Retrospective Population-based Case-control Study Research Articles

Health service use in major trauma survivors: a population-based cohort study from Ontario, Canada.

Little is known about how major trauma survivors access health services in the years following their injury. Our study sought to characterize patterns of health services use in trauma survivors following discharge from a provincial trauma centre and to identify sociodemographic factors associated with service utilization. We conducted a population-based retrospective case-control study using linked administrative data on trauma survivors' population-based controls between April 1, 2011, to March 31, 2021. For each major trauma survivor, we matched four cases based on age and sex. The primary outcome was the composite rate (sum) of health service use episodes including outpatient visits to family physicians and specialists, emergency department (ED) visits, and acute care hospital admissions during the five-year period following discharge from the trauma centre. We used multivariate regression to compute rate ratios comparing the rates of health service use in trauma survivors versus controls and to assess for associations between sociodemographic variables and health services use. The study cohort consisted of a total of 273,406 individuals: 55,060 trauma survivors and 218,346 controls. Trauma survivors were predominately males (71%) with a median age of 46 years (IQR: 26-65 years). Health service use in trauma survivors peaked within a year of hospital discharge but remained increased throughout the follow up period. Trauma survivorship was associated with a 56% increase in overall health services use (Adjusted Rate Ratio 1.56, 95% CI: 1.55-1.57), including an 88% increase in hospital admissions (Adjusted Rate Ratio 1.88, 95% CI: 1.85-1.92). Male sex and rural residence were associated with a reduced overall use of health services but greater use of ED services. Major trauma survivors have long-term health services needs that persist for years after discharge from the trauma centre. Future research should focus on the understanding why trauma survivors have prolonged health services requirements and ensure care needs are aligned with service delivery. Retrospective cohort study, Level IV.

Factors Associated with Maternal Morbidity among Black Women in the United States.

Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). This is a population-based retrospective case-control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. · The rate of SMM in NHBP may be modifiable.. · NHBP have a three-fold higher rate of maternal mortality.. · Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity..

Investigation of Periodontal Condition, and Tooth Loss in Multiple Myeloma Patients: A Case-Control Study

Objectives: Studies have long suggested a link between Periodontal Disease and an increased risk of other inflammatory diseases, and diverse types of cancer. The aim of the current research was to investigate the possible differences regarding the periodontal condition and tooth loss between individuals suffering from Multiple Myeloma (MM) and healthy ones. Methods: This was a population-based retrospective case-control study in which 98 MM patients and 196 matching healthy controls were interviewed and dental and oral clinically examined. The clinical indices used to define the periodontal condition for MM patients and healthy individuals concerned Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), Plaque Index (PlI), Gingival Index (GI), and number of missing teeth. Univariate and logistic regression models were carried out to assess the data analyzed. Results: Individuals with increased BMI (p=0.003, 95% CI= 2.405) who suffered from MM and those with a family history of MM (p=0.000, 95% CI=8.495), were statistically significantly different compared with the healthy ones. Moreover, GI (p=0.042, 95% CI=2.451), was statistically significantly different between MM patients and the healthy individuals after controlling for smoking and socio-economic status. Conclusion: GI was statistically significantly different between individuals who were suffered from MM and healthy individuals.

Increased Risk of Coronary Artery Disease in People with Diagnosis of Neuromuscular Disorders: A Nationwide Retrospective Population-Based Case-Control Study.

The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case-control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan's National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD.

Associations Between Obstructive Sleep Apnea Syndrome, Dry Eye Disease, and CPAP Usage Among Taiwanese Patients: A Retrospective Analysis.

To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED. This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer's test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren's syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared. In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47-10.49, P = 0.006). OSA severity is associated with DED and might be attributed to the use of CPAP.

