Municipality Of Residence Research Articles

Association between air quality and neurodegenerative diseases in River Sacco Valley: A retrospective cohort study in Latium, central Italy.

Association between air quality and neurodegenerative diseases in River Sacco Valley: A retrospective cohort study in Latium, central Italy.

Do public attitudes support intellectual disability and autism rights and inclusion? – Lessons from a representative survey

PurposeThis study aims to explore public attitudes towards disabled people and their human rights and the variation of attitudes towards people with different disabilities, including people with an intellectual disability and autistic people. Attitudes towards adults and children, as well as men and women with different disabilities, were explored separately.Design/methodology/approachData was collected as part of an omnibus survey on a probability sample of 1,000 respondents, representative of Hungary’s adult population by gender, age, level of education and type of municipality of residence. Logistic regression models were used to examine the relationship between sociodemographic background and acceptance or rejection of people with different disabilities. To analyse attitudes towards men and women with particular disabilities, independent samples t-test was used.FindingsFindings show a generally high acceptance of people with sensory or mobility limitations; however, acceptance of autistic people and people with intellectual disability is significantly lower. Public attitudes are the least approving towards certain rights of autistic people and people with intellectual disability, including their right to vote, to marry, to raise children, to work in the open labour market and to attend education with others.Originality/valueThe findings underscore a strong hierarchy between disability groups where the least accepted groups are people with intellectual disability and autistic people. Legal and policy progress need to be supported by the measurement of public attitudes and targeted interventions to counter stigma.

Predictors for residential mobility in later life: Empirical findings for the young-old living in an Austrian small town

The article addresses residential mobility in later life from the perspective of the young-old, an under-explored topic in Austria. Data originating from a written survey conducted as part of a cross-sectional case study on people aged 60 to 74 years living in an Austrian small town are used to estimate prospective behaviour using logistic regression. The results show that women and people with a higher educational attainment are more likely to leave their current urban residential municipality, while men are more likely to relocate to a nursing home. Moreover, a duration of residence of 20 or more years decreases the probability of relocation. The findings confirm previous studies and highlight, that more spatially disaggregated data is needed to improve decision-making in town planning.

Measurement of absolute poverty in Italy: an empirical analysis

Absolute poverty is a socio-economic measure based on the monetary evaluation of a basket of goods and services, considered essential to avoid serious forms of social exclusion. Absolute poverty has been estimated in Italy since 2005 by the Italian Institute of Statistics, with reference to household consumption, using data from the Household Budget Survey (HBS), comparing the expenditure of Italian households with the absolute poverty thresholds. The reference unit is the household, considered in relation to the characteristics of the individual components, their specific needs (nutritional, for instance) and any scale or forms of savings that can be achieved when the family composition varies. Essential needs have been identified in adequate nutrition, in the availability of a dwelling - equipped with necessary goods and services according to the needs of the household - and in the minimum necessary to dress, communicate, get informed, move in the territory, educate and maintain good health. Consequently, the basket is composed of three macro components - food, housing, residual - whose monetary valuation was not carried out at the absolute minimum price, but at the minimum price accessible to all households taking into account the different distribution channels. The monetary value of the total basket was obtained from direct sum of the various components and corresponds to the household absolute poverty threshold. Monthly expenditure used to purchase goods and services exclusively devoted to meet the households needs (including presents purchased), is compared with the value of the poverty threshold, in order to classify a household as absolutely poor or non-poor. After a methodological revision in 2022, the poverty threshold is now defined by the combination of the household type, the region and the municipality of residence. As a consequence, it is possible to identify as many absolute poverty lines as many combinations exist between the elements mentioned before. The methodology revision has allowed the release of more punctual data, capturing the heterogeneity of the expenditure for the different household types in the different areas/territories of the Country. Then, in this paper we briefly show the main changes in the methodology for the measurement of absolute poverty and we present some descriptive analysis on the poverty thresholds calculated for the period of 2014-2022.

Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study.

Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes.

Long-term effects of attention deficit hyperactivity disorder (ADHD) on social functioning and health care outcomes.

