Prevalent Cases Research Articles

Implementation of a Hepatocellular Carcinoma Surveillance Program in a Community-Based Integrated Health System in Patients With Hepatitis C Cirrhosis.

Underutilization of hepatocellular cancer (HCC) surveillance has been reported, although data evaluating interventions to improve surveillance are sparse. We assessed the effect of a population-based HCC surveillance program on HCC surveillance utilization and outcomes. In this retrospective cohort study, we assessed preinclusion and postinclusion HCC surveillance patterns among 597 patients with hepatitis C virus cirrhosis enrolled in a program at an integrated health system between 2013 and 2020. Adequate surveillance was defined as at least 5 surveillance studies within 36 months pre-enrollment and postenrollment; a secondary outcome was proportion of time covered by surveillance over 36 months. Tumor size, stage, and receipt of curative therapy were compared between HCC detected on the first imaging examination (prevalent HCC) and surveillance-detected HCC (incident HCC). We performed Kaplan-Meier analysis and multivariable competing risk analysis to characterize the association between surveillance and mortality. The surveillance program significantly improved surveillance completion (77.6% vs 5.0%, P < 0.001) and proportion time covered (80.9% vs 15.8%, P < 0.001). Compared with prevalent HCC, surveillance-detected cases were more likely unifocal (77.8% vs 44.8%, P < 0.001), early-stage (85.2% vs 44.8%, P < 0.001), with smaller maximum diameter (median 2.3 vs 3.2 cm), and more likely to undergo curative therapy (92.5% vs 72.4% P = 0.010). Survival was improved compared with prevalent cases hazard ratio (HR) 0.23 (0.11-0.51) after adjusting for age and Model for End Stage Liver Disease score. Implementation of a population-based program resulted in significant improvement in HCC surveillance use and clinical outcomes among patients with hepatitis C virus cirrhosis. These findings may inform similar interventions by other healthcare systems.

On the proportion of patients who experience a prodrome prior to psychosis onset:A systematic review and meta-analysis.

Preventing or delaying the onset of psychosis requires identification of those at risk for developing psychosis. For predictive purposes, the prodrome - a constellation of symptoms which may occur before the onset of psychosis - has been increasingly recognized as having utility. However, it is unclear what proportion of patients experience a prodrome or how this varies based on the multiple definitions used. We conducted a systematic review and meta-analysis of studies of patients with psychosis with the objective of determining the proportion of patients who experienced a prodrome prior to psychosis onset. Inclusion criteria included a consistent prodrome definition and reporting the proportion of patients who experienced a prodrome. We excluded studies of only patients with a prodrome or solely substance-induced psychosis, qualitative studies without prevalence data, conference abstracts, and case reports/case series. We searched Ovid MEDLINE, Embase (Ovid), APA PsycInfo (Ovid), Web of Science Core Collection (Clarivate), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, APA PsycBooks (Ovid), ProQuest Dissertation & Thesis, on March 3, 2021. Studies were assessed for quality using the Critical Appraisal Checklist for Prevalence Studies. Narrative synthesis and proportion meta-analysis were used to estimate prodrome prevalence. I2 and predictive interval were used to assess heterogeneity. Subgroup analyses were used to probe sources of heterogeneity. (PROSPERO ID: CRD42021239797). Seventy-one articles were included, representing 13,774 patients. Studies varied significantly in terms of methodology and prodrome definition used. The random effects proportion meta-analysis estimate for prodrome prevalence was 78.3% (95% CI = 72.8-83.2); heterogeneity was high (I2 97.98% [95% CI = 97.71-98.22]); and the prediction interval was wide (95% PI = 0.411-0.936). There were no meaningful differences in prevalence between grouped prodrome definitions, and subgroup analyses failed to reveal a consistent source of heterogeneity. This is the first meta-analysis on the prevalence of a prodrome prior to the onset of first episode psychosis. The majority of patients (78.3%) were found to have experienced a prodrome prior to psychosis onset. However, findings are highly heterogenous across study and no definitive source of heterogeneity was found despite extensive subgroup analyses. As most studies were retrospective in nature, recall bias likely affects these results. While the large majority of patients with psychosis experience a prodrome in some form, it is unclear if the remainder of patients experience no prodrome, or if ascertainment methods employed in the studies were not sensitive to their experiences. Given widespread investment in indicated prevention of psychosis through prospective identification and intervention during the prodrome, a resolution of this question as well as a consensus definition of the prodrome is much needed in order to effectively direct and organize services, and may be accomplished through novel, densely sampled and phenotyped prospective cohort studies that aim for representative sampling across multiple settings.

