Sex-specific Trends Research Articles

Sex-specific time trends of long-term graft survival after kidney transplantation – a registry-based study

Background Sex-specific trends over time with respect to kidney graft survival have scarcely been described in earlier studies. The present study aimed to examine whether kidney graft survival differs between women and men over time. Methods This study was based on prospectively collected data extracted from a quality registry including all kidney transplant patients between January 1965 and September 2017 at the transplantation center of a university hospital in Sweden. The transplantation center serves a population of approximately 3.5 million inhabitants. Only the first graft for each patient was included in the study resulting in 4698 transplantations from unique patients (37% women, 63% men). Patients were followed-up until graft failure, death, or the end of the study. Death-censored graft survival analysis after kidney transplantation (KT) was performed using Kaplan-Meier analysis with log-rank test, and analysis adjusted for confounders was performed using multivariable Cox regression analysis. Results Median age at transplantation was 48 years (quartiles 36–57 years) and was similar for women and men. Graft survival was analyzed separately in four transplantation periods that represented various immunosuppressive regimes (1965-1985, 1986–1995, 1996–2005, and 2006–2017). Sex differences in graft survival varied over time (sex-by-period interaction, p = 0.026). During the three first periods, there were no significant sex differences in graft survival. However, during the last period, women had shorter graft survival (p = 0.022, hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.1–2.7, adjusted for covariates). Biopsy-proven rejections were more common in women. Conclusions In this registry-based study, women had shorter graft survival than men during the last observation period (years 2006–2017).

Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation.

To investigate sex-specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018. The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy. We identified 229,565 patients with new-onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07-1.10) and 0.97 (0.96-0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women. This nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex-related disparities resolved over the course of the study period.

TCT-490 Sex-Specific Temporal Trends in Incidence and Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

TCT-490 Sex-Specific Temporal Trends in Incidence and Outcomes of Cardiogenic Shock in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

Suicide Among Asian American, Native Hawaiian, and Pacific Islander Veterans: Rates and Methods, 2005–2019

Knowledge of suicide rates and methods among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Veterans remains sparse. Age- and sex-specific suicide rates, methods, and trends were examined among AANHPI Veterans and were compared with findings reported for all Veterans. For this population-based retrospective cohort study, average annual suicide rates (2005-2019) were computed in 2023 using population (U.S. Veterans Eligibility Trends and Statistics) and mortality (National Death Index [NDI]) data. The cohort included 416,454 AANHPI Veterans (356,146 males, 60,229 females) separated from military service and alive as of 1/1/2005. Suicide was determined from NDI underlying cause-of-death ICD-10 codes. The age-adjusted average annual suicide rate among AANHPI Veterans increased 36.85% from 2005-2009 to 2015-2019 (2015-2019: 30.97/100,000). Relative to other ages, 2015-2019 suicide rates were highest among AANHPI Veterans 18-34 (overall: 53.52/100,000; males: 58.82/100,000; females: 32.24/100,000) and exceeded those of similarly aged Veterans in the overall Veteran population (overall: 44.71/100,000; males: 50.59/100,000; females: 19.24/100,000). The sex difference in suicide rates was lower among AANHPI Veterans than in Veterans overall (relative risk [males to females]=1.65 and 2.33, among those 18-54). Firearms were used less and suffocation more among AANHPI Veterans, relative to Veterans overall. Suicide among AANHPI Veterans is an increasing public health concern, with younger males and females at particularly elevated risk. Lethal means safety strategies for AANHPI Veterans should consider distinctions in suicide methods compared to the overall Veteran population. Research is warranted to understand the lower magnitude sex difference in suicide rates among AANHPI Veterans.