Adherence to outpatient care among individuals with pre-existing psychiatric disorders following the 2024 Noto Peninsula Earthquake: A retrospective study.

The study aim was to investigate the effect of the 2024 Noto Peninsula earthquake on regular psychiatric outpatient check-ups at Kanazawa Medical University Hospital, Japan. We retrospectively collected electronic medical records from January 4 to January 17, 2024, and analyzed data from 656 patients. χ 2 was used to analyze the association between adherence to scheduled visits and related factors, and the association between inability to attend scheduled visits and self-reported earthquake-related reasons among 84 nonadherent patients. A geographical information system was used to analyze geographic characteristics, such as municipality of residence and seismic intensity distribution. Of the 656 patients, 572 (87.2%) adhered to their scheduled visits. The failure to keep appointments was significantly associated with residence in areas with a seismic intensity of ≥6 (n = 21, 35.6%; p < 0.001). Among the 84 patients who failed to keep appointments, the inability to keep appointments owing to earthquake-related reasons was significantly associated with residence in areas with a seismic intensity of ≥6 (n = 16, 76.2%; p < 0.001) and presence of an F3 main disease code: Mood (affective) according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (n = 12, 60.0%; p = 0.034). Patients in areas with higher seismic intensity were more likely to miss appointments, probably because of factors such as infrastructure damage and personal losses. Among patients who missed appointments, those with F3 diagnoses were more likely to cite earthquake-related reasons. However, the high overall appointment adherence rate despite the effects of a major earthquake warrants further study.

P1210 Risk of post-acute sequalae of COVID-19 in patients with immune-mediated inflammatory diseases

Abstract Background Evidence suggest that about 10-30% of individuals with COVID-19 develop a chronic condition following the acute phase, now referred to as the post-acute sequalae of COVID-19 (PASC) or long COVID1,2. Dysregulation of the immune system and chronic inflammation, which are among the primary drivers of PASC3, are at the heart of immune-mediated inflammatory disease (IMID) pathology. As PASC still remains underexplored in the IMID population, we aimed to carry out a population-based cohort study to estimate the risk of PASC in patients with IMIDs compared to those without a recorded diagnosis of an IMID. Methods We used the Danish national registers to identify all individuals with a recorded positive SARS-CoV-2 test between 01 January 2020 and 01 January 2022. Individuals with IMIDs including Crohn’s disease (CD), ulcerative colitis (UC), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), spondylarthritis (SpA), and psoriasis were identified using ICD-10 codes and medication with indication (only for psoriasis) before 01 January 2020. The IMID and non-IMID groups were matched (1:2) on age, sex, municipality of residence, and calendar period. With the first positive date as index, individuals were followed up until a PASC diagnosis, emigration, death or end of the study period (31 July 2022), whichever is earliest. If an individual from the non-IMID group is diagnosed with an IMID, they are censored. Cox proportional hazard regression was carried out to estimate hazard ratios (HRs) with adjustments for age, sex and Charlson Comorbidity Index in all analyses. Subgroup analysis by vaccination status, hospitalization for COVID-19, IMID medication, IMID group, and SARS-CoV-2 variant were carried out. Results We compared 25,889 IMID patients to 51,778 individuals without an IMID for the risk of PASC. The median age was 48 (IQR: 35, 61) and 56% were women. Psoriasis was the largest group constituting 47% of the IMID group. During a median follow-up of 7.7(IQR:7.1-16.3) months, a total of 753 cases of PASC were reported in the entire cohort. The Cox proportional hazard regression showed an increased risk of PASC in the IMID group (HR: 1.51, 95% CI: (1.30-1.74)) compared to the non-IMID group. SpA (HR: 1.91, 95% CI:(1.21-3.01)), RA (HR: 1.72, 95% CI:(1.25-2.37)) and psoriasis (HR: 1.50, 95% CI:(1.21-1.85)) were individually associated with an increased risk of PASC. Conclusion This cohort study using nationwide registers showed an increased risk of PASC in individuals with an IMID and in spondylarthritis, rheumatoid arthritis and psoriasis individually. The results underline the need for clinicians to be aware of the chronic impact of early SARS-CoV-2 infection that IMID patients are living with at present.