Plasma proteomic profiles of UK Biobank participants with multiple sclerosis.

We aimed to describe plasma protein biomarkers of multiple sclerosis risk and to explore protein biomarkers of disease severity using radiological outcome measures. Multiple sclerosis cases and controls were identified in UK Biobank, a longitudinal cohort study of ~500,000 British adults. Plasma proteins were assayed in ~50,000 UK Biobank participants using the Olink proximity extension assay. We performed case-control association testing to examine the association between 2911 proteins and multiple sclerosis, using linear models adjusted for confounding covariates. Associations with radiological lesion burden and brain volume were determined in a subset of the cohort with available magnetic resonance imaging, using normalized T2-hyperintensity volume or whole brain volume as the outcome measure. In total, 407 prevalent multiple sclerosis cases and 39,979 healthy controls were included. We discovered 72 proteins associated with multiple sclerosis at a Bonferroni-adjusted p value of 0.05, including established markers such as neurofilament light chain and glial fibrillary acidic protein. We observed a decrease in plasma Granzyme A, a marker of T cell and NK cell degranulation, which was specific to multiple sclerosis. Higher levels of plasma proteins involved in coagulation were associated with lower T2 lesion burden and preserved brain volume. We report the largest plasma proteomic screen of multiple sclerosis, replicating important known associations and suggesting novel markers, such as the reduction in granzyme A. While these findings require external validation, they demonstrate the power of biobank-scale datasets for discovering new biomarkers for multiple sclerosis.

MACHINE LEARNING CLASSIFICATION OF THE EPIDEMIOLOGIC STAGES OF INFLAMMATORY BOWEL DISEASE ACROSS GEOGRAPHY AND TIME

Abstract BACKGROUND Epidemiologic stages of inflammatory bowel disease (IBD) have been proposed: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapidly rising incidence, low prevalence); and 3. Compounding Prevalence (stabilizing incidence, rapidly rising prevalence). To date, these stages have been theoretical without quantified definitions of incidence and prevalence. AIM To use machine learning to determine incidence and prevalence ranges corresponding to the epidemiologic stages and provide stage classifications across time for global regions. METHODS We built a supervised random forest classifier in R to determine epidemiologic stages of IBD from population-based studies (n=340), a subset derived from a systematic review on the incidence and prevalence of IBD. A labelled training data set comprising rates of incidence and prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) extracted from the systematic review was used to predict classifications of stage 1, stage 2, or stage 3 for each region, stratified by decade (1960–2019). Model accuracy was measured using a blind validation data set. The validated model was then used to predict stage classifications for regions in the data set. Interquartile ranges for incidence and prevalence of CD and UC were calculated on the random forest output, and the distributions were compared using negative binomial regression. RESULTS The random forest’s classification accuracy on the blinded validation data was 93.7% (95%CI: 90.6, 96.1) indicating an appropriate model fit and performance. Significant differences between all stages for the incidence and prevalence of CD and UC (p&amp;lt;0.001) were found. The clear distinction across stages defines the incidence and prevalence ranges (25th–75th, per 100,000) for IBD as: CD incidence 0.0–0.3, UC incidence 0.2–0.7, CD prevalence 0.3–2.2, and UC prevalence 1.7–8.1 for stage 1; CD incidence 1.0–4.4, UC incidence 2.3–6.3, CD prevalence 9.0–33.9, and UC prevalence 22.8–73.3 for stage 2; and CD incidence 6.6–14.0, UC incidence 10.1–18.1, CD prevalence 163.2–274.7, and UC prevalence 189.1–323.2 for stage 3 (Figure 1). A decade-by-decade analysis shows global regions transitioning across the epidemiologic stages (Figure 2). By the 2010s, North America, Scandinavia, Western Europe, Australia, and New Zealand were in stage 3. Most regions in Asia and Latin America were in stage 1 in the last half of the 20th century, with many transitioning to stage 2 in the 2010s. DISCUSSION Temporal incidence and prevalence data show that regions transition across epidemiologic stages. Numerical definitions of the epidemiologic stages can be used to establish the anticipated burden growth of IBD by providing estimated rates of the number of incident and prevalent IBD cases a region can expect as it transitions between IBD epidemiologic stages in the future. Figure 1 Coalescing ranges for incidence (panel A) and prevalence (panel B) by Crohn’s disease and ulcerative colitis at epidemiologic stage 1, stage 2, and stage 3. Data were categorized by data type (incidence or prevalence), disease type (Crohn’s disease or ulcerative colitis), and epidemiologic stage, as per results from the random forest classifier. The 25th and 75th percentiles were calculated using the rates across all regions included in the analysis for all available time points for each box group. Figure 2 Global maps depicting epidemiologic stages of IBD evolution from 1960 to 2019 broken down by decade, as predicted by the random forest model. Panel A contains stage classifications from 1960 to 1969; panel B contains stage classifications from 1970 to 1979; panel C contains stage classifications from 1980 to 1989; panel D contains stage classifications from 1990 to 1999; panel E contains stage classifications from 2000 to 2009; and panel F contains stage classifications from 2010 to 2019.