Risk of neurodegenerative diseases in patients with sleep disorders: A nationwide population-based case-control study

ObjectiveOur study aimed to explore the associative relationship between neurodegenerative diseases and sleep disorders. PatientsThis 15-year retrospective longitudinal nationwide population-based matched case-control study used data extracted from the National Health Insurance Research Database. We evaluated 25,589 patients diagnosed with neurodegenerative diseases between 2000 and 2015 and a matched control of 102,356 patients without neurodegenerative diseases. ResultsSleep disorders were an independent risk factor for the development of neurodegenerative diseases (adjusted odds ratio (OR): 1.794, 95% confidence interval (CI): 1.235–2.268, P < 0.001), with a positive dose-effect relationship (adjusted OR (95% CI): <1 year: 1.638 (1.093–2.872), P < 0.001; 1–5 years: 1.897 (1.260–3.135), P < 0.001; >5 years: 2.381 (1.467–3.681), P < 0.001. Moreover, patients with sleep disorder and comorbid depression had a significantly higher risk of neurodegenerative disorders (adjusted OR: 5.874). Subgroup analysis showed that insomnia was associated with Alzheimer's disease, Pick's disease and essential tremor (adjusted OR (95% CI): 1.555 (1.069–1.965), 1.934 (1.331–2.445) and 2.089 (1.439–2.648), respectively). Obstructive sleep apnea was associated with Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 1.801 (1.239–2.275), 5.523 (3.802–6.977), and 4.892 (3.365–6.178), respectively). Other specific sleep disorders were associated with Pick's disease, Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 8.901 (6.101–11.010), 1.549 (1.075–1.986), 2.791 (1.924–3.531), and 9.114 (6.283–10.506), respectively). ConclusionSleep disorders are associated with the subsequent development of neurodegenerative disorders. Moreover, sleep disorder patients with comorbid depression have a higher risk of neurodegenerative diseases.

Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010

Anthracyclines increase the risk for congestive heart failure (CHF); however, long-term cumulative incidence and risk factors for CHF after anthracycline therapy are not well defined in population-based studies. To compare the long-term cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracycline therapy compared with healthy controls from the same community. This retrospective population-based case-control study included data from the Rochester Epidemiology Project. Participants included residents of Olmsted County, Minnesota, diagnosed with breast cancer or lymphoma from January 1985 through December 2010 matched for age, sex, and comorbidities with healthy controls, with a final ratio of 1 case to 1.5 controls. Statistical analysis was performed between July 2017 and February 2022. Cancer treatment and CHF risk factors. The main outcome was new-onset CHF, as defined by the modified Framingham criteria. Cox proportional hazards regression was used to estimate hazard ratios (HRs) to compare the risk of CHF in participants with cancer vs controls, adjusted for age, sex, diabetes, hypertension, hyperlipidemia, coronary artery disease, obesity, and smoking history. A total of 2196 individuals were included, with 812 patients with cancer and 1384 participants without cancer. The mean (SD) age was 52.62 (14.56) years and 1704 participants (78%) were female. Median (IQR) follow-up was 8.6 (5.2-13.4) years in the case group vs 12.5 (8.7-17.5) years in the control group. Overall, patients with cancer had higher risk of CHF compared with the control cohort even after adjusting for age, sex, diabetes, hypertension, coronary artery disease, hyperlipidemia, obesity, and smoking status (HR, 2.86 [95% CI, 1.90-4.32]; P < .001). After adjusting for the same variables, CHF risk was greater for patients with cancer receiving anthracycline (HR, 3.25 [95% CI, 2.11-5.00]; P < .001) and was attenuated and lost statistical significance for patients with cancer not receiving anthracyclines (HR, 1.78 [95% CI, 0.83-3.81]; P = .14). Higher cumulative incidence for patients treated with anthracyclines vs comparator cohort was observed at 1 year (1.81% vs 0.09%), 5 years (2.91% vs 0.79%), 10 years (5.36% vs 1.74%), 15 years (7.42% vs 3.18%), and 20 years (10.75% vs 4.98%) (P < .001). There were no significant differences in risk of CHF for patients receiving anthracycline at a dose of less than 180 mg/m2 compared with those at a dose of 180 to 250 mg/m2 (HR, 0.54 [95% CI, 0.19-1.51]) or at a dose of more than 250 mg/m2 (HR, 1.23 [95% CI, 0.52-2.91]). At diagnosis, age was an independent risk factor associated with CHF (HR per 10 years, 2.77 [95% CI, 1.99-3.86]; P < .001). In this retrospective population-based case-control study, anthracyclines were associated with an increased risk of CHF early during follow-up, and the increased risk persisted over time. The cumulative incidence of CHF in patients with breast cancer or lymphoma treated with anthracyclines at 15 years was more than 2-fold that of the control group.