P1244 Differential impact of appendectomy with appendiceal inflammation versus no inflammation on inflammatory bowel disease risk in a population-based cohort

Abstract Background The appendix is implicated in inflammatory bowel disease (IBD) risk. However, the relationship of appendectomy for appendicitis versus other indications, when the appendix is not inflamed, with IBD onset is ambiguous. We conducted a population-based cohort study to explore the risk of ulcerative colitis (UC) and Crohn’s disease (CD) following appendectomy of the inflamed appendix and removal of the uninflamed appendix for other indications. Methods We conducted a matched cohort study where all individuals with appendectomy in the Danish National Patient Register between January 1997 and August 2022 were matched 1:10 by sex, year of birth and municipality of residence at the time of appendectomy to individuals without appendectomy. Study participants were excluded if they were not residents of Denmark for at least two years prior to the index date. Based on cross-linked data from the Danish Pathology Register, we categorized appendectomy cases into those with and without appendiceal inflammation. Follow up started 180 days after appendectomy until IBD diagnosis, based on primary and secondary diagnoses codes in the National Patient Register, emigration, death or end of the study period, whichever came first. We used Cox proportional hazards regression to calculate the hazard ratios and 95% confidence interval for outcomes UC and CD, in appendectomy cases with and without appendiceal inflammation, compared to individuals without appendectomy after adjusting for age at appendectomy (index date), sex, calendar year, urbanization, and municipal-level socioeconomic index. Results A total of 145,147 individuals who underwent appendectomy and 1,451,470 individuals without appendectomy were followed for a median of 12 (IQR 6,19) years. Of all individuals with appendiceal inflammation, no appendiceal inflammation, and individuals without appendectomy, 308, 149 and 6,052 were diagnosed with UC, and 336, 191 and 3,166 with CD, respectively, during follow up. Kaplan Meier curves are demonstrated in the Figure. The adjusted hazard ratio (95% CI) for UC among those with and without appendiceal inflammation, compared to individuals without appendectomy, was 0.65 (0.58 - 0.73) and 1.26 (1.06 - 1.50), respectively. Corresponding estimates for CD were 1.33 (1.19 - 1.50) and 3.13 (2.65 - 3.69), respectively. Conclusion In a nationwide cohort with long-term follow up data, appendectomy following appendiceal inflammation was protective against UC while appendectomy following no inflammation was associated with increase in UC risk. Appendectomy, irrespective of appendiceal inflammation, was associated with CD risk.

Childbirth dynamics in the riverside region of the Brazilian Amazon from the perspective of geospatialization.

to analyze the spatial-temporal pattern of childbirths and flow of postpartum women assisted at a regional reference maternity hospital. ecological study of 4,081 childbirths, between September 2018 and December 2021, at a public maternity hospital in the Baixo Tocantins region, Pará, Brazil. With data collected from five sources, a geographic database was constructed, and spatial analysis was used with Kernel density interpolator. Maps were generated using QGis/3.5 and TerraView/4.3, calculating chi-square (p<0.05). the highest concentrations of normal and cesarean childbirths were observed in Barcarena (n=2,558/62.68%), Abaetetuba (n=750/18.38%), Moju (n=363/8.89%) and Igarapé-Miri (n=219/5.37%). Among the municipalities in the region, ten had obstetric beds, totaling 210 beds. In this scenario, postpartum women traveled up to 288 km to reach the maternity hospital. long distances between certain municipalities of residence and maternity hospital, and low supply of obstetric beds, were identified as risk factors for unfavorable obstetric outcomes.