The incremental healthcare cost associated with cancer in Belgium: A registry-based data analysis.

Similar to many countries, Belgium experienced a rapid increase in cancer diagnoses in the last years. Considering that a large part of cancer types could be prevented, our study aimed to estimate the annual healthcare burden of cancer per site, and to compare cost with burden of disease estimates to have a better understanding of the impact of different cancer sites in Belgium. We used nationally available data sources to estimate the healthcare expenditure. We opted for a prevalence-based approach which measures the disease attributable costs that occur concurrently for 10-year prevalent cancer cases in 2018. Average attributable costs of cancer were computed via matching of cases (patients with cancer by site) and controls (patients without cancer). Years of life lost due to disability (YLD) were used to summarize the health impact of the selected cancers. The highest attributable cost in 2018 among the selected cancers was on average €15,867 per patient for bronchus and lung cancer, followed by liver cancer, pancreatic cancer, and mesothelioma. For the total cost, lung cancer was the most costly cancer site with almost €700 million spent in 2018. Lung cancer was followed by breast and colorectal cancer that costed more than €300 million each in 2018. In our study, the direct attributable cost of the most prevalent cancer sites in Belgium was estimated to provide useful guidance for cost containment policies. Many of these cancers could be prevented by tackling risk factors such as smoking, obesity, and environmental stressors.

P940 A glance into paediatric Inflammatory Bowel Disease in Australasia – Crohn’s Colitis Cure (CCC) data insights program

Abstract Background Around 10% of people with inflammatory bowel diseases (IBD) are diagnosed in childhood1. Clinical manifestations are known to differ in children compared to adults2,3. This study aims to describe the real-world characteristics of children with IBD. Methods Crohn’s Colitis Care (CCCare) is an IBD-specific electronic medical record (EMR) used at IBD centres across Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in November 2023. All children (&amp;lt;18 years at time of extract) under active care (encounter within 14 months) were included. Results Clinical data from 162 children across 14 centres were available for analysis. Of these, 64.8% (n=105) had Crohn’s disease (CD), 31.5% (n=51) ulcerative colitis (UC) and 3.7% (n=6) IBD-unclassified. There was a roughly equal split in gender (male=55.0%), with a minority aged &amp;lt;10 years (9.9%, n=16). The mean recorded body mass index was 20.5kg/m2 (n=101 with BMI data), with 78.2% in the ‘normal’ range (18.5-24.9kg/m2). Five patients (5.0%) were ‘underweight’ (&amp;lt;18kg/m2), and 16.8% (n=17) were overweight or obese (&amp;gt;25kg/m2). Only 7.4% (n=12) were currently receiving steroids, and over half (55.6%, n=90) had received an advanced therapy (biologic or small molecule). Few reported incontinence (n=5, 3.1%), and 6% (n=9) had an IBD-related surgery recorded. Around 20% (11/56) had current or previous fistulising CD. On most recent data, the mean faecal calprotectin was 637μg/g, C-reactive protein 6.1mg/L and ESR 9.4mm/hr. In those with UC, 43.7% had either moderate (S2) or severe (S3) disease activity at last assessment (Figure 1). In those with CD, 31.1% had either stricturing (B2, 21.5%) or penetrating intra-abdominal disease (abscess/perforation/phlegmon, B3, 10.6%). Conclusion This study provides a detailed real-world overview of IBD in children in Australasia, demonstrating the ability of CCCare to help collate data at scale across a large geography. Data show clear changes in phenotype over time. Such data allow for the tracking and benchmarking of outcomes over time across centres, thus promoting evidence-based care improvements. Ongoing real-world data collection is crucial in optimising management strategies and improving care outcomes. 1 - Burgess CJ et al. Paediatric Patients (Less Than Age of 17 Years) Account for Less Than 1.5% of All Prevalent Inflammatory Bowel Disease Cases. J Pediatr Gastroenterol Nutr. doi: 10.1097/MPG.0000000000002842. 2 - Seyedian SS et al. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. doi:10.25122/jml-2018-0075 3 - Moon JS. Clinical Aspects and Treatments for Pediatric Inflammatory Bowel Diseases. Pediatr Gastroenterol Hepatol Nutr. doi:10.5223/pghn.2019.22.1.50