Significant Association between Obsessive-Compulsive Disorder and Atopic Dermatitis - a Retrospective Population-Based Case-Control Study.

Atopic dermatitis (AD) is a global health problem. There are no data on the association of AD with obsessive-compulsive disorder (OCD). This study aimed to map a wide spectrum of different diseases among patients with atopic dermatitis compared to healthy controls in the Region of Jönköping County, Sweden with special focus on OCD. We conducted a retrospective case control study from January 1st 2013 until December 31st 2021 using an electronic medical records database covering the entire population of the County of Jönköping. ICD-10 codes were used to identify patients with AD. Individuals without AD served as controls. A total number of 398,874 citizens under the age of 90 was included in this study and among these 2,946 individuals were diagnosed with AD. Regression analysis was performed to describe the risk for comorbidities in patients with AD compared to controls, adjusted for age and gender. We found an association between obsessive-compulsive disorder (OCD) in patients with AD (adjusted odd ratio 2.0, 95% confidence interval 1.5-2.7, p<0.001). Other results are in the line with other studies. Pointing to previous studies, the cause of AD and OCD share several gene-environmental mechanisms and this association should be further studied on larger populations. The results of the present study underline the need for dermatologists to be aware of OCD and to screen for this condition in AD patients because early diagnosis and treatment may improve outcome.

Differential Association of FTO Gene variants and Haplotypes with the Susceptibility to Polycystic Ovary Syndrome According To Obesity in Women with PCOS.

We explored the relation between FTO single gene variants (rs1861868, rs9939973, rs1421085, rs1121980, rs17817449, rs8050136, rs9939609, rs9930506, and rs8044769) and polycystic ovary syndrome (PCOS), in particular, according to the obesity status. This retrospective population-based case-control study involved women with PCOS (583) and 713 eumenorrheic control women; genotyping was done by real-time PCR. Significantly higher minor allele frequency (MAF) of rs9939973, rs17817449, rs9939609, and rs9930506 and lower MAF of rs1121980 were seen in PCOS cases. Lower risk of PCOS was associated with rs1121980 and rs8050136 heterozygous and minor allele-homozygous genotypes, while an elevated risk of PCOS was seen with minor allele-homozygous rs9939973, rs17817449, and r9939609 heterozygous and genotypes and minor allele-homozygous rs9930506 and rs8044769 genotype. While none of the tested FTO SNPs variants was associated with PCOS in normal body weight/lean subjects, rs9939973, rs9939609, and rs9930506 were negatively associated with PCOS in overweight subjects. In comparison, rs1861868 was negatively, while rs8044769 was positively associated with PCOS in obese subjects. Haplotype analysis identified haplotypes GACCTCTAT, AACCTCTAT, AACCTATAT and AGTTGCAGC, and GACCTCTAC to be positively associated with PCOS, while haplotypes GGTTGAAGC, GACCTATAT, GGTTGCAGC, and GATCTATAT were negatively associated with PCOS. Apart from GGTTGAAGC, these haplotypes remained associated with altered risk of PCOS after adjusting for covariates. In addition to rs17817449, rs9939609, rs9930506, and rs1121980, this study is the first to demonstrate association of rs9939973 and rs8044769 with altered risk of PCOS and the first to confirm the BMI dependency on the association of FTO variants with PCOS. This underscores the role of FTO gene variants as predisposing factors of PCOS.

Health conditions and service use of autistic women and men: A retrospective population-based case-control study.