Temporo-spatial analysis of amyotrophic lateral sclerosis in Spain: Altitude and land use as new determinants of the disease

Temporo-spatial analysis of amyotrophic lateral sclerosis in Spain: Altitude and land use as new determinants of the disease

Human–nature connectedness and sustainability across lifetimes: A comparative cross‐sectional study in France and Colombia

Abstract To achieve sustainable targets, international panels call for a transformative change in human–nature interactions to foster human well‐being and promote pro‐environmental behaviour. The extent to which people considered themselves as part of nature—known as human–nature connectedness—has been shown to be a key societal trait for achieving such a transformative change. Human–nature connectedness is linked to improved human welfare and actions for nature conservation and can be increased by direct contact with natural environments in adults living in the Global North. It has not been shown whether these relations are true across lifetimes and in the Global South, making it difficult to generalise about the effects of human–nature connectedness globally. Here, we conducted a cross‐sectional study to examine and compare human–nature connectedness across ages in 1858 participants aged 3–87 years from two countries: France (N = 1059) and Colombia (N = 799). We also investigated the links between human–nature connectedness, pro‐environmental behaviours, well‐being and two indicators of opportunity to experience nature (i.e. degree of urbanisation and forest cover around the participants' municipality of residence). Results show that human–nature connectedness is positively related to well‐being and pro‐environmental behaviours in both countries. Analyses revealed an age‐related pattern of human–nature connectedness with a significant decline from childhood to the mid‐teens in both countries. Overall, Colombian participants have a higher human–nature connectedness than French participants and individuals' human–nature connectedness was negatively linked to the urbanisation's indices in both countries. Here, we show that human–nature connectedness is linked to sustainable outcomes in a Global South country, just as it is in the Global North. Our study also suggests that increasing contact with nature during formative teenage years could mitigate the observed decline in human–nature connectedness. Future studies are warranted combining qualitative and quantitative measures related to human–nature connectedness, nature experiences, values and practices in relation to nature, in multiple countries from the global South. Our study indicates that enhancing human–nature connectedness could provide an additional tool for achieving sustainable targets globally, not just in highly developed northern‐hemisphere countries. Read the free Plain Language Summary for this article on the Journal blog.

Labor market participation in people with intellectual disability – a follow-up study in Sweden

Abstract Background Work is vital to people’s health and quality of life. The Convention on the Rights of Persons with Disabilities affirms the right to work on an equal basis with others including an opportunity to earn a living by work, but evidence shows that people with intellectual disability (ID) are at greater risk of unemployment and social exclusion. Due to the lack of comprehensive data for longitudinal follow-ups, information on long-term labor market participation (LLMP) in people with ID is scarce. This study aimed to investigate factors of importance for LLMP in individuals with ID in Sweden. Methods The study was based on data from the upper secondary school for pupils with ID between 2001 and 2020 (N = 26,905) and from the longitudinal integrated database for health insurance and labor market studies. A sample of gainfully employed in 2011 (n = 2,719), was followed with respect to LLMP until 2020. Odds ratios (ORs) with 95% confidence intervals (CI) for associations between educational, sociodemographic, and work factors and LLMP (i.e. gainful employment throughout the follow-up), were estimated stratified on sex. Results LLMP was twice as likely in men compared with women, OR 2.06 (1.78-2.58) as was work in the private sector. Factors of significance for LLMP in men and women alike were: completed national education program, OR 3.40 (3.06-3.86) and OR 2.91 (2.40-3.54), parents’ education; compulsory school in mothers’, OR 1.22 (1.06-1.41) and 1.24 (1.00-1.55) and in fathers’ OR 1.35 (1.17-1.56) and 1.49 (1.20-1.85), while municipality of residence was significant only in men, OR 1.30 (1.10-1.56). Conclusions Public health prevention for disadvantaged groups requires accurate and up-to-date knowledge. Using unique register-based data, this is the first study on LLMP in people with ID in Sweden. Knowledge on what social determinants may strengthen LLMP is important since limited LLMP increases the risk of missing out on health benefits that employment may offer. Key messages • There was a significant gender difference in long-term labor market participation in people with intellectual disability in Sweden. • There is a need for increased knowledge on what social determinants may strengthen long-term labor market participation in people with intellectual disability.