Prevalence of stunting and determinants of growth failure in children with Type 1 diabetes

Objectives: India is home to the highest number of prevalent cases of Type-1 diabetes (T1D) in children. There is scarcity of data on the growth failure of children with diabetes, especially those having complications and comorbidities, thus, we conducted this study with the objective to determine the prevalence and predictors of stunting in children with T1D. Methods: This cross-sectional study included 350 children and adolescents aged 1–18 years with T1D. Demographic data, anthropometry, diet, sexual maturity rating, and biochemical measurements were performed using standard protocols. Short stature was defined as height for age Z-score &lt;−2. p&lt;0.05 was considered statistically significant. Results: We report a 15.7% prevalence of stunting in our cohort of children with T1D. Stunted children had higher cholesterol, lower hemoglobin, lower mid-parental height Z-scores, and higher urinary albumin creatinine ratio. Binary logistic regression revealed that pre-existing comorbidities, compromised renal function, longer disease duration, and short mid-parental height were significant predictors of stunting. Conclusion: A little under one-sixth of children with T1D had short stature. Monitoring growth in these patients, especially in subjects with short parents, prolonged duration of diabetes, existing comorbidities, and deteriorating renal function are critical.

P434 Incidence of chronic end-stage renal disease in patients with inflammatory bowel disease: a population-based cohort study from the French National Health Insurance Database

Abstract Background Renal disorders are among the extra-intestinal manifestations of inflammatory bowel disease (IBD), and treatments may also lead to renal failure. However, the incidence of end-stage renal disease (ESRD), defined as the need for renal replacement therapy (dialysis and/or renal transplantation(RT)), is poorly known. The primary objective of our study was to assess the incidence of ESRD in IBD patients, and to compare it with the non-IBD population. Methods We conducted a prognostic cohort study based on data from the French National Health Insurance Database(SNDS). Prevalent cases of IBD affiliated to the general health insurance scheme during the period 2011-2020 were identified on the basis of declarations long-term diseases ALD 24 or the presence of 2 hospital stays for IBD with ICD-10 codes or a single stay with reimbursement of specific treatments. Incident cases of ESRD were identified on the basis of a stay with a RT or a period with dialysis sessions for at least 45 days. Crude incidence rates of ESRD were calculated over the period for the IBD and the non-IBD population, with their 95% confidence intervals. Results A total of 280,283 IBD patients were included in the study over the period 2011-2020, 134,567 with ulcerative colitis(UC) and 145,716 with Crohn’s disease(CD). The mean age at study inclusion was 39.8 (± 17.1) years. The M/F sex ratio was 0.9. The mean age at incidence of ESRD in the non-IBD population was 65.0 (±17.0) years, the M/F sex ratio cases was 1.7. Among IBD patients, 534 patients began replacement therapy by dialysis or RT, they were younger than non-IBD patients (60.3(±16.7)years, P&amp;lt;0.001).The mean incidence rate of ESRD over the period was 26.4 per 100,000 person-years (IC95% 23.1-29.6), 480 (89.9%) patients entered ESRD by dialysis, and 54 (10.1%) by preemptive RT. In the non-IBD population the mean rate of ESRD was 15.9 per 100,000 person-years (IC95% 14.8- 17.1; P&amp;lt;0.0001 compared with IBD): 79,606 (94.5%) patients entered ESRD by dialysis, and 4,634 (5.5%) by RT (as compared with IBD,P&amp;lt;0.001). In subgroup analysis, the mean incidence rate of ESRD was 22.8 per 100,000 person-years (IC95% 18.9-26.7) in UC patients and 29.5 (IC95% 25.3-33.6) in CD patients. The rates of preemptive RT were 12.4% in UC patients (87.6% dialysis) and 8.6% in CD patients (91.4% dialysis). Over a median follow-up of 6.8 years, the survival rate after ESRD was 40.8% in ESRD-IBD patients VS 34.2% in ESRD non-IBD patients (P&amp;lt;0.001). Conclusion This study shows that the incidence of ESRD is significantly higher in IBD than in the non-IBD population, confirming the need for regular monitoring of renal function in our patients. The high incidence of RT confirms that access to transplantation is not restricted in this population.