#3892 AGE-RELATED TRAJECTORY PATTERN OF HANDGRIP STRENGTH AND MORTALITY IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims Muscle weakness is a factor known to worsen prognosis in patients on hemodialysis [1], and the prevention of muscle weakness is extremely important in disease management. In particular, understanding age-related changes in muscle strength can be advantageous for long-term interventions. A previous study on community-dwelling older adults examined sex-specific age trends in muscle strength in order to identify potential trajectory patterns, and it showed that muscle strength tended to display similar age-related changes later in life regardless of the baseline level. Additionally, individuals in the low trajectory group had a higher mortality risk than did the high trajectory group [2]. However, reports examining longitudinal trajectories of muscle strength in patients on hemodialysis are limited, and their association with life prognosis remains unclear. Therefore, this study aimed to identify sex-specific aging patterns of handgrip strength as an indicator of muscle strength in patients on hemodialysis and to further investigate their association with life prognosis. Method Patients on hemodialysis with a minimum of two available measurements of handgrip strength between the years 2002 and 2022 were analyzed. In total, 544 patients (age: 65.1±11.9 years, 59.5% male, total observation data: 2,499) were enrolled in this study. Aging patterns of handgrip strength were classified by sex using group-based semiparametric mixture modeling. The association between typed aging patterns of handgrip strength and all-cause mortality was examined using Cox regression analysis after adjusting for the baseline age, body mass index, dialysis history, comorbidity index score, and hemoglobin and albumin levels. The statistical significance level was set at 5%. Results Age-related trajectory patterns of handgrip strength in men and women were categorized into three groups, low, middle, and high, as shown in Fig. 1. All three groups showed an age-related decline. The “low group” showed a reduction in handgrip strength (<28 kg for men and <18 kg for women) from baseline and continued to decline thereafter. The “middle group” did not show any decline at baseline, but decline was noted after 65 years of age. The “high group” displayed a decline in handgrip strength after 80 years of age, despite high handgrip strength at baseline. 23.9%, 60.1%, and 16.0% for men and 30.1%, 46.3%, and 23.7% for women were assigned to the low, middle, and high groups, respectively. When the high group was used as the reference group, the low groups showed a significantly higher mortality risk after adjusting for confounders in both men and women (men; p = 0.03, women; p<0.001). Conclusion In patients on hemodialysis, age-related decline of handgrip strength was observed in both men and women, regardless of baseline values. Among the three patterns of decline, the low group had a higher mortality rate compared to the high group in both men and women. The results suggest that even if decline in muscle weakness over time can be expected, handgrip strength needs to be improved in order to improve life prognosis.

Strength-training and balance activities in Canada: historical trends and current prevalence.

Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000-2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000-2014) in adherence to recommendations. Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000-2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression. Youth aged 12 to 17 years (56.6%, 95% CI: 52.4-60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1-56.8) had significantly greater adherence to the muscle/ bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9-44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014. Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation.

Rising Incidence of Non-Cardia Gastric Cancer among Young Women in the United States, 2000-2018: A Time-Trend Analysis Using the USCS Database.

Although the global incidence of non-cardia gastric cancer (NCGC) is decreasing, there are limited data on sex-specific incidence in the United States. This study aimed to investigate time trends of NCGC from the SEER database to externally validate findings in a SEER-independent national database, and to further assess trends among subpopulations. Age-adjusted incidence rates of NCGC were obtained from the SEER database from 2000 to 2018. We used joinpoint models to calculate average annual percentage change (AAPC) to determine sex-specific trends among older (≥55 years) and younger adults (15-54 years). Using the same methodology, findings were then externally validated using SEER-independent data from the National Program of Cancer Registries (NPCR). Stratified analyses by race, histopathology, and staging at diagnosis were also conducted in younger adults. Overall, there were 169,828 diagnoses of NCGC from both independent databases during the period 2000-2018. In SEER, among those <55 years, incidence increased at a higher rate in women (AAPC = 3.22%, p < 0.01) than men (AAPC = 1.51%, p = 0.03), with non-parallel trends (p = 0.02), while a decreasing trend was seen in both men (AAPC = -2.16%, p < 0.01) and women (AAPC = -1.37%, p < 0.01) of the ≥55 years group. Validation analysis of the SEER-independent NPCR database from 2001 to 2018 showed similar findings. Further stratified analyses showed that incidence is disproportionately increasing in young non-Hispanic White women [AAPC = 2.28%, p < 0.01] while remaining stable in their counterpart men [AAPC = 0.58%, p = 0.24] with non-parallel trends (p = 0.04). This pattern was not observed in other race groups. NCGC incidence has been increasing at a greater rate in younger women compared to counterpart men. This disproportionate increase was mainly seen in young non-Hispanic White women. Future studies should investigate the etiologies of these trends.