Variations in access to acute care services by immigrant background and sociodemographic factors

Abstract Background The Emergency Medical Communication Center (EMCC) plays a vital role in the medical emergency response system by triaging contacts, notifying local physicians, and providing medical advice. The utilization of acute care services and the subsequent care pathway by individuals with immigrant background remains unclear in the Norwegian context. This study aims to investigate whether disparities exist in the acute care pathway for patients with different sociodemographic background who use ambulance services. Methods We examined all code red ambulance dispatches for life-threatening emergencies in 2021 in Norway. These ambulance dispatches were linked to primary health care and specialist health care contacts to trace patient pathways and outcomes. Statistical analyses were conducted using linear regression models, adjusted for patient characteristics, such as immigrant background, age, sex, municipality of residence, living condition, socioeconomic status, comorbidity and cause of emergency contact. Results Preliminary crude findings indicate that patients with immigrant background are overrepresented in the groups receiving acute primary care only and underrepresented in the groups transferred directly to specialist health care, within 8 hours after ambulance arrival at the patients’ location. Conclusions The preliminary results suggest challenges for the EMCC in triaging patients with immigrant background, but further research is needed to explore potential systematic differences. This study aims to improve understanding of disparities in access to acute care and inform targeted interventions to optimize resource allocation in emergency departments. Key messages • This study may improve understanding of disparities in access to acute care in Norway. • This study can inform targeted interventions to improve resource allocation in emergency departments.

Men’s and women’s visions of employment policies to combat depopulation in rural Spain

The paper draws on the data gathered from a survey on men and women living in Spanish municipalities affected by depopulation. Using factor analysis, it identifies labour profiles among men and women associated with socio-demographic, economic and technological variables. We establish four profiles related to employment status for the men and women in a rural environment. For the women, we identify a group linked to the services sector, another to the public administration sector, and a group with unstable employment and the intention to emigrate, with these women being the youngest. Additionally, there is a group of women that report not working or never having worked, with these individuals being older and associated with family businesses. Regarding the men, the first three groups correspond to the agricultural sector, the industry sector and the services sector, with there also being a further group consisting of young men either without a job or with an unstable one. The article also applies cluster analysis to examine men and women’s preferences as regards the policies currently most widely used to promote rural employment in Spain: concession of tax benefits for job creation, the promotion of entrepreneurial activity, innovation in the primary sector and the advancement of rural tourism. The order of preference for the four policies is the same for both sexes, with entrepreneurship and improved funding being the most preferred, followed by innovation in agricultural activity. The results show, however, that variables such as age, level of education, type of job, economic sector, income and size of municipality of residence, have a different impact on men’s and women’s choices.

8473 Prediabetes As A Risk Factor For All-Cause And Cause-Specific Mortality In 117,227 Diabetes-Free Adults In Mexico City

Abstract Disclosure: C.A. Fermin-Martinez: None. O.Y. Bello-Chavolla: None. N.E. Antonio-Villa: None. D. Ramirez Garcia: None. J.A. Seiglie: None. Background: Prediabetes has been consistently linked to high risk of diabetes progression, cardiovascular disease, and all-cause mortality. However, no large-scale studies have been conducted in Mexico or Latin America examining these associations despite the growing prevalence of this condition in low- and middle-income countries. Methods: We analyzed data from 117,227 adults without diabetes aged ≥35 years who participated in the Mexico City Prospective Study (1998-2004). Individuals with self-reported chronic comorbidities at baseline were excluded to mitigate reverse causation. Participants were followed-up until January 1st, 2021 for cause-specific mortality. We defined prediabetes according to the American Diabetes Association (ADA, HbA1c ≥5.7%) and the International Expert Committee (IEC, HbA1c ≥6.0%) definitions. Cox regressions were used to estimate prediabetes-related risk for all-cause and cause-specific mortality, stratified by sex and age-at-risk and adjusted for municipality of residence, education level, physical activity, smoking, alcohol consumption, and adiposity markers. Results: Compared to individuals with normoglycemia, participants with IEC-defined prediabetes had a higher risk of all-cause (HR 1.16, 95%CI 1.05-1.27), cardiac (HR 1.29, 95%CI 1.05-1.59), renal (HR 1.59, 95%CI 1.14-2.23), and acute diabetes-related (HR 2.60, 95%CI 1.52-4.43) mortality at ages 40-74 years compared to normoglycemic participants. HRs were attenuated at older ages. Results were broadly similar irrespective of the definition of prediabetes except for cardiac deaths, in which the risk was non-significant using the ADA cutoff (HR 1.14, 95%CI 0.99-1.31). Long-term effects of prediabetes (IEC-defined) accounted for ∼37% of renal deaths and ∼61% of acute diabetes-related deaths in Mexican adults without diabetes at baseline. Conclusion: Prediabetes is an important risk factor that accounts for a significant fraction of all-cause, cardiac, renal, and acute diabetes-related deaths among Mexican adults, particularly when using the higher threshold of IEC-defined prediabetes. Endpoint-driven definitions of prediabetes should be considered for widespread implementation of screening and preventive strategies that minimize overdiagnosis and improve cardiometabolic outcomes in this population. Presentation: 6/1/2024