The incidence, prevalence, and health burden of hip fractures in China: Data from the global burden of disease study 2019

BackgroundHip fracture is commonly in the elderly as a consequence of osteoporsis. Currently, China is entering an aging society and there is a lack of studies about the epidemiology and health burden of hip fracturs there. MethodsWe used data from the Global Burden of Disease study 2019 (GBD 2019) to estimate the incidence, prevalence and disease burden of hip fractures in China and the temporal trends from 1990 to 2019. These estimates were produced by DisMod-MR 2.1, a Bayesian meta-regression tool. Estimated annual percentage change (EAPC) was used to represent the temporal trends. ResultsIn 2019, there was estimated to be 2.0 million incident and 2.6 million prevalent hip fracture cases in China. The age standardized incidence and prevalence rate were estimated to be 117.8 (95 % UI, 83.8 to 161.6) per 100,000 and 139.8 (95 % UI, 125.7 to 154.7) per 100,000, respectively. From 1990 to 2019, the incidence (EAPC, 1.06; 95 % CI, 0.6 to 1.52) and prevalence (EAPC, 1.41; 95 % CI, 1.02 to 1.8) rates have increased, while the age standardized DALY decreased (95 %CI, −1.8; 95 % CI, −2.3 to −1.2). The incidence and DALY rates of hip fractures increased with age, and female people have higher incidence rate and disease burden. Falls were the leading cause for hip fractures, followed by road injuries. ConclusionDue to population growth and ageing, the challenges from hip fractures are expected to increase in the future, and related measures are in need to reduce the related health and economic burden.

Hospitalization-based epidemiology of systemic and cardiac amyloidosis in the Veneto Region, Italy

AimDefining the epidemiology of systemic and cardiac amyloidosis (CA) is a contemporary challenge. The present study aimed to estimate incidence and time trends in amyloidosis-related hospitalizations (AH) in Veneto Region (5 million inhabitants, Northeastern Italy). MethodsInternational Classification of Diseases (ICD-9) codes were used to identify AH in Veneto from 2010 to 2020. AH were defined as any hospitalization with a discharge summary reporting an ICD-9 code for systemic amyloidosis. Hospitalization for CA was defined as records with ICD-9 code for systemic amyloidosis and ICD-9 code for heart failure,cardiomyopathy or arrhythmia. Hospital/outpatient encounters for carpal tunnel syndrome (CTS) surgeries also were extracted. AH incidence was estimated using a buffer of 5 years. ResultsIn the time range 2015–2020, the incidence rate of AH was 23.5 cases per 106 (95% confidence interval, CI, 21.8; 25.3), mainly affecting patients>65 years (76.2%) and males (63.5%), with a progressively increasing trend (percent annual increase 17%, 95% CI 12; 22%). The 10 year prevalence of AH in 2020 was 124.5 per 106 (95% CI 114.9; 134.8). In 2020, annual hospitalized prevalent cases of CA were about 70% of all cases (159/228), mainly patients >65 years and males. Among patients with multiple CTS surgeries, a subsequent code for cardiac disease was found in 913 after a median of 3.9 years, more frequently in men than in women (463/6.526 7.1% versus 450/11.406 3.9%). ConclusionsIn Veneto, we recorded a significantly increasing trend in the incidence of AH, with concordant increasing prevalence estimates.

The congenital birth defects burden in children younger than 14 years of age, 1990 - 2019: An age-period-cohort analysis of the global burden of disease study.

