 2.8 mmHg, P < 0.001). The prevalence of atrial fibrillation was higher in the slow progression group; there was no significant between-group difference in the prevalence of other comorbidities. The rapid progression group had a significantly higher AVR rate (HR 3.4 [2.4–4.8], P < 0.001); there was no between-group difference in mortality (HR 0.7 [0.5–1.0]; P = 0.079). Leveraging longitudinal echocardiographic data, we identified two distinct groups of patients with moderate AS: slow and rapid progression. A higher initial MPG (≥ 24 mmHg) was associated with more rapid progression of AS and higher rates of AVR, thus indicating the predictive value of MPG in management of the disease.

A STUDY TO EVALUATE THE EFFECT OF ANAEMIA IN TYPE-2 DIABETIC PATIENTS

Introduction: As the tribulation of diabetes escalates, developing countries like India is expected to be the diabetic capital in the world in coming years. Diabetes Mellitus progressively results in various complications including both microvascular and macrovascular disorders. The nephropathy undermines the renal production of erythropoietin, positively contributing to an increased anaemic framework. However, anaemia in type 2 diabetic patients is often untended. Aims And Objectives: • To correlate the levels of haemoglobin with the degree of glycaemic control (HbA1c&gt;6.5% vs HbA1c&lt;6.5%) • To determine the morphology and severity of anaemia in type 2 diabetic patients. • To know prevalence of other comorbidities as a result of anaemia and diabetes. Materials And Methods: A prospective observational study was conducted in 100 type 2 diabetic patients visiting the Out Patient Department in Acs Medical College and Hospital, Chennai. Haemoglobin and red cell indices were estimated. Comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy were recorded. Peripheral blood smear examination was done using leishman's stain. Ion exchange chromatography was used to measure the HbA1c levels. Results: In the poor glycaemic control group, a signicant decrease in the haemoglobin levels was noted especially in females and elderly population. Microcytic Hypochromic Anaemia was the most prevalent which was of mild to moderate severity. Predominantly reduced iron stores in Microcytic Hypochromic Anaemia were attributed to increased HbA1c levels. The poor control of diabetes when associated with anaemia, were also found to have comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy. Conclusion: To conclude, though anaemia is signicantly prevalent in diabetic patients, it is often neglected. In accordance with the study, poor glycaemic control is the result of increased glycation of haemoglobin A1c (HbA1c) due to reduced iron stores. Hence in diabetic patients, it would be benecial to assess haemoglobin levels often, for better quality of life

The increased prevalence of keloids in atopic dermatitis patients with allergic comorbidities: a nationwide retrospective cohort study

Atopic dermatitis (AD) is associated with allergic comorbidities, such as asthma, allergic rhinitis (AR), and allergic contact dermatitis (ACD). The etiology of keloid is largely unknown; however, AD and keloid share inflammatory pathways characterized by T-helper cell 2 cytokines and increased dermal fibroblast activity. The prevalence of keloids has been reported to increase in patients with AD, but it remains controversial. This study aimed to estimate the prevalence of keloids in patients with AD, and compare it with the prevalence of other comorbidities of AD. We assessed the Korean National Health Information Database and medical records including coexisting asthma, AR, and ACD. Single and multiple logistic regression models were created for keloids and each allergic disease. The prevalence of keloids was higher in the AD group than in the control group. Among patients with AD, adolescents and adults had a higher prevalence of keloids than infants and children. The risk of keloids was high with AD alone, and coexisting asthma significantly increased the risk. Similarly, the risk of keloids was higher in AR associated with AD and ACD associated with AD than in AD alone. Thus, among Koreans, patients with AD have a higher risk of keloid development, with coexisting allergic diseases increasing the risk.

Abstract 10124: Chronic Kidney Disease as Predictor for Length of Stay in Patients with New-Onset Atrial Fibrillation with Rapid Ventricular Response

