Regional Variations In Incidence Research Articles

Regional variations in incidence and treatment trends of Achilles tendon ruptures in Finland: a nationwide study.

The aim of our study was to assess the regional variations in Achilles tendon rupture incidence and treatment methods in Finland during the period 1997-2019. The Finnish National Hospital Discharge Register (NHDR) and the Finnish Register of Primary Health Care Visits (PHCR) were searched to identify all adult patients diagnosed with Achilles tendon rupture during our study period. The population-based annual incidence and incidences of surgically and non-surgically treated Achilles tendon ruptures were calculated for each hospital district. Achilles tendon rupture incidence increased from 17.3 per 105person-years in 1997 to 32.3 per 105in 2019. The mean incidence of Achilles tendon ruptures ranged from 26.4 per 105(North Savo) to 37.2 per 105(Central Ostrobothnia). The incidence of Achilles tendon ruptures increased in all areas. The proportion of non-surgical treatment of Achilles tendon ruptures ranged in 1997 from 7% (Vaasa) to 67% (Åland) and in 2019 from 73% (Southwest Finland) to 100% (East Savo, Kainuu, Länsi-Pohja, Åland). During the study period, a shift towards non-surgical treatment was evident in all hospital districts. Regional variations in Achilles tendon rupture incidence exist in Finland; however, the incidence increased in all areas during the follow-up period. More Achilles tendon rupture patients are currently being treated non-surgically throughout the country.

Decreasing incidence of celiac disease in Southern Sweden

Background The incidence of celiac disease (CD) has increased rapidly in the late 20th and early 21st centuries, but there are recent reports of rates levelling off in countries with a high prevalence. The aim of this study was to investigate current trends in CD in southern Sweden. Patients and methods Children and adults diagnosed with CD by biopsy or serology in the region of Skåne, southern Sweden, from 2010–2022 were included. The home address was identified through registers to analyze temporal and geographical trends. Results A total of 3218 CD-patients were identified (52.2% children), the vast majority detected in clinical care but a few children by screening studies. The age-standardized incidence rate was 18.6 cases/105. The incidence decreased at a rate of −0.75 cases/105 (95% CI −1.14 to −0.35, p 0.002). The incidence among girls under 18 years almost halved throughout the study period, decreasing by −2.94 cases/105 (95% CI −4.59 to −1.29, p 0.002), while there only were small changes among men. The most common age of onset was 3–9 years. CD incidence varied by place of living and was more common in small towns than urban or rural areas. Conclusions The incidence of CD in southern Sweden is decreasing, primarily in children and women who traditionally have had the highest risk of CD. CD was diagnosed most frequently in children 3–9 years old. There were regional variations in incidence. CD was most common in small towns, pointing to the importance of environmental factors in CD etiology.

Liver Cancer Incidence in Kazakhstan: Fifteen-Year Retrospective Study.

The aim is to study the trends of liver cancer (LC) incidence in the regional context in Kazakhstan. The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. Between 2005 and 2019, 13,510 cases of LC were documented, comprising 59.3% males and 40.7% females. Most diagnoses were seen in age groups 55-59 years (13.3%) to 75-79 years (11.7%). LC patients' average age increased from 63.6 to 64.5 years. Incidence rates per 100,000 peaked at ages 65-69 years (35.1±1.0) and 70-74 years (43.3±1.0). LC incidence notably rose in the 70-74 years age group (APC=+0.89), contrasting with declining trends in younger age groups. Regional incidence variations revealed diverse patterns, mostly demonstrating unimodal increases, and some regions displaying bimodal growth. The age-standardized incidence rate was 5.7±0.1 per 100,000, declining from 2005 to 2012 (APC: -3.93), then rising until 2019 (APC: +1.13). Gender-specific standardized rates showed varied trends. Analyses of standardized indicators indicated declining trends in most regions but increased values in specific areas. Thematic maps classified incidence rates based on standardized indicators: low (up to 5.22), average (5.22 to 7.11), high (above 7.11 per 100,000 for the entire population). The study on liver cancer in Kazakhstan reveals marked gender and age differences. The standardized incidence rate among men was twofold greater than that among women. A distinct rise in cases was noted among individuals aged 70-74 years. Regional variations in incidence were evident. These findings emphasize the necessity for focused research to comprehend the causes behind these differences, enabling customized interventions for Kazakhstan's population.