Evolutionary history drives the geographical distribution of dorsal patterns in the common wall lizard (Podarcis muralis)

Abstract Melanin-based dorsal pattern polymorphisms are common in reptiles and generally evolve under the interaction between opposite selective pressures, notably thermal advantage in cold environments and background matching to avoid predation. When those pressures change over space and time, the relative frequencies of morphs can vary across the species range. However, no previous study has analysed the spatial patterns of variation of morphs under a phylogenetic perspective in addition to the adaptive responses to natural selection. In this study, we focused on the distributional patterns of the three dorsal morphs of Podarcis muralis at wide-range scale to assess how they associate with geography, climate, microhabitat, phylogeny and sexual dimorphism. By using open access data from iNaturalist, we assembled a dataset of 4096 georeferenced points with information on sex and morph. Data were analysed through Bayesian GLMs, and four alternative models were formulated depending on the specific factors affecting morphs’ frequency. The dorsal morphs are not randomly distributed in Europe, but follow clear geographic patterns, vary with altitude and habitats, show sex-specific trends, and correlate with the phylogenetic history of the species. When comparing models, the phylogenetic model always obtained the best performance, and no overlap with other models occurred, thus best explaining the distributional patterns of dorsal morphs. The evolutionary processes, in addition to present environmental pressures, can significantly affect local-scale microevolutionary adaptations, influencing the current distribution of dorsal phenotypes across the species range. More generally, results point out the importance of considering the evolutionary processes when analysing distributional patterns of polymorphisms.

Spatio-Temporal Trends in the Incidence of Type 2 Diabetes in Germany.

There are no data on recent trends in the incidence rate of type 2 diabetes (T2D) in Germany. The aim of this study was to determine the sex-, age-, and region-specific trends in the T2D incidence rate between 2014 and 2019. Based on nationwide data from statutorily insured persons in Germany, negative binomial regression models were used to analyze age- and sex-specific trends in the T2D incidence rate. Age- and sex-adjusted trends were calculated for 401 administrative districts using a Bayesian spatio-temporal regression model. During the period concerned, approximately 450 000 new cases of T2D were observed each year among some 63 million persons. Taking all age groups together, the incidence rate decreased in both women and men, from 6.9 (95% confidence interval [6.7; 7.0]) and 8.4 [8.2; 8.6] respectively per 1000 persons in 2014 to 6.1 [5.9; 6.3] and 7.7 [7.5; 8.0] per 1000 persons in 2019. This corresponds to an annual reduction of 2.4% [1.5; 3.2] for women and 1.7% [0.8; 2.5] for men. The incidence rate increased in the age group 20-39 years. The age- and sex-adjusted incidence rate decreased in almost all districts, although regional differences persisted. The T2D incidence rate should be closely monitored to see whether the decreasing trend continues. One must not forget that the prevalence can rise despite decreasing incidence. For this reason, the findings do not necessarily mean a decrease in the disease burden of T2D and the associated demand on healthcare resources.

Tromsø Study: Northern Lights of Sex-specific Time Trends in Incident Atrial Fibrillation.

We have read the research paper entitled ‘Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994–2016’ by Sharashova E. et al.1 Here, we would like to draw your attention to a few points of the study. In the Tromsø Study, it has been indicated that atrial fibrillation (AF) incidence decreased in women and increased following a reverse U-shape in men between 1994 and 2016. Reduction in blood pressure had the largest contribution to the decrease in AF incidence in women, and increase in body mass index (BMI) had the largest contribution to the increase in AF incidence in men. Body mass index increase in women had almost no effect on the AF incidence trend. On the other hand, increase in BMI in men doubled AF incidence rate and obesity is recognized as an independent risk factor for the incidence and progression of AF. The study named ‘Obesity and the risk of new-onset atrial fibrillation’ revealed that in multivariable models adjusted for cardiovascular risk factors, a 4% increase in AF risk per 1-unit increase in BMI was observed both in men and in women.2 In the study, the maximum difference between the mean BMI in males was 1.2 kg/m2. So, it is doubtful to explain the two-fold increase in AF incidence in males by associating it with increase in BMI alone. The Women’s Health Study, which included 34 309 women, revealed that for each 1 kg/m2 increase in BMI, there is a 4.7% increase in the risk of developing AF.3 However, in the Tromsø Study, BMI increase in women had almost no effect on the AF incidence trend. The fact that the increase in BMI led to different results between male and female groups suggests that other factors may be effective.