Background: Atrial fibrillation with rapid ventricular response (AFib with RVR) is an arrhythmia caused by the atria of the heart beating chaotically and irregularly and is frequently associated with worse outcomes in chronic kidney disease (CKD). We sought to investigate the length of stay (LOS) in patients presenting at the emergency department with Afib with RVR and a history of CKD. Methods: Comorbidity, clinical outcomes and length of stay (LOS) were analyzed retrospectively in a cohort of 1638 patients presenting with new-onset of Afib with RVR at the emergency department from 2013 to 2018. Patients with a history of CKD vs. no history of CKD were compared using descriptive statistics, chi-square and Mann-Whitney tests. Results: The 343 patients admitted with a history of CKD had a median [IQR] glomerular filtration rate of 42 [29.4-51], were older 76(10.4) vs. 70.4(14) years of age, p&lt;.0001, were more likely to be African American 12.5% vs. 6.7% p=0.025,OR 1.99 [1.352-2.93] and had a higher median (IQR) CHA 2 DS 2 -VASc score of 5[4-6] vs. 4[2-5] (P&lt;.0001), and their median LOS was 4[2-6] vs.3[1-4] (Fig 1). Conclusion: CKD patients admitted with new-onset of Afib with RVR required additional care and longer LOS. Prevalence of other comorbidities is higher in this population, including heart failure and hypertension (most common), and thyroid disorder and COPD (least common).

Healthcare delivery for non-communicable diseases among breast cancer survivors in Sri Lanka: Is there a missed opportunity?

PurposeBreast cancer is the most common cancer globally as well as in Sri Lanka. Improvements in cancer care have allowed patients to live to an older age. With advancing age, incidence of non-communicable diseases (NCDs) increases. Cancer diagnoses tend to take attention away from the treatment of other comorbidities, given its importance. The objective of this study was to describe healthcare delivery for NCDs among female breast cancer survivors treated at the National Cancer Institute of Sri Lanka (NCISL) and identify opportunities to optimise non-cancer medical care in this cohort.MethodsA total of 420 women were identified from the breast cancer database at the NCISL, who were 50–80 years at the time of their breast cancer diagnosis, were within 12–24 months from the date of diagnosis, had completed their active cancer treatment and were in complete remission. Of this population, 228 (54%) women who had documented NCDs at the time of diagnosis were identified and were followed-up via telephone to collect details regarding existing comorbidities and the screening and development of new comorbidities.ResultsAt the time of cancer diagnosis, 216/228 (95%) of patients had hypertension, 104/228 (46%) had type 2 diabetes and 17/228 (8%) had ischaemic heart disease (IHD). The prevalence of other comorbidities was very low. During the post diagnosis period, 11 patients developed type 2 diabetes, while 2 developed IHD. Osteoporosis screening using dual-energy X-ray absorptiometry scanning was very low at diagnosis 21/228 (9%) but improved in post cancer treatment follow-up 112/228 (49%, p < 0.001). Only 95/228 (42%) were screened for other cancers.ConclusionsHypertension was the most prevalent comorbidity while type 2 diabetes and dyslipidaemia were the most common diagnoses post-treatment. In these patients, screening for osteoporosis and other cancers remains very low, emphasising a missed opportunity.

Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study.

The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with mean ± SD type 2 diabetes duration of 4.9 ± 1.5 years. After 7 years of additional follow-up, we report the risk factors for progression of DR in the TODAY cohort. Retinal photographs (n = 517) were obtained in 2010-2011 and again in 2017-2018 (n = 420) with standard stereoscopic seven-field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. A total of 367 patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of DR, defined as an increase of three or more steps on the ETDRS scale. With mean ± SD age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, there was a 49% prevalence of any DR among participants. Prevalence by DR stage was as follows: 39% for very mild or mild nonproliferative DR (NPDR), 6% moderate to severe NPDR, and 3.8% proliferative DR. Compared with nonprogressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression. Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood.

Clinical Outcomes, Echocardiographic Findings, and Care Quality Metrics for People Living With Human Immunodeficiency Virus (HIV) and Rheumatic Heart Disease in Uganda.

Rheumatic heart disease (RHD) affects 41 million people worldwide, mostly in low- and middle-income countries, where it is co-endemic with human immunodeficiency virus (HIV). HIV is also a chronic inflammatory disorder associated with cardiovascular complications, yet the epidemiology of patients affected by both diseases is poorly understood. Utilizing the Uganda National RHD Registry, we described the echocardiographic findings, clinical characteristics, medication prescription rates, and outcomes of all 73 people carrying concurrent diagnoses of HIV and RHD between 2009 and 2018. These individuals were compared to an age- and sex-matched cohort of 365 subjects with RHD only. The median age of the HIV-RHD group was 36 years (interquartile range [IQR] 15), and 86% were women. The HIV-RHD cohort had higher rates of prior stroke/transient ischemic attack (12% vs 5%, P = .02) than the RHD-only group, with this association persisting following multivariable adjustment (odds ratio [OR] 3.08, P = .03). Prevalence of other comorbidities, echocardiographic findings, prophylactic penicillin prescription rates, retention in clinical care, and mortality were similar between the 2 groups. Patients living with RHD and HIV in Uganda are a relatively young, predominantly female group. Although RHD-HIV comorbid individuals have higher rates of stroke, their similar all-cause mortality and RHD care quality metrics (such as retention in care) compared to those with RHD alone suggest rheumatic heart disease defines their clinical outcome more than HIV does. We believe this study to be one of the first reports of the epidemiologic profile and longitudinal outcomes of patients who carry diagnoses of both conditions.

Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study.

BackgroundThe interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19.MethodsIn this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality.FindingsAmong the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27–1·43), past tuberculosis (1·26, 1·15–1·38), current tuberculosis (1·42, 1·22–1·64), and both past and current tuberculosis (1·48, 1·32–1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22–1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals.InterpretationIndividuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment.FundingSouth African National Government.

Patients’ compliance to clinical treatment that benefit from the Brazilian National Glaucoma Program

Abstract Objective: To evaluate the adherence to clinical glaucoma treatment in patients that benefit from the Brazilian National Glaucoma Program and receive antiglaucomatous eye drops free of charge. Methods: This cross-sectional study included 255 patients that benefit from the Brazilian National Glaucoma Program (BNGP) and were assisted at the Altino Ventura Foundation (FAV), Pernambuco state, Brazil. The Morisky’s Adhesion Scale (MAS) was used to evaluate adhesion profile to treatment. Patients with a Morisky’s Adhesion score ≥ 6 was considered adherent to treatment. The analyzed variables included sex, educational level, distance from home to the treatment center, number of eye drops used, time since the glaucoma diagnosis, patients’ subjective classification of their quality of vision, and prevalence of other comorbidities. Results: A total of 255 patients [167 (65.4%) females] were included in this study with a mean age was 65.9 ± 13.8 years (range, 11-99 years). Adherence to clinical glaucoma treatment was seen in 155 patients (60.8%). Worse adherence to treatment was observed in female patients (p=0.034), with low education level (p=0.046), who presented other comorbidities (p=0.048), living in remote areas (p=0.038), judged their vision as satisfactory (p=0.046), and who were recently diagnosed with glaucoma (p=0.001). Conclusion: 40% of patients who benefited from the Brazilian National Glaucoma Program were not compliant to treatment. Low adhesion rate was mostly seen in female patients, socially vulnerable, living in remote areas, recently diagnosed with glaucoma, using fewer eyedrops, presenting other comorbidities, and in those that considering themselves of having a satisfactory vision.

COVID-19 In-Hospital Mortality in South Africa: The Intersection of Communicable and Non-Communicable Chronic Diseases in a High HIV Prevalence Setting

Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis (TB) are unclear, particularly in low- and middle-income countries in Africa. We investigated this interaction using a nationally representative hospital surveillance system for laboratory-confirmed COVID-19 hospital admissions in South Africa.Methods: Using DATCOV data, we describe the demographic characteristics, clinical features, and in-hospital mortality among individuals admitted to public and private hospitals with COVID-19 during 5 March to 11 August 2020. Multivariable logistic regression models were used to assess the role of HIV-status and underlying comorbidities on in-hospital COVID-19 mortality.Findings: Hospital admissions peaked at 1,560 admissions per day, in late July. Among the 41,877 individuals admitted with laboratory-confirmed COVID-19, 7,662 (18.3%) died. Comorbidities were documented in 27,555 (65.8%) individuals, most commonly observed were hypertension (36.8%), diabetes (29.6%), obesity (19.7%), and HIV (8.7%); TB was reported in 0.7% of individuals. Increased risk of in-hospital mortality was associated with HIV and TB, as well as other described risk factors for COVID-19, such as increasing age, male sex, non-White race (Black, mixed and Indian race), chronic underlying conditions particularly hypertension, diabetes and obesity. In addition, HIV-infected individuals with immunosuppression had increased risk of mortality (adjusted odds ratio 2.2; 95% confidence interval 1.6-3.1). Among HIV-infected individuals, the prevalence of other comorbidities associated with severe COVID-19 outcomes was 39.9%. The effect of multiple comorbidities on mortality was similar in HIV-infected and -uninfected individuals.Interpretation: These data provide a better understanding of the interaction of non-communicable diseases, chronic infectious diseases like HIV and TB and COVID-19. Increasing age and presence of chronic underlying comorbidities (particularly hypertension and diabetes) are important additional factors associated with COVID-19 mortality in a middle-income African setting and are common among HIV-infected individuals. HIV- and TB-infected individuals, particularly those with additional comorbidities, would benefit from COVID-19 prevention programmes, as well as early referral and treatment.Funding Statement: DATCOV is funded by the National Institute for Communicable Diseases (NICD) and the South African National Government. No additional funding was obtained towards the completion of this analysis and the development of this manuscript.Declaration of Interests: The authors declare that there are no conflicts of interest.Ethics Approval Statement: The Human Research Ethics Committee (Medical), University of the Witwatersrand, approved the project protocol as part of a national surveillance program (M160667). This activity was reviewed by the U.S. Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy. All personal identifying information was de-linked for our analysis and stored in a secure server.