Editor's Choice – Incidence of Lower Limb Amputations in Sweden from 2008 to 2017

This study examined the recent national and regional incidence of lower limb amputations (LLAs) in Sweden and their annual changes. This was an observational study using Swedish national register data. All initial amputations were identified in Sweden from 2008 to 2017 in individuals 18 years or older using the national inpatient register. The amputations were categorised into three levels: high proximal (through or above the knee joint), low proximal (through the tibia to through the ankle joint), and partial foot amputations. To examine the national and regional incidence and annual changes, the age, sex, and region specific population count each year was used as the denominator and Poisson regression or negative binomial regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) adjusted for age and sex. The national annual incidence of LLAs was 22.1 per 100 000 inhabitants, with a higher incidence in men (24.2) than in women (20.0). The incidence of LLAs (all levels combined) declined during the study period, with an IRR of 0.984 per year (95% CI 0.973 - 0.994). This was mainly due to a decrease in high proximal amputations (0.985, 95% CI 0.974 - 0.995) and low proximal amputations (0.973, 95% CI 0.962 - 0.984). No change in the incidence of partial foot amputations was observed (0.994, 95% CI 0.974 - 1.014). Such declines in LLA incidence (all levels combined) were observed in nine of the 21 regions. Compared with the national average and with adjustment for age, sex, diabetes, and artery disease, the regional IRR varied from 0.85 to 1.36 for all LLAs, from 0.67 to 1.61 for high proximal amputations, from 0.50 to 1.51 for low proximal amputations, and from 0.13 to 3.68 for partial foot amputations. The incidence of LLAs has decreased in Sweden. However, regional variations in incidence, time trends, and amputation levels warrant further research.

Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006-2015.

On the basis of a 1957 geographic Coccidioides seropositivity survey, 3 counties in southwestern Utah, USA, were considered coccidioidomycosis-endemic, but there has been a paucity of information on the disease burden in Utah since. We report findings from a recent clinical and epidemiologic study of coccidioidomycosis in Utah. To describe clinical characteristics, we identified all coccidioidomycosis cases in an integrated health system in the state during 2006–2015. For epidemiologic analysis, we used cases reported to the Utah Department of Health during 2009–2015. Mean state incidence was 1.83 cases/100,000 population/year. Washington County, in southwestern Utah, had the highest incidence, 17.2 cases/100,000 population/year. In a generalized linear model with time as a fixed effect, mean annual temperature, population, and new construction were associated with regional variations in incidence. Using these variables in a spatiotemporal model, we estimated the adjusted regional variation by county to predict areas where Coccidioides infections might increase.

Regional variation of lower limb major amputations on different geographic scales – a Hungarian nationwide study over 13 years

Background: The incidence of lower limb major amputations is an important healthcare quality indicator, as it reflects all efforts aimed to prevent limb loss. Analysis of within-country regional variations in incidence may reveal the sources of disparities in care. Materials and methods: Based on the data of the Hungarian healthcare beneficiary population from 2004 to 2016, the incidence of lower limb major amputations and its spatial variations was determined regionally on four levels of geographic resolution. Variability and autocorrelation were quantified on different resolutions. Results: A total of 56,468 lower limb major amputation procedures were identified in 49,528 patients over the observation period. Marked regional variations were detected at all geographic scale levels. In the case of county-level and local administrative level, the systematic component of variation was 0.03 and 0.09, respectively. Only half of the variation at local administrative level was explained by county. Conclusions: Lower limb major amputations show marked regional variations on the different geographic levels of resolution. The more granular the assessment, the higher the regional variation was. Assumingly, this observation is partially a mathematical necessity but may also be related to the different characteristics of care at a given level of spatial aggregation. The decomposition of the variance of amputation rates indicates that the potential explanatory factors contributing to spatial variability are multiple and may be interpreted on different levels of geographic resolution. Addressing the unwarranted variations and resolving the issues that contribute to high lower limb major amputation rates needs further explorative analysis.