Implementation of risk enhancers in ASCVD risk estimation and hypolipidemic treatment eligibility: A sex-specific analysis

ObjectiveSex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high-sensitivity C-reactive protein (hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention of atherosclerotic cardiovascular disease (ASCVD). MethodsWe aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n = 698, 50.9% women and Menopause Clinic n = 373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2 (SCORE2) tools. The presence of carotid plaque and hsCRP ≥2 mg/L were integrated as risk modifiers. ResultsMen had increased odds to achieve target LDL-C levels based on ASCVD risk (23.8% vs. 17.7%, OR: 1.45 95% CI: 1.05–2.00, p = 0.023, for men vs. women). Additionally, considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation (11.5% vs. 26.4%, p < 0.001) compared with men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in a higher relative increase in hypolipidemic treatment eligibility in women (from 11.5% to 70.9% vs. 26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs. 26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs. 26.4% to 75% for their combination, all for women vs. men, pforinteraction < 0.001 for all) than men. ConclusionsImplementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than in men. The impact on clinical outcomes in these untreated patients merits further investigation.

Abstract 82: Sex Differences In Recurrent Stroke: Twenty-Year Trends From A Population-Based Study

The growing number of stroke survivors in the US, especially among women, makes understanding sex-specific trends in recurrent strokes crucial. Yet, such data are rare. We estimated 20-year sex-specific trends in recurrence in a population-based stroke study. Methods: We included first-ever ischemic strokes (IS) ascertained between January 1, 2000 and December 31, 2019 from the Brain Attack Surveillance in Corpus Christi (BASIC) Project in South Texas. Time to recurrence was calculated from first-ever IS to recurrence, death, or December 31, 2019, whichever came first. We estimated the cumulative incidence function (CIF) of recurrence by a multivariable Fine-Gray subdistribution hazard model, which accounted for the competing risk of death. An interaction term between calendar year and sex was used to generate 1-year and 5-year sex-specific trends in risks of recurrence between 2000-2019 from the fitted CIF. Results: Among the 5,752 IS (median age 69, 49.9% women), 786 (13.7%) had recurrences over a median of 7.6 years of follow-up and 2,653 (46.1%) died over a median of 3.7 years of follow-up. Women had significantly higher adjusted 1-year and 5-year risks of recurrence than men in 2000 (Figure). One-year and 5-year risk of recurrence declined in both sexes over time but women experienced larger declines such that the risks were similar between both sexes around 2009 but higher among men after that. The largest sex difference in recurrence was in the 5-year risk in 2000 with women having 5.0% (1.5%-8.4%) higher risk. Conclusions: The welcoming trends in recurrent strokes suggest successful secondary stroke prevention, especially in women, where greater declines were noted.

Triglyceride-Glucose Index as a Potential Indicator of Sarcopenic Obesity in Older People.

This population-based cross-sectional study aimed to determine whether the triglyceride-glucose index (TyG index) is associated with sarcopenic obesity (SO) and whether it would be a helpful indicator of SO. A total of 3821 participants aged ≥ 60 years were selected for the study group, and 4919 participants aged 20-39 years were included as a reference group. The participants were allocated to sarcopenia, obesity, and SO groups depending on if their body mass index (BMI) was ≥25 kg/m2 and their sarcopenia index was ≤1 standard deviation (SD) lower than the mean of the reference group. The sex-specific differences and trends among the participants were analyzed by using the TyG index tertiles, and appropriate cut-off values of the TyG index for SO were calculated. As the TyG index increased, BMI increased, but the sarcopenia index decreased in both sexes. Males and females in the middle and highest tertiles of the TyG index were 1.775 and 3.369, and they were 1.993 and 3.157 times more likely to have SO, respectively. The cut-off values of the TyG index for SO in males and females were ≥8.72 and 8.67, respectively. A high TyG index is positively associated with SO, and the TyG index may be considered a potential indicator of SO.