This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.

Breast Cancer Incidence among Female Workers by Different Occupations and Industries: A Longitudinal Population-Based Matched Case–Control Study in Taiwan

Background: Breast cancer is the leading cause of cancer incidence worldwide and in Taiwan. The relationship between breast cancer and occupational types remains unclear. This study aimed to investigate lifetime breast cancer incidence by different occupational industries among female workers in Taiwan. Methods: A population-based retrospective case–control study was conducted using three nationwide population-based databases. Matched case and control groups were identified with 1-to-4 exact matching among 103,047 female workers with breast cancer diagnosed in 2008–2017 and those without breast cancer. Their lifetime labor enrollment records were tracked using the National Labor Insurance Database, 1950–2017. Conditional logistic regression was used to analyze the association between types of occupational industries and risk of incident breast cancer. Results: Our study found slightly significant breast cancer risk among the following major occupational classifications: manufacturing (OR: 1.027, 95% CI: 1.011–1.043); wholesale and retail trade (OR: 1.068, 95% CI: 1.052–1.084); information and communication (OR: 1.074, 95% CI: 1.043–1.105); financial and insurance activities (OR: 1.109, 95% CI: 1.086–1.133); real estate activities (OR: 1.050, 95% CI: 1.016–1.085); professional, scientific, and technical activities (OR: 1.118, 95% CI: 1.091–1.145); public administration, defense, and social security (OR: 1.054, 95% CI: 1.023–1.087), education (OR: 1.199, 95% CI: 1.168–1.230); and human health and social work activities (OR: 1.125, 95% CI: 1.096–1.156). Conclusions: Greater percentages of industrial occupations (i.e., manufacturing, wholesale and retail, or health professionals) were associated with slightly increased breast cancer risk. Further studies should investigate the possible risk factors among female workers in those industries with slightly higher incidence of breast cancer.

Guillain-Barré syndrome following influenza vaccination: A 15-year nationwide population-based case-control study.

Influenza vaccination may increase the risk of developing Guillain-Barré syndrome (GBS) due to an elicited immune response, but the exact magnitude and duration of risk is unclear and hence the aim of this study. We conducted a retrospective nationwide population-based case-control study of prospectively collected data on all patients with first-time hospital-diagnosed GBS in Denmark between 2002 and 2016 and 10 age-, sex- and index date-matched population controls per case. The primary exposure was incident influenza vaccination 1 month prior to admission with GBS. We used medical registries to ascertain a complete hospital contact history of pre-existing morbidities. To examine duration of GBS risk, we repeated the analysis for five consecutive 1-month risk periods following vaccination. Of the 1295 GBS cases and 12,814 controls, 20 cases (1.5%) and 119 controls (0.9%) had received an influenza vaccination within the last month, yielding a comorbidity-adjusted odds ratio of 1.9 (95% confidence interval 1.1-3.2) for GBS. Stratified analyses by calendar time, gender and age showed similar results. The increased risk of GBS was largely confined to 1 month following influenza vaccination. The population-attributable fraction of GBS from influenza vaccination in Denmark was 0.4%. Influenza vaccination was associated with a slightly elevated risk of GBS occurrence within 1 month after vaccination. However, only 1.5% of GBS cases in Denmark are associated with recent influenza vaccination. Thus, the benefit of influenza vaccines in preventing influenza infections and associated morbidity and mortality needs to be weighed against the small absolute risk of GBS.

Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case-control study.