Spatio-temporal pattern of malignant neoplasm of brain in Fars province I.R.Iran (2011–2015): A population-based cross sectional study

BackgroundTumors of the central nervous system (CNS) are a heterogeneous group of neoplasms with different prevalence in different genders, age groups and various parts of the CNS. This study aimed to investigate the incidence of malignant neoplasm of brain (C71) based on Fars population data. MethodsThis study was cross-sectional, carried out based on Fars population –based Cancer Registry (FPCR) data. Data was collected retrospectively reviewing all malignant neoplasm of brain patients’ records during a 5-year period (2011–2015). Age Standardized Incidence Rates (ASR) were calculated based on world population standards. To analyze the ASR time trends by gender, we carried out a chi-square goodness of fit test. ResultsFindings revealed that 1043 cases of malignant neoplasm of brain were registered, 438 (%41.9) of which were women. Malignant neoplasm of brain became the eighth malignancy in 2015 in both genders. Its incidence was higher in men (26.15/100000) than in women (19.45/100 000). There was an increasing but not significant trend from 2011 to 2013 in both men and women (p = 0.722, p = 0.478, respectively). The highest increase was in 2013 (ASR = 6.64 in men and ASR = 5.71 in women per 100,000). ConclusionBrain and other CNS tumors are an important source of cancer deaths around the world. Regional variations in incidence may provide clues leading to genetic and/or environmental causes as well as a basis for expanding knowledge about their epidemiology. This study demonstrated that the trend had been increasing in the years during which the study was conducted.

Demography and clinicopathological characteristics of primary gastric cancers in Northern India

Introduction: Stomach cancer is the third leading cause of cancer related deaths in either sex. Compared to world statistics, India has a lower incidence and prevalence of this cancer. The diversity in dietary habits accounts for regional variations in incidence of stomach cancers across different parts of India. In this retrospective audit, we have tried to analyze the epidemiology of gastric cancers of northern India which were treated in our institution. Material and Methods: Review of the Hospital Based Cancer Registry (HBCR) of PGIMER, Chandigarh showed that 156 stomach cancer patients (only adenocarcinoma and signet ring cell histopathologies included) were treated from August 2012 to December, 2016. Descriptive statistics were employed for analyzing results. Results: The median age of patients was 52 years with a predilection for male sex. Mostly patients were alcoholics (53.2%) but nonsmokers (59.6%). More than 70% patients ate fruits and vegetables and did not consume processed meat. Anorexia and weight loss was the commonest presenting complaint. The commonest stages observed were stage IIIC (21.1%) and IIB (19.2%). More than 90% patients had adenocarcinoma of which intestinal variant was the commonest. Subtotal gastrectomy with D1 lymph node dissection was practiced more than total gastrectomy and/or D2 dissection. Conclusions: Our patients belonged to a low risk population for gastric cancer mostly due to protective dietary habits. Further reports can give better insight into the epidemiological diversity of this cancer.

INCIDENCE OF ACUTE PANCREATITIS IN ALBANIAN POPULATION.

Background:Acute Pancreatitis (AP) is an inflammatory pathology with large regional variations in incidence and etiologyAim:The aim of the study was to provide a description of the epidemiologic situation of AP in Albanian population, regarding incidence, etiology and severity of the diseaseMethods:We have studied all the files of all patients with acute pancreatitis admitted at the UHC ‘Mother Theresa” during an eight year period (2005-2012).The results:We had 964 admissions with the diagnosis acute pancreatitis, making an incidence of 5.64 per 100 000 inhabitants per year. Mean age of patients was 54.5 ± 16.93 years old. Among risk factors, alcohol consumption was found in 382 patients (39.6%), gallstone in 362 patients (37.6%), and others in 220 patients (22.8%).Conclusion:The incidence of acute pancreatitis in Albania ranges from 3.6 – 5.64 new cases per 100 000 inhabitants per year, with an increasing trend during the last years. The incidence of AP among females almost doubles during 2005-2012. Alcohol consumption is the predominating etiologic factor among young males.