9253 Prediabetes As A Risk Factor For All-Cause And Cause-Specific Mortality In 117,227 Diabetes-Free Adults In Mexico City

Abstract Disclosure: C.A. Fermin-Martinez: None. O.Y. Bello-Chavolla: None. N.E. Antonio-Villa: None. D. Ramirez Garcia: None. J.A. Seiglie: None. Background: Prediabetes has been consistently linked to high risk of diabetes progression, cardiovascular disease, and all-cause mortality. However, no large-scale studies have been conducted in Mexico or Latin America examining these associations despite the growing prevalence of this condition in low- and middle-income countries. Methods: We analyzed data from 117,227 adults without diabetes aged ≥35 years who participated in the Mexico City Prospective Study (1998-2004). Individuals with self-reported chronic comorbidities at baseline were excluded to mitigate reverse causation. Participants were followed-up until January 1st, 2021 for cause-specific mortality. We defined prediabetes according to the American Diabetes Association (ADA, HbA1c ≥5.7%) and the International Expert Committee (IEC, HbA1c ≥6.0%) definitions. Cox regressions were used to estimate prediabetes-related risk for all-cause and cause-specific mortality, stratified by sex and age-at-risk and adjusted for municipality of residence, education level, physical activity, smoking, alcohol consumption, and adiposity markers. Results: Compared to individuals with normoglycemia, participants with IEC-defined prediabetes had a higher risk of all-cause (HR 1.16, 95%CI 1.05-1.27), cardiac (HR 1.29, 95%CI 1.05-1.59), renal (HR 1.59, 95%CI 1.14-2.23), and acute diabetes-related (HR 2.60, 95%CI 1.52-4.43) mortality at ages 40-74 years compared to normoglycemic participants. HRs were attenuated at older ages. Results were broadly similar irrespective of the definition of prediabetes except for cardiac deaths, in which the risk was non-significant using the ADA cutoff (HR 1.14, 95%CI 0.99-1.31). Long-term effects of prediabetes (IEC-defined) accounted for ∼37% of renal deaths and ∼61% of acute diabetes-related deaths in Mexican adults without diabetes at baseline. Conclusion: Prediabetes is an important risk factor that accounts for a significant fraction of all-cause, cardiac, renal, and acute diabetes-related deaths among Mexican adults, particularly when using the higher threshold of IEC-defined prediabetes. Endpoint-driven definitions of prediabetes should be considered for widespread implementation of screening and preventive strategies that minimize overdiagnosis and improve cardiometabolic outcomes in this population. Presentation: 6/1/2024

Epidemiology of major heart rhythm and conduction disorders

Epidemiology of major heart rhythm and conduction disorders

Excess of severe autoimmune diseases in women with premature ovarian insufficiency: a population-based study.