In the attempt of a trial of labor after a cesarean section approximately one in 200 women experience a complete uterine rupture. As a complete uterine rupture is associated with an adverse perinatal outcome, data regarding subsequent pregnancies are needed to provide proper care and guidance to women with a complete uterine rupture when informing them of future possibilities. The objective of this study was to investigate the fetal and maternal outcomes in subsequent pregnancies after a complete uterine rupture. Retrospective population-based case-control study. Denmark 1997-2017. A total of 175 women with complete uterine rupture during an attempted trial of labor after cesarean (TOLAC) at term (cases) and a corresponding group of 272 women with no uterine rupture during an attempted TOLAC at term (controls) were labeled as index deliveries. Index deliveries were included from January 1, 1997 to December 31, 2008. From the date of the index delivery to December 31, 2017 the information on subsequent pregnancies and deliveries, and on referral to hospital with any obstetric or gynecological diagnosis were retrieved from the Danish Medical Birth Registry and National Patient Registry. Main outcome measures were miscarriage, perinatal death, neonatal morbidity, preterm birth, and recurrence of uterine rupture. Outcome measures were compared between cases and controls. After the index deliveries; there were 109 pregnancies and 70 deliveries after gestational age 22+0 weeks in the population of cases. In the population of controls, there were 183 pregnancies and 126 deliveries after 22+0 weeks. Cases had a significantly higher risk of miscarriage (odds ratio [OR] 3.99; 95% confidence interval [CI] 1.36-13.17). The incidence of uterine rupture was 8.6% among cases and 0.8% among controls (OR 11.7; 95% CI 1.36-543.1). Among cases, 98.6% had live-born infants, and none of these had severe neonatal morbidity. No significant association was found between previous complete uterine rupture and preterm delivery, placenta previa, hysterectomy in relation to subsequent births, diagnosis such as meno/metrorrhagia, dysmenorrhea, or procedures such as hysteroscopy or hysterectomy. In pregnancies following complete uterine rupture continuing after 22+0 weeks, maternal and fetal outcomes are good when managed promptly with cesarean delivery.

Social Determinants of Preterm Birth Amongst Non-Hispanic Black Women

Efforts to recognize risk factors for preterm birth (PTB) are essential as this is a leading cause of perinatal mortality in the US. This study aims to identify risk factors that may be drivers of higher preterm birth rates amongst non-Hispanic black women. Population-based retrospective case-control study of the US birth records (2012—2016). Factors potentially associated with preterm birth and considered as indicators of social determinants of health (SDH) were compared between singleton live births of non-Hispanic Black women delivering preterm (< 37 weeks gestation) and term (≥ 37 weeks gestation). Multivariate logistic regression quantified the association between social determinants and PTB such as maternal age, insurance type, education level, and amount of prenatal care, and reported as odds ratios (95% confidence interval, CI). Of 2,763,235 live births to Black women in the US during the study period, 340,480 (12% of births to Black women) occurred < 37 weeks. Factors most strongly associated with preterm birth (P< .001), presented as odds ratio (95% CI) included no prenatal care 3.0 (95% CI, 2.9—3.1) or insufficient prenatal care 2.7 (95% CI, 2.7—2.8); smoking during pregnancy 1.4 (95% CI, 1.43—1.47), age ≥ 35 years 1.3 (95% CI, 1.3—1.35), unmarried 1.18 (95% CI, 1.17—1.19), lack of high school diploma 1.1 (95% CI, 1.12—1.40), lack of father of baby listed on birth certificate 1.22 (1.21—1.23), and Black paternal race 1.10 (1.08—1.12). Utilization of government-funded resources of Medicaid and WIC had opposite influence on PTB risk in Black women, OR 1.08 (1.07—1.09) and 0.83 (0.83—0.84), respectively. Non-Hispanic Black women with older age, smokers, Medicaid insurance, lower education, unmarried, lack of prenatal care, Black paternal race, and lack of father of baby listed on birth record had increased risk of PTB. Addressing these indicators of SDH that contribute to the risk of PTB, specifically amongst Black women, may help to address the racial disparity in adverse perinatal outcomes in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk factor of plasmodium knowlesi infection in Sabah Borneo Malaysia, 2020: A population-based case-control study.