Incidence and trends of acute pancreatitis in Albanian Population

Background: Acute pancreatitis is pathology with large regional variations in incidence and etiology. Aims: The aim of the study was performed to establish the incidence, etiology and severity of acute pancreatitis in the Albanian population. Patients & methods: We have studied all the files of all patients with acute pancreatitis admitted at the UHC ‘Mother Theresa” during a nine year period (2005-2013). Results: We had 964 admissions with the diagnosis acute pancreatitis, giving an incidence of 5.64 per 100 000 inhabitants. Mean age of patients was 54.5 ± 16.926 years old. We had 377 females or 39.1% and 587 males or 60.9%. 780 patients 80.9% had mild to moderate pancreatitis, while 184 patients or 19.1% had severe pancreatitis. Overall mortality was 2.8% (we had 27 deaths out of 964 diagnosed patients). Alcohol consumptionwas found to be the etiological factor in 382 patients (39.6%), gallstone in 362 patients (37.6%), and other etiologies including hipertriglideridemia, autoimmune pancreatitis, trauma and idiopathic causes in 220 patients (22.8%). There was a significant increase of the new cases during the last years, and there was also a significant increase of acute alcoholic pancreatitis in young patients. Conclusion: The incidence of acute pancreatitis was found to be 5.6 per 100 000 inhabitants, which is lower than the incidence of pancreatitis in the region. The alcoholic etiology (39.6%) and the young age of patients tend to be trend of the last years. Pancreatitis was found to be severe in 19.1% of patients, overall mortality was 2.8%.

Early nasogastric tube feeding versus nil-by-mouth in patients with mild and moderate acute pancreatitis: A randomised controlled trial

Background: Acute pancreatitis is pathology with large regional variations in incidence and etiology. Aims: The aim of the study was performed to establish the incidence, etiology and severity of acute pancreatitis in the Albanian population. Patients & methods: We have studied all the files of all patients with acute pancreatitis admitted at the UHC ‘Mother Theresa” during a nine year period (2005-2013). Results: We had 964 admissions with the diagnosis acute pancreatitis, giving an incidence of 5.64 per 100 000 inhabitants. Mean age of patients was 54.5 ± 16.926 years old. We had 377 females or 39.1% and 587 males or 60.9%. 780 patients 80.9% had mild to moderate pancreatitis, while 184 patients or 19.1% had severe pancreatitis. Overall mortality was 2.8% (we had 27 deaths out of 964 diagnosed patients). Alcohol consumptionwas found to be the etiological factor in 382 patients (39.6%), gallstone in 362 patients (37.6%), and other etiologies including hipertriglideridemia, autoimmune pancreatitis, trauma and idiopathic causes in 220 patients (22.8%). There was a significant increase of the new cases during the last years, and there was also a significant increase of acute alcoholic pancreatitis in young patients. Conclusion: The incidence of acute pancreatitis was found to be 5.6 per 100 000 inhabitants, which is lower than the incidence of pancreatitis in the region. The alcoholic etiology (39.6%) and the young age of patients tend to be trend of the last years. Pancreatitis was found to be severe in 19.1% of patients, overall mortality was 2.8%.

Methicillin-Resistant Staphylococcus aureus and Community-Acquired Pneumonia: An Evolving Relationship

Methicillin-Resistant Staphylococcus aureus and Community-Acquired Pneumonia: An Evolving Relationship

P01-303 - Huntington's disease in an Asian-Indian male - a case report and discussion