Is there an association between premature ovarian insufficiency (POI) and severe autoimmune diseases before and after POI diagnosis? Women with POI had at least one hospital-treated autoimmune disorder preceding POI diagnosis 2.6 times more often compared with matched female controls, and a 2- to 3-fold risk for these diseases for several years after POI diagnosis. It has been suggested that autoimmunity is an important factor in the pathogenesis of POI. Estimations of the prevalence of POI cases with autoimmune origin have ranged from 4% to 50%. This population-based registry study included 3972 women diagnosed with spontaneous POI between 1988 and 2017 and 15708 female population controls and used both case-control and cohort analysis. Autoimmune disease diagnoses were evaluated from childhood until the end of the year 2017. Women with POI were identified from the reimbursement registry of the Finnish Social Insurance Institution by their right to hormone replacement therapy (HRT). Four female population controls matched by age and municipality of residence were searched for each POI case to form a reference cohort. Women with a history of cancer or bilateral oophorectomy were excluded. Severe autoimmune disorder diagnoses for the years 1970-2017 were identified from the Hospital Discharge Registry. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated using binary logistic regression for cases of having any, or one or more, specific autoimmune diseases preceding the index date (the date when reimbursement for HRT was granted for the POI) among women with POI as compared to controls. Standardized incidence ratios (SIR) with 95% CIs for getting diagnosed with an autoimmune disease after the index date in 3-year follow-up periods among women with POI (who did not have these diseases prior to the index date) were also calculated. The expected numbers of autoimmune disease cases were based on the incidence of first-onset severe autoimmune disease among the controls. The prevalence of having at least one severe autoimmune disease in women with POI was 5.6% (n = 233), with an OR of 2.6 (95% CI 2.2, 3.1) when compared to population controls. Women with POI had an increased prevalence of several specific autoimmune diseases prior to the index date compared to controls: polyglandular autoimmune diseases (OR 25.8, 95% CI 9.0, 74.1), Addison's disease (OR 22.9, 95% CI 7.9, 66.1), vasculitis (OR 10.2, 95% 4.3, 24.5), systemic lupus erythematosus (OR 6.3 95% CI 4.2, 20.3), rheumatoid arthritis (OR 2.3, 95% CI 1.7, 3.2), sarcoidosis (OR 2.3, 95% CI 1.2, 4.5), inflammatory bowel diseases (OR 2.2, 95% CI 1.5, 3.3), and hyperthyroidism (OR 1.9, 95% CI 1.2, 3.1); whereas the prevalence of diabetes type 1 and ankylosing spondylitis did not differ between the women with POI and the reference cohort. The SIRs for being diagnosed for the first time with a severe autoimmune disease after POI diagnosis was 2.8 (95% CI 2.3, 3.4), during the first three years after POI diagnosis, decreasing gradually to 1.3 (1.1, 1.6) after 12 years. This study only included autoimmune disorders diagnosed in specialized health care; hence, the overall prevalence of autoimmune disorders in women with POI may be higher. Severe autoimmune diseases have a strong association with POI, suggesting that immunological mechanisms play a pivotal role in POI. Future studies should focus on specific autoimmune mechanisms behind POI, from both preventive and curative perspectives. This work was financially supported by Oulu University Hospital. S.M.S. received grants from the Finnish Menopause Society, the Finnish Medical Foundation, and the Juho Vainio Foundation. H.S. received grants from the Finnish Menopause Society, the Oulu Medical Research Foundation, the Finnish Research Foundation of Gynecology and Obstetrics, UniOGS graduate school, The Finnish Medical Society Duodecim, Orion Research Foundation, and the University of Oulu Scholarship Fund. M.-M.O. received a grant from the Sakari Alhopuro Foundation and the Finnish Diabetes Research Foundation. None of the funders had any involvement in the study design or its execution or reporting. The authors do not have any competing interests to report. N/A.

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score

ObjectiveTo develop and validate a novel score predictive of nursing home placement in elderly. Study designPopulation-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy. MethodsThe 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration. ResultsTwenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk. ConclusionsA simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.