Temporal trends in mortality and provision of intensive care in younger women and men with acute myocardial infarction or stroke

BackgroundTimely management of acute myocardial infarction (AMI) and acute stroke has undergone impressive progress during the last decade. However, it is currently unknown whether both sexes have profited equally from improved strategies. We sought to analyze sex-specific temporal trends in intensive care unit (ICU) admission and mortality in younger patients presenting with AMI or stroke in Switzerland.MethodsRetrospective analysis of temporal trends in 16,954 younger patients aged 18 to ≤ 52 years with AMI or acute stroke admitted to Swiss ICUs between 01/2008 and 12/2019.ResultsOver a period of 12 years, ICU admissions for AMI decreased more in women than in men (− 6.4% in women versus − 4.5% in men, p < 0.001), while ICU mortality for AMI significantly increased in women (OR 1.2 [1.10–1.30], p = 0.032), but remained unchanged in men (OR 0.99 [0.94–1.03], p = 0.71). In stroke patients, ICU admission rates increased between 3.6 and 4.1% per year in both sexes, while ICU mortality tended to decrease only in women (OR 0.91 [0.85–0.95, p = 0.057], but remained essentially unaltered in men (OR 0.99 [0.94–1.03], p = 0.75). Interventions aimed at restoring tissue perfusion were more often performed in men with AMI, while no sex difference was noted in neurovascular interventions. ConclusionSex and gender disparities in disease management and outcomes persist in the era of modern interventional neurology and cardiology with opposite trends observed in younger stroke and AMI patients admitted to intensive care. Although our study has several limitations, our data suggest that management and selection criteria for ICU admission, particularly in younger women with AMI, should be carefully reassessed.Graphical

The reference intervals for thyroid hormones: A four year investigation in Chinese population.

The reference intervals (RIs) are of great importance for physicans to determine whether or not an individual is healthy. However, many clinical laboratories in China still adopted the default RI provided by the manufacturers; and these "uncalibrated" RIs might lead to the misdiagnosis of diseases. In the present study, we enroll reference people with the purpose of determining the RIs of serum triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in Chinese population, and explore the possible roles of age and sex on the levels of biomarkers. Serum samples from 66,609 individuals who met the inclusion criteria were analyzed using an Roche Cobas E 601 hormone analyzer. The dynamic trends of biomarker were visually assessed by their concentrations over age and sex. Specific partitions were determined by the method of Harris and Boyd. RIs, corresponding to the 2.5th and 97.5th percentiles, as well as the 0.5th, 25th, 50th, 75th and 99.5th percentiles were calculated for each reference partition using a non-parametric rank approach. The serum level of T3, T4, FT4 or TSH showed a right-skewed distribution in both males and females while FT3 presented an approximate normal distribution. Females had a higher mode value of serum T3 or T4, but a lower mode value of serum TSH, FT3 or FT4. All five biomarkers did not need age partitioning according to the approach of harris and boyd, while T3 and FT3 need sex partitioning. The present study not only determined the age- and sex-specific trends of the five thyroid hormones, but provided sex-stratified RIs for T3 and FT3, valuably contributing to the current literature and timely evaluation of thyroid health and disease.

Age- and Sex-Specific Trends in Medical Complications After Acute Ischemic Stroke in the United States.

To test the hypothesis that the age and sex-specific prevalence of infectious (pneumonia, sepsis, and urinary tract infection [UTI]) and noninfectious (deep venous thrombosis [DVT], pulmonary embolism [PE], acute renal failure [ARF], acute myocardial infarction [AMI], and gastrointestinal bleeding [GIB]) complications increased after acute ischemic stroke (AIS) hospitalization in the United States from 2007 to 2019. We conducted a serial cross-sectional study using the 2007-2019 National Inpatient Sample. Primary AIS admissions in adults (aged 18 years or older) with and without complications were identified using International Classification of Diseases codes. We quantified the age/sex-specific prevalence of complications and used negative binomial regression models to evaluate trends over time. Of 5,751,601 weighted admissions, 51.4% were women. 25.1% had at least 1 complication. UTI (11.8%), ARF (10.1%), pneumonia (3.2%), and AMI (2.5%) were the most common complications, while sepsis (1.7%), GIB (1.1%), DVT (1.2%), and PE (0.5%) were the least prevalent. Marked disparity in complication risk existed by age/sex (UTI: men 18-39 years 2.1%; women 80 years or older 22.5%). Prevalence of UTI (12.9%-9.7%) and pneumonia (3.8%-2.7%) declined, but that of ARF increased by ≈3-fold (4.8%-14%) over the period 2007-2019 (all p < 0.001). AMI (1.9%-3.1%), DVT (1.0%-1.4%), and PE (0.3%-0.8%) prevalence also increased (p < 0.001), but that of sepsis and GIB remained unchanged over time. After multivariable adjustment, risk of all complications increased with increasing NIH Stroke Scale (pneumonia: prevalence rate ratio [PRR] 1.03, 95% CI 1.03-1.04, for each unit increase), but IV thrombolysis was associated with a reduced risk of all complications (pneumonia: PRR 0.80, 85% CI 0.73-0.88; AMI: PRR 0.85, 95% CI 0.78-0.92; and DVT PRR 0.87, 95% CI 0.78-0.98). Mechanical thrombectomy was associated with a reduced risk of UTI, sepsis, and ARF, but DVT and PE were more prevalent in MT hospitalizations compared with those without. All complications except UTI were associated with an increased risk of in-hospital mortality (sepsis: PRR 1.97, 95% CI 1.78-2.19). Infectious complications declined, but noninfectious complications increased after AIS admissions in the United States in the last decade. Utilization of IV thrombolysis is associated with a reduced risk of all complications.