This study aims to delineate the burden of congenital birth defects (CBDs) in children under 14 years of age from 1990 to 2019, using an age-period-cohort framework to analyse data from the Global Burden of Disease Study (GBD). Data on prevalence cases, age-standardised prevalence rates (ASPRs), death cases, and age-standardised death rates (ASDRs) of congenital birth defects (CBDs) from 1990 to 2019 were obtained from GBD 2019. Using this data set, we conducted an age-period-cohort (APC) analysis to examine patterns and trends in mortality, prevalence, and disability-adjusted life years (DALYs) associated with CBDs, while exploring correlations with age, time periods, and generational birth cohorts. Furthermore, to quantify the temporal trends, we calculated the estimated annual percentage changes (EAPCs) for these parameters. The global prevalence of CBDs decreased from 1404.22 to 1301.66 per 100 000 with an EAPC of -0.18% from 1990 to 2019. CBD mortality decreased by 42.52% between 1990 and 2019, with the global age-standardised death rate declining from 49.72 to 25.58 per 100 000. The age-standardised DALY rate decreased from 4529.16 to 2393.61 per 100 000. Prevalence declined most notably among older children. The risk of CBDs reached its lowest during adolescence (10-14 years) across all regions. The most recent period (2015-2019) showed a reduced risk of prevalence compared to 2000-2004. Earlier birth cohorts displayed declining tendencies followed by slight increases in risk. This study demonstrates encouraging global reductions in the burden of CBDs among children over the past three decades. Prevalence, mortality, and DALYs attributable to CBDs have exhibited downward trajectories, although regional disparities remain. APC analysis provides valuable insights to inform prevention and management strategies for pediatric CBDs.

A synthetic agent ameliorates polycystic kidney disease by promoting apoptosis of cystic cells through increased oxidative stress

Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic cause of chronic kidney disease and the fourth leading cause of end-stage kidney disease, accounting for over 50% of prevalent cases requiring renal replacement therapy. There is a pressing need for improved therapy for ADPKD. Recent insights into the pathophysiology of ADPKD revealed that cyst cells undergo metabolic changes that up-regulate aerobic glycolysis in lieu of mitochondrial respiration for energy production, a process that ostensibly fuels their increased proliferation. The present work leverages this metabolic disruption as a way to selectively target cyst cells for apoptosis. This small-molecule therapeutic strategy utilizes 11beta-dichloro, a repurposed DNA-damaging anti-tumor agent that induces apoptosis by exacerbating mitochondrial oxidative stress. Here, we demonstrate that 11beta-dichloro is effective in delaying cyst growth and its associated inflammatory and fibrotic events, thus preserving kidney function in perinatal and adult mouse models of ADPKD. In both models, the cyst cells with homozygous inactivation of Pkd1 show enhanced oxidative stress following treatment with 11beta-dichloro and undergo apoptosis. Co-administration of the antioxidant vitamin E negated the therapeutic benefit of 11beta-dichloro in vivo, supporting the conclusion that oxidative stress is a key component of the mechanism of action. As a preclinical development primer, we also synthesized and tested an 11beta-dichloro derivative that cannot directly alkylate DNA, while retaining pro-oxidant features. This derivative nonetheless maintains excellent anti-cystic properties in vivo and emerges as the lead candidate for development.

Increasing Burden of Osteoarthritis in China: Trends and Projections from the Global Burden of Disease Study 2019.

BACKGROUND This study aimed to evaluate the epidemiology of osteoarthritis in China in a comprehensive and reliable way, to project its future epidemiological patterns, and to mitigate its health hazards. MATERIAL AND METHODS Data were extracted and analyzed from the Global Burden of Diseases Study 2019. Trends in osteoarthritis epidemiology were explored using joinpoint regression analysis. Additionally, we analyzed dynamic trends using the sociodemographic index (SDI) of China. To assess and predict the epidemiology of osteoarthritis from 2020 to 2039, we used both the Bayesian age-period-cohort model and Nordpred model. RESULTS The number of prevalent cases, incident cases, and years lived with disability (YLDs) for osteoarthritis in China increased from 51.8, 4.6, and 1.8 million, respectively, in 1990, to 132.8, 10.7, and 4.7 million, respectively, in 2019, and the average annual percentage changes were 3.286, 2.938, and 3.324, respectively. The prevalence and YLDs peaked in the population aged over 90 years old, while the incidence peaked in the population aged around 50 years old. A significant positive correlation was found between osteoarthritis burden and SDI. Osteoarthritis burden is expected to continue to increase. In the population studied here, it was higher in women than in men, but this may invert by 2039. CONCLUSIONS The prevalence, incidence, and YLDs of osteoarthritis had significantly increased and may continue to increase during the next 2 decades. Prevention and treatment strategies should target women, middle-aged individuals, and the elderly.