ObjectivesTo present a case of Huntington's Disease and discuss neuropsychiatric management.MethodsCase presentation.We would like to present a case of Huntington's disease in an adult asian-indian male. The poster consists of a case report followed by a discussion on Huntingtons. We discuss the aetiopathogenesis, presentation and recent management trends of this neuropsychiatric condition.Mr. H was an Asian Indian immigrant in the United Kingdom. He presented with gradually worsening chorea, personality change and cognitive decline. Psychiatric symptoms closely followed with the development of aggression, paranoid delusions and visual and auditory hallucinations.Management included a multidisciplinary approach involving psychiatrists, neurologists, the local Huntington's disease service and a host of Para clinical teams.In the discussion, we trace the aetiology of Huntington's disease, the epidemiology and regional variations in Incidence and prevalence rates. The presentation, disease process and prognosis of Huntington's Disease is discussed. We present recent trends in management including the use of Omega 3 Fatty Acids.ConclusionThough there has been a significant increase in the amount of research on the condition, this appears to have been concentrated mainly on those populations with a higher prevalence. Studies on the causes of lower prevalence in Asian, especially Indian populations are still few in number. Such research could provide valuable clues including detection of protective factors in these populations. These in turn could prove useful in the management of the disease on both an individual and wider socio-economic level.

Functional Variants in ADH1B and ALDH2 Coupled With Alcohol and Smoking Synergistically Enhance Esophageal Cancer Risk

Esophageal squamous cell carcinoma (ESCC) is prevalent among Asian populations, with marked regional variations in incidence and mortality. Patients with ESCC have a very poor prognosis, but detection of ESCC at earlier stages could improve clinical outcome. Therefore, identification of epidemiologic factors that influence the development of ESCC would facilitate prevention and/or early detection of the disease. We performed a 2-step genome-wide association study with subsequent replication analysis using a total of 1070 Japanese ESCC cases and 2836 controls. We also used logistic regression analysis to estimate the effect of gene-gene and gene-environmental interactions. We identified the significant associations of ESCC with 4q21-23 and 12q24 regions, which include nonsynonymous single nucleotide polymorphisms (SNP) in ADH1B (rs1229984, P = 6.76 x 10(-35)) and ALDH2 (rs671, P = 3.68 x 10(-68)) that were previously shown to be associated with ESCC susceptibility. Multiple logistic regression analysis revealed SNP rs671, rs1229984, alcohol drinking, and smoking as the independent risk factors for ESCC (odds ratios of 1.66, 1.85, 1.92, and 1.79, respectively). Moreover, individuals who had both genetic and lifestyle-related risk factors had a nearly 190 times higher risk of ESCC than those who had neither of these. We found 2 known functional variants involved in the metabolism of alcohol and tobacco by-products as the most significant risk factors for the development of ESCC in a Japanese population. The individuals carrying both risk genotypes have a higher baseline risk of ESCC that is substantially increased by 2 lifestyle risk factors.

Dynamic changes in the trends in incidence of type 1 diabetes in children in Hungary (1978-98)

To determine the recent trends in incidence, to analyze the age and geographic distribution, as well as the seasonal pattern of type 1 diabetes in Hungarian children aged 0-14 yr for the period from 1978 to 1998. Primary ascertainment of cases was by retrospective (1978-88) and by prospective (1989-98) registration using hospital notifications. The level of ascertainment was estimated by the capture-recapture method. The temporal trend was estimated by fitting Poisson regression models to the yearly incidence data. Roger's test was used to investigate possible seasonal variation in time of diagnosis. Heterogeneity between geographic areas was assessed by Poisson regression. A total of 2616 patients (1214 in the first 11 yr, 1402 in the remaining 10 yr) were identified; the male:female ratio was 0.93. The overall standardized incidence rate was 7.87 (95% CI = 7.57-8.18) per 100,000 person-yr, the lowest in the youngest (0-4 yr) and highest in the oldest (10-14 yr) age group. There was an increasing trend in incidence with a largest relative annual increase in the youngest age group. Seasonal and regional variations in incidence were also observed. Our 21-yr study shows dynamic changes in incidence of childhood type 1 diabetes in Hungary, probably reflecting changes in the environment.

Prostate carcinoma incidence and patient mortality: the effects of screening and early detection.