BackgroundIn the Malaysian state of Sabah, P. knowlesi notifications increased from 2% (59/2,741) of total malaria notifications in 2004 to 98% (2030/2,078) in 2017. There was a gap regarding P. knowlesi acquisition risk factors related to practice specifically in working age group. The main objective of this study was to identify the risk factors for acquiring P. knowlesi infection in Sabah among the working age group.Methods and methodsThis retrospective population-based case-control study was conducted in Ranau district to assess sociodemographic, behavioural and medical history risk factors using a pretested questionnaire. The data were entered and analyzed using IBM SPSS version 23. Bivariate analysis was conducted using binary logistic regression whereas multivariate analysis was conducted using multivariable logistic regression. We set a statistical significance at p-value less than or equal to 0.05.ResultsA total of 266 cases and 532 controls were included in the study. Male gender (AOR = 2.71; 95% CI: 1.63–4.50), spending overnight in forest (AOR = 1.92; 95% CI: 1.20–3.06), not using mosquito repellent (AOR = 2.49; 95% CI: 1.36–4.56) and history of previous malaria infection (AOR = 49.34; 95% CI: 39.09–78.32) were found to be independent predictors of P. knowlesi infection.ConclusionsThis study showed the need to strengthen the strategies in preventing and controlling P. knowlesi infection specifically in changing the practice of spending overnight in forest and increasing the usage of personal mosquito repellent.

Atopic asthma as a potentially significant but unrecognized risk factor for Kawasaki disease in children

Objectives Childhood asthma is known to be associated with risks of both respiratory and non-respiratory infections. Little is known about the relationship between asthma and the risk of Kawasaki disease (KD). We assessed associations of asthma status and asthma phenotype (e.g. atopic asthma) with KD. Methods We performed a population-based retrospective case-control study, using KD cases between January 1, 1979, and December 31, 2016, and two matched controls per case. KD cases were defined by the American Heart Association diagnostic criteria. Asthma status prior to KD (or control) index dates was ascertained by the two asthma criteria, Predetermined Asthma Criteria (PAC) and Asthma Predictive Index (API, a surrogate phenotype of atopic asthma). We assessed whether 4 phenotypes (both PAC + and API+; PAC + only; API + only, and non-asthmatics) were associated with KD. Results There were 124 KD cases during the study period. The group having both PAC + and API + was significantly associated with the increased odds of KD, compared to non-asthmatics (odds ratio [OR] 4.3; 95% CI: 1.3 − 14.3). While asthma defined by PAC was not associated with KD, asthma defined by PAC positive with eosinophilia (≥4%) was significantly associated with the increased odds of KD (OR: 6.7; 95% CI: 1.6 − 28.6) compared to non-asthmatics. Asthma status defined by API was associated with KD (OR = 4.7; 95% CI: 1.4–15.1). Conclusions Atopic asthma may be associated with increased odds of KD. Further prospective studies are needed to determine biological mechanisms underlying the association between atopic asthma and increased odds of KD.

Acute upper gastrointestinal bleeding: a population-based, five-year follow-up study

Objective Data on long-term rebleeding risk and mortality in acute upper gastrointestinal bleeding (AUGIB) patients are scarce and comparison to controls are lacking. Aimsof the study were to assess long-term prognosis of AUGIB patients and compare to controls. Methods A population-based retrospective case-control study conducted at the National University Hospital of Iceland and included all patients who underwent endoscopy in 2010–2011. AUGIB was defined as haematemesis or coffee ground vomiting leading to hospitalization or occurring in a hospitalized patient. Controls underwent endoscopy in 2010–2011, matched for sex/age. Rebleeding was defined as AUGIB >14 days up to five years after index bleeding. Results Overall, 303 patients had AUGIB, mean age 67 (±18), controls66 years (±19), females, 51 and 46%, respectively. The five-year rebleeding rate for AUGIB patients was 13% (95%CI 9–17%), higher than the rate of bleeding events in controls, 3% (95%CI 1–5%; log-rank <0.001), hazard ratio (HR) 6.0 (95%CI 2.4–15) when correcting for comorbidities, NSAID’s, PPI’s and antithrombotics. The mortality of AUGIB patients at end of follow-up was higher when compared to controls, 39% (95%CI 49–33%) vs. 26% (95%CI 30–21%), log-rank <0.001, comorbidity-adjusted HR 1.4 (1.1–1.9). A subanalysis of non-variceal AUGIB yielded similar results in regard to rebleeding and mortality rates. Conclusions AUGIB patients were at 6-fold risk of rebleeding compared to bleeding events in controls at five years of follow-up. Five-year mortality was higher in AUGIB patients when compared to controls even when correcting for age and comorbidities, suggesting that an episode of AUGIB indicates serious frailty.

Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case-control study.

This study aimed to evaluate fetal adverse outcomes of laparoscopy and laparotomy in pregnant women to determine the safety of these surgical approaches. This was a retrospective nationwide case-control study of women who became pregnant for the first time between 2000 and 2012 in Taiwan. The case (with adverse fetal outcomes) and control groups comprised 208,604 and 417,124 participants, respectively. Participants who underwent appendectomy, cholecystectomy, ovarian cystectomy, or myomectomy were treated with either laparoscopy or laparotomy. A conditional logistic regression model was used to calculate the odds ratios (ORs) for adverse fetal outcomes. The laparotomy and laparoscopy groups comprised 632 and 536 patients, respectively. Women who underwent laparoscopy had a significantly higher risk of adverse fetal outcomes (adjusted OR [AOR] = 2.33; 95% CI 1.66-2.99) than those who underwent laparotomy. Adverse fetal outcomes were found to be significantly associated with laparoscopy among women aged 20-39years (AOR = 2.30; 95% CI 1.70-3.31). Regarding surgical indication, unlike laparotomy, laparoscopic cholecystectomy and appendectomy were not associated with adverse fetal outcomes. However, laparoscopic myomectomy and ovarian surgeries were associated with a higher incidence of adverse fetal outcomes than the laparotomy group (AOR = 2.29 [95% CI 1.57-3.35, p < 0.0001] and AOR = 2.52 [95% CI 1.58-4.04, p = 0.0001], respectively). Pregnant women who underwent laparoscopic surgery experienced significantly more adverse fetal outcomes than those who underwent laparotomy. Therefore, pregnant women undergoing either laparotomy or laparoscopy should be informed of the risk of adverse fetal outcomes.

Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long-term liver disease: A population-based study.

To describe outcome linked to neonatal cholestasis in a defined cohort of very preterm infants. Population-based retrospective case-control study of preterm infants, gestational age <30weeks, surviving for 28days, in Stockholm County. Cholestasis was defined as conjugated bilirubin ≥30μmol/L exceeding 20% of total level at least twice and graded as high if exceeding 100μmol/L. Cholestatic cases were matched on gestational week with two non-cholestatic controls. The incidence rate of cholestasis was 37/250 (14.8%), with increasing rates in lower gestational weeks. Perinatal factors associated with cholestasis were pre-eclampsia and being born small for gestational age. Cholestatic infants had three times more bronchopulmonary dysplasia and eight times more retinopathy of prematurity. The mortality was 13.5% in cholestatic infants versus 2.7% in controls (P=.040). All deceased cholestatic infants had high-grade cholestasis. No surviving infants developed chronic liver disease by 10years of age. Cholestasis was common in very preterm infants and linked to disease severity and adverse outcome. Cholestasis may be an independent risk factor for bronchopulmonary dysplasia and retinopathy of prematurity and more severe cholestasis associated with increased mortality. Cholestasis was not associated with chronic liver disease later in childhood.

369 Pregnancy outcomes in female patients with alopecia areata: A nationwide population based study in Korea

Alopecia areata (AA) is a common hair loss disorder characterized by an autoimmune reaction against hair follicles. Several autoimmune disorders are associated with adverse pregnancy outcomes, but the effect of AA on pregnancy outcome is unknown. To investigate pregnancy outcomes in female patients with AA, we performed a nationwide, population-based retrospective case-control study using the Korean National Health Insurance claims database from 2011 to 2017. The pregnancy outcomes of 4552 female patients with AA and 508,345 control subjects were analyzed.