Prevalence, incidence and healthcare burden of eosinophilic granulomatosis with polyangiitis in the UK.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare but serious disease characterised by the combination of small-to-medium vessel vasculitis, blood and tissue eosinophilia, and asthma and/or sinonasal disease. This study estimated the prevalence and incidence of diagnosed EGPA in the United Kingdom (UK), and described the demographics, clinical characteristics and healthcare resource utilisation (HCRU) of this population. This retrospective longitudinal study of patients with newly diagnosed EGPA (index) (2005-2019) used the Clinical Practice Research Datalink AURUM and Hospital Episode Statistics databases. The primary outcomes were the annual prevalence (2005-2019) and incidence (2006-2019) of EGPA, and secondary outcomes included patient demographics and clinical characteristics, and HCRU in the year pre- and post-index (diagnosis). Populations of patients with EGPA comprised 940 prevalent cases and 502 incident cases, of which 377 were linked to Hospital Episode Statistics. EGPA prevalence increased from 22.7 to 45.6 cases per 1 000 000 (2005-2019), driven by patients aged ≥18 years. Incidence ranged from 2.3 to 4.0 per 1 000 000 person-years (2006-2019). Pre-index, the most common clinical symptoms were respiratory related, and the most common comorbidities were asthma (80.6%) and nasal polyps (32.1%). Post-index, 19.1% had an EGPA-related inpatient stay (median length of stay 11.0 days) and 38.7% had five or more oral corticosteroid (OCS) prescriptions with a mean OCS possession ratio per patient of 47.0%. Although EGPA incidence in the UK remains relatively stable, prevalence is increasing, and HCRU and OCS use remain frequent, suggesting considerable healthcare burden for patients with EGPA.

Evaluating bias with loss to follow-up in a community-based cohort: empirical investigation from the CARRS Study

BackgroundRetention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias.MethodsData are from an ongoing...

Global evolving patterns and cross-country inequalities of inflammatory bowel disease burden from 1990 to 2019: a worldwide report.

Inflammatory bowel disease (IBD) is a global disease. We aim to summarize the latest epidemiological patterns of IBD at the national, regional and global levels to give well-deserved attention and outline facilitating measures to reduce the disease burden. We collected the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of IBD in 204 countries and territories from 1990 to 2019 using data from the Global Burden of Disease Study 2019. We further calculated the estimated annual percentage change (EAPC) to qualify the temporal trends of IBD burden by sex, age and region over the past 30years. Globally, a total of 404.55 thousand incident cases, 4898.56 thousand prevalent cases, 41.00 thousand deaths and 1622.50 thousand DALYs of IBD were estimated in 2019. The age-standardized DALYs decreased from 27.2 in 1990 to 20.15 per 100,000 people in 2019, with an EAPC of -1.04. The high socio-demographic index regions presented pronounced age-standardized rates (ASRs) consistently over the last 30years. The high-income North America had the highest ASRs in 2019, followed by Western Europe and Australasia. No gender difference was observed after being stratified by sex. The accumulated IBD patients are expected to increase in the future due to the increased rate of IBD in developing countries, and social aging in developed countries. Understanding the changes in epidemiological patterns helps to provide evidence to mitigate the rising burden of IBD.

Re-estimation of the burden of serious fungal diseases in Uganda.

It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.