Identifying age- and sex-specific COVID-19 mortality trends over time in six countries

ObjectivesThe COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. MethodsWe focus on five European countries and the United States. Using standardized and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, and demographic characteristics and seasonality patterns. ResultsOur results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analyzed but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared with women, men have higher COVID-19 mortality rates at most ages and in most seasons. ConclusionThere is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having targeted those ages specifically.

Abstract 15511: Sex-Specific Trends in Obesity-Attributable Atrial Fibrillation in the United States

Introduction: The prevalence of atrial fibrillation (AF) has significantly increased in the United States over the past 2 decades. Obesity is a major risk factor for AF, and the association between obesity and AF may vary by sex. We sought to investigate sex-specific trends in obesity-attributable AF in the US Methods: We used data from the 2019 Global Burden of Disease Study to determine changes in age-standardized AF disability-adjusted life years (DALYs) and mortality in the US between 1990 and 2019. We examined the trends in the contribution of obesity to AF mortality and DALYs by sex. Results: Between 1990 and 2019, age-standardized AF DALYs increased by 13% in males (181 to 205 per 100K) and by 15% in females (110 to 126 per 100K). Age-adjusted AF mortality increased by 22% in males (4.9 to 6.0 per 100K) and by 26% in females (3.5 to 4.4 per 100K). Overall, obesity contributed to higher percentage of AF in females compared with males. Between 1990 and 2019, the percentage of obesity-attributed AF DALYs increased in females (27% to 34%) and males (21% to 31%). The percentage of obesity-attributed AF deaths increased both in females (25% to 32%) and males (18% to 28%) between 1990 and 2019, figure. Conclusion: AF morbidity and mortality showed a disproportionate increase among females compared with males in the US over the past 3 decades. Obesity disproportionately contributes to AF morbidity and mortality among females compared with males.

Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016.

To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.

Worldwide trends in mortality related to Parkinson's disease in the period of 1994-2019: Analysis of vital registration data from the WHO Mortality Database.

BackgroundMortality due to Parkinson's disease (PD) and its long-term trends worldwide in recent decades remain unknown. No previous studies have simultaneously studied age- and sex-specific mortality trends at a population level worldwide. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing Parkinson's disease globally.ObjectivesThe aim of the study was to examine trends in mortality from Parkinson's disease by age-group and sex across countries all over the world. In this study, we used worldwide registry data to examine the temporal trends in PD mortality across most counties of the world from 1994 to 2019 using joinpoint regression.ResultsIn data from vital registration systems, huge variations in the patterns of deaths due to Parkinson's disease were observed both over time and between countries. Between 1994 and 2019, there was a significant increase in mortality rates globally in both men and women. In more detail, the mortality rate (per 100,000) in 1994 was 1.76 and reached 5.67 in 2019. Greater increases in mortality were seen in men than in women; and in older than in younger people.ConclusionsThere has been a striking rising trend in Parkinson's disease mortality globally. Persistent age and sex disparities are found in Parkinson's disease mortality trends. Our findings may have important implications for future research, healthcare planning, and provision.