The effect of obstructive sleep apnoea on timing of acute coronary syndrome

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

Temporal Trends of Hypovitaminosis D: A Population-Based Study of Cases Under 19 Years of Age

There is a growing epidemic of hypovitaminosis D in the western hemisphere, however the exact incidence is not known. Additionally, vitamin D has been shown to be associated with atopic and infectious disorders. We aimed to determine the incidence of hypovitaminosis D in a population-based cohort, as well as the prevalence of other comorbidities. We performed a historical cohort study of residents under 19 years of age in Olmsted County, Minnesota, during a 16-year period from January 2, 2002 through December 31, 2017, using the Rochester Epidemiology Project. Using each patient’s first total 25-hydroxyvitamin D concentration less than 30.0 ng/mL, a patient was classified as having either a vitamin D deficiency (<20 ng/mL) or insufficiency (20.1-30.0 ng/mL). Comorbidities at that index date were abstracted from the medical record. The age-and sex-adjusted incidence (per 100,000 person-years) of vitamin D deficiency/insufficiency increased significantly each year from 31.3 (95%CI, 18.7-43.8) in 2002-2003 to 589.7 (95%CI, 535.7-643.6) in 2012-2013, stabilizing at 606.0 in 2014-2015 and 580.1 in 2016-2017. The overall age-adjusted incidence was significantly higher for females compared to males (388.2 (95%CI, 365.9-410.5) vs. 257.4 (95%CI 239.8-275.1), respectively). The prevalence of allergic rhinitis (31.6% vs. 25.9%) and atopic dermatitis (21.7% vs. 17.4%) were significantly higher among patients with a vitamin D insufficiency (N=1353) compared to those with deficiency (N=634). The incidence of hypovitaminosis D increased significantly during 2002 to 2012, with stabilization afterward. The association of hypovitaminosis D in atopic conditions may warrant further inquiry.

1-year results after PCI with the COMBO stent in all-comers in Asia versus Europe: Geographical insights from the COMBO collaboration

BackgroundThe COMBO drug-eluting stent combines sirolimus-elution from a biodegradable polymer with an anti-CD34+ antibody coating for early endothelialization. ObjectiveWe investigated for geographical differences in outcomes after percutaneous coronary intervention (PCI) with the COMBO stent among Asians and Europeans. MethodsThe COMBO Collaboration is a pooled patient-level analysis of the MASCOT and REMEDEE registries of all-comers undergoing attempted COMBO stent PCI. The primary outcome was 1-year target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR). ResultsThis study included 604 Asians (17.9%) and 2775 Europeans (82.1%). Asians were younger and included fewer females, with a higher prevalence of diabetes mellitus but lower prevalence of other comorbidities than Europeans. Asians had a higher prevalence of ACC/AHA C type lesions and received longer stent lengths. More Asians than Europeans were discharged on clopidogrel (86.5% vs 62.8%) rather than potent P2Y12 inhibitors. One-year TLF occurred in 4.0% Asians and 4.1% of Europeans, p = 0.93. The incidence of cardiac death was higher in Asians (2.8% vs. 1.3%, p = 0.007) with similar rates of TV-MI (1.5% vs. 1.2%, p = 0.54) and definite stent thrombosis (0.3% vs. 0.5%, p = 0.84) and lower incidence of TLR than Europeans (1.0% vs. 2.5%, p = 0.025). After adjustment, differences for cardiac death and TLR were no longer significant. ConclusionsIn the COMBO collaboration, although 1-year TLF was similar regardless of geography, Asians experienced higher rates of cardiac death and lower TLR than Europeans, while incidence of TV-MI and ST was similar in both regions. Adjusted differences did not reach statistical significance. Clinicaltrial.gov identifier-numbersNCT01874002 (REMEDEE Registry), NCT02183454 (MASCOT registry).