Global, regional, and national burden of upper respiratory infections, 1990–2021: Findings from the Global Burden of Disease study 2021

BackgroundUpper respiratory infections (URIs) are common infectious diseases worldwide. Accurate and timely assessment of the disease burden of URIs is crucial for governments to develop comprehensive prevention and control strategies, and to allocate and utilize healthcare resources more efficiently. MethodsFor URIs in Global Burden of Disease (GBD) 2021 database, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), age-standardized mortality rates (ASMR), disability-adjusted life-years (DALYs), and case numbers for incidence, prevalence, deaths, and DALYs across the globe, five socio-demographic index (SDI) regions, 21 geographical regions, and 204 countries and territories were provided and analyzed. Trends from 1990 to 2021 were described using the average annual percentage change (AAPC), and future URIs burden was projected with a Bayesian age-period-cohort (BAPC) model. ResultsFrom 1990 to 2021, there was a significant decline in global ASIR (APCC = −289.86, 95% confidence interval [CI]: −298.59 to −281.12), ASPR (AAPC = −4.04, 95% CI: −4.16 to −3.92), ASMR (AAPC = −0.02, 95 % CI: −0.02 to −0.03) and age-standardized DALY rate (AAPC = −0.75, 95% CI: −0.76 to −0.74). The ASIR, ASPR, ASMR, and age-standardized DALY rate were high in elderly for both males and females, and both genders. Similarly, the number of incident cases, prevalence cases, deaths, and DALY cases for URIs was highest in children under five years. The ASMR and age-standardized DALY rate exhibited a negative correlation with SDI across 204 countries and territories in 2021. The ASIR and ASPR for URIs will show an upward trend from 2022 to 2050, while ASMR and age-standardized DALY rate are expected to decline. Low birth weight for gestation remains the leading contributor to deaths related to URIs. ConclusionDespite the global decline in URIs burden, significant challenges remain among the elderly population. These findings support the optimization and implementation of public health policies, including targeted vaccination and integrated One Health approaches to reduce the burden in high-risk populations.

Self-Supervised Learning-Based General Laboratory Progress Pretrained Model for Cardiovascular Event Detection.

Leveraging patient data through machine learning techniques in disease care offers a multitude of substantial benefits. Nonetheless, the inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for target vessel revascularization (TVR) detection. The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority ([Formula: see text]) compared to prior GLP processing. Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise. Our study effectively transposes patient progression from one cohort to another, surpassing the constraints of episodic observation. The transferability of disease progression contributed to cardiovascular event assessment.

The long-term spatio-temporal trends in burden and attributable risk factors of major depressive disorder at global, regional and national levels during 1990-2019: a systematic analysis for GBD 2019.

Caused by multiple risk factors, heavy burden of major depressive disorder (MDD) poses serious challenges to public health worldwide over the past 30 years. Yet the burden and attributable risk factors of MDD were not systematically known. We aimed to reveal the long-term spatio-temporal trends in the burden and attributable risk factors of MDD at global, regional and national levels during 1990-2019. We obtained MDD and attributable risk factors data from Global Burden of Disease Study 2019. We used joinpoint regression model to assess the temporal trend in MDD burden, and age-period-cohort model to measure the effects of age, period and birth cohort on MDD incidence rate. We utilized population attributable fractions (PAFs) to estimate the specific proportions of MDD burden attributed to given risk factors. During 1990-2019, the global number of MDD incident cases, prevalent cases and disability-adjusted life years (DALYs) increased by 59.10%, 59.57% and 58.57%, respectively. Whereas the global age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) of MDD decreased during 1990-2019. The ASIR, ASPR and ASDR in women were 1.62, 1.62 and 1.60 times as that in men in 2019, respectively. The highest age-specific incidence, prevalence and DALYs rate occurred at the age of 60-64 in women, and at the age of 75-84 in men, but the maximum increasing trends in these age-specific rates occurred at the age of 5-9. Population living during 2000-2004 had higher risk of MDD. MDD burden varied by socio-demographic index (SDI), regions and nations. In 2019, low-SDI region, Central sub-Saharan Africa and Uganda had the highest ASIR, ASPR and ASDR. The global PAFs of intimate partner violence (IPV), childhood sexual abuse (CSA) and bullying victimization (BV) were 8.43%, 5.46% and 4.86% in 2019, respectively. Over the past 30 years, the global ASIR, ASPR and ASDR of MDD had decreased trends, while the burden of MDD was still serious, and multiple disparities in MDD burden remarkably existed. Women, elderly and populations living during 2000-2004 and in low-SDI regions, had more severe burden of MDD. Children were more susceptible to MDD. Up to 18.75% of global MDD burden would be eliminated through early preventing against IPV, CSA and BV. Tailored strategies-and-measures in different regions and demographic groups based on findings in this studywould be urgently needed to eliminate the impacts of modifiable risk factors on MDD, and then mitigate the burden of MDD.