Screening for and the aggressive treatment of prostate carcinoma are controversial, but they are nevertheless being practiced in the U.S. Current clinical studies of the effectiveness of screening will take years to complete. Meanwhile, screening for prostate carcinoma is already having an effect on society. National and regional trends in prostate carcinoma incidence and data on patient mortality and survival from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute are described in this article. SEER is a population-based cancer data base comprised of nine discrete areas. Fundamental principles of screening are used in this article to explain the impact that prostate carcinoma screening has had in the U.S. According to the data in the SEER registries, overall prostate carcinoma incidence rates increased at a far greater pace than prostate carcinoma mortality rates during the period 1973-1994. During that period, there was a shift in stage at diagnosis characterized by an increase in local and regional disease, and a decline in distant disease at diagnosis. Overall 5-year survival rates for prostate carcinoma patients also increased. The increase in incidence rates, the shift in stage at diagnosis, and the increase in survival rates are all evidence of increasing early detection. However, these changes are consistent with lead-time bias, length bias, a decline in mortality, and all three could have occurred. In the geographic SEER registries, the prostate carcinoma incidence rates vary markedly. These variations in incidence rates are due to regional variations in practice patterns and screening efforts. On the other hand, the SEER registries have comparable mortality rates. This is evidence of both lead-time bias and length bias. Substantial regional variations in incidence were found, but regional mortality rates were similar. This is evidence that screening and early detection efforts are resulting in the diagnosis of prostate carcinoma in some men who do not need therapy; thus, prostate carcinoma screening can lead to unnecessary treatment for such men. Furthermore, epidemiologic data do not demonstrate that screening is decreasing mortality. The benefits of screening and early detection, although theoretically possible, are yet unproven, whereas the risks and harms of screening and resultant treatment are definite.

Epidemiological study of achalasia in children.

One hundred and twenty nine children under the age of 15 years were diagnosed as having achalasia in Britain and Ireland between 1976 and 1985 by 175 surgeons with an interest in paediatrics or oesophageal disease. The incidence in Eire was 0.31 cases/10(5) population/year and this was significantly higher than in England and Wales (0.1/10(5)/year), Scotland (0.06/10(5)/year/or Northern Ireland (0.02/10(5)/year). Details of age at diagnosis were only obtained for 36 of the 129 patients. The disease appeared to become commoner with increasing age but there is no evidence of a delay in diagnosis until early adulthood. Such a delay would not account for the apparent regional variations in incidence, as they have also been reported in adults. Southern Irish children are at greater risk of the disease than other children in the British Isles.

Immunity as a factor in the epidemiology of medieval plague.

The rise, disappearance, and demography of medieval plague remain mysterious. This paper reviews those features of plague immunity in animals and humans that might help explain these aspects of medieval plague. The absence of a focus of sylvatic plague in medieval Europe is postulated, while it is suggested that the susceptible population was much more varied both in terms of immunity and number of species than has been assumed. The sex, age, and regional variations in incidence of plague among humans are examined on the basis of primary and secondary historical sources. Nutritional factors, especially iron status, and cross-immunities with other diseases help provide an explanation of the observations in the literature.

Cancer of the corpus uteri: increasing incidence in the United States, 1970--1975.

Incidence rates of cancer of the corpus uteri have been estimated from a one per cent sample of hospital discharges in the United States for the years 1970--1975. Among postmenopausal women, rates rose sharply in 1970--1975, while for younger women there was little net change. There were substantial regional variations in incidence, which were largest between the ages of 65 and 69 years. All rates have been corrected for the numbers of women in each region and age group with uteri intact.

Regional variations in the incidence of upper urinary tract stones in England and Wales.

Data from the Hospital In-patient Enquiry were used to define the regional patterns of hospital discharge rates for upper urinary tract stones and renal colic in England and Wales. By combining the rates for stones and colic, and by distinguishing emergency from planned admissions, the biases produced by repeated admissions of the same patient and by regional variations in diagnosis and coding may be reduced. There are regional variations in incidence of upper urinary tract stones: Wales and the southern regions of England have a generally higher incidence than northern regions. These variations may be related to regional differences in diet or occupation; or they may partly depend on associations between stone incidence and atmospheric temperature, exposure to ultraviolet irradiation, and hardness of drinking water.