1687-P: An Examination of Clinical Outcomes in People with T1D and Obesity

A lack of knowledge exists concerning how best to treat type 1 diabetes (T1D) and obesity simultaneously. This cross-sectional study examined whether people with T1D and obesity have differences in the prevalence of outcomes, treatment methods, and healthcare utilization. The data were pulled from the electronic medical record for 1546 patients with T1D (≥ 18 years) seen at NorthShore University HealthSystem during 2017. The study population was 53% female; mean age was 46.4 ± 18.0 years. About 32% of patients had a normal weight (BMI 20-24.99) and 28% of patients had obesity (BMI ≥ 30). The patients with obesity were compared to the patients with normal weight (NW).There was a significantly higher prevalence of hypertension (p&amp;lt;0.001) and depression (p=0.038) among patients with obesity compared to patients with NW. No significant difference in the prevalence of other comorbidities (heart failure, myocardial infarction, cancer, dementia, peripheral vascular disease, chronic kidney disease, stroke) were observed. Patients with obesity had a significantly higher rate of retinopathy, neuropathy, and microalbuminuria (p&amp;lt;0.0001, p=0.005, p=0.005, respectively) compared to patients with NW. Adjusted for age, sex, and years of T1D duration, patients with obesity were 57%, 92%, and 60% more likely to have neuropathy, retinopathy, and microalbuminuria, respectively, than NW patients. There were no difference in mean HbA1C or total cholesterol level between the groups. Adjusted for age, sex, and years of T1D duration, the use of an insulin pump was not associated with BMI. Patients with obesity attended more outpatient visits in 2017 than NW patients (p=0.001), but did not differ in ER or inpatient visits. The higher rate of diabetes-related outcomes, hypertension, depression and healthcare utilization among T1D patients with obesity, compared to those of NW provide the impetus for further investigation into how best to treat patients with T1D and obesity to prevent the disparities in outcomes elucidated by this study. Disclosure E.R. Stewart: None. A.M. Monie: None. L.K. Billings: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S.

PDB75 EVENT RATE OF HYPOGLYCEMIA AND PREVALENCE OF COMORBIDITIES IN PATIENTS WITH TYPE 2 DIABETES IN TIANJIN, CHINA

To evaluate the event rate of hypoglycemia and prevalence for diabetes comorbidities in patients with type 2 diabetes (T2D) in Tianjin, China. Adult patients with T2D were selected from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) Special Outpatient System for diabetes (2011-2015). Hypoglycemia events were identified by primary diagnosis of both inpatient and outpatient claims, with the first date of hypoglycemia diagnosis defined as index date. Ten controls were matched to hypoglycemia group using the eligibility of UEBMI, first T2D diagnosis date, and designated the same index date of their matched cases. The prevalence of macrovascular and microvascular diabetes complications and diabetes comorbidities were calculated in the period of 12 months post index date. Among 60,607 eligible patients with T2D (mean age ± standard deviation: 59.5.±10.6 years, 46.3% female), 1,225 (2.0%) experienced at least one episode of severe hypoglycemia, and the event rate was 1.84 episodes per 100 person-years (95% CI, 1.79-1.90). A total of 7,876 patients (716 in hypoglycemia-cohort vs. 7,160 in controlled) were included in the retrospective cohort study, and the prevalence of both macrovascular and microvascular complications were significantly higher in patients who experienced hypoglycemia than control group, including cerebrovascular disease (31.6% vs. 26.8%, P=0.007), peripheral vascular disease (57.3% vs. 38.6%, P<0.001), nephropathy (30.6% vs. 21.7%, P<0.001). Mean Charlson comorbidity index (4.38 vs, 3.80, P<0.001) and the prevalence of other comorbidities, including hypertension (79.9% vs. 75.3%, P<0.001), depression (7.0% vs. 4.5%, P=0.002), were also significant higher in patients who experienced hypoglycaemia. Over 12 months follow up, patients with T2D who experienced hypoglycemia had higher prevalence of diabetes comorbidities compared to patients who did not experience hypoglycemia.