Sex-standardized Incidence Rates Research Articles

Risk of cardiac rhythm disturbances and aortic regurgitation in different spondyloarthritis subtypes in comparison with general population: a register-based study from Sweden

ObjectivesTo describe the incidence of atrioventricular (AV) block II–III, atrial fibrillation (AF), pacemaker implantation (PM) and aortic regurgitation in patients with ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA) and psoriatic arthritis...

Regional differences in the incidence of tuberculosis among patients with newly diagnosed diabetes mellitus.

There are regional differences in the burden of tuberculosis (TB). Although these differences might be explained by regional differences in the risk factors of TB, whether such risk factors are actually associated with the regional differences in the TB burden remains unclear. This study aimed to investigate the relationship between the risk factors of and regional differences in TB incidence. A cohort study applying nationwide claims database in Republic of Korea included patients newly diagnosed with type 2 diabetes mellitus (DM) in 2009. The main outcome was the incidence of TB defined based on the diagnostic codes combined with anti-tuberculosis treatment repeated within 90 days. Sixteen regions were categorized into 3 groups according to the age- and sex-standardized TB incidence rates. Multivariate logistic regression analysis adjusted for risk factors was performed to identify the determinants of the regional differences in TB incidence. Among 331601 participants newly diagnosed with type 2 DM and with no history of previous TB, 1216 TB cases were observed. The regional TB incidence rates ranged between 2.3 and 5.9/1000 patients. Multivariate analyses did not identify any determinants of regional differences in the TB incidence among the various risk factors, including age, sex, health care utilization, co-morbidities, medication and treatment and complications of DM. Similarly, temperature, humidity and latent TB infection rate also did not affect the results. Although substantial regional differences in the TB incidence rate were observed among patients with newly diagnosed DM, no determinants of regional difference were identified among the risk factors.

Incidence and relative risk of stroke in the diabetic and the non-diabetic population between 1998 and 2014: A community-based stroke register.

One major objective of the St. Vincent Declaration was to reduce excess risk of stroke in people with diabetes mellitus. The aim of this study is to estimate the trend of incidence and relative risk of stroke in the diabetic and the non-diabetic populations in Germany over a 17-year period. We estimated age–sex standardised incidence rates of all stroke and ischaemic stroke in people with and without diabetes based on an ongoing prospective community-based stroke register covering 105,000 inhabitants. Time trends were analysed using Poisson regression. In total, 3,111 individuals (diabetes: 28.4%, men 46.9%, mean age 73.1 years (SD 13.2)) had a first stroke, 84.9% of which were ischaemic stroke. Among people with diabetes we observed a significant reduction in all stroke incidence by 1.5% per year (relative risk: 0.985; 95% confidence interval 0.972–0.9995) Likewise, this incidence tended to decrease for ischaemic stroke by 1% per year (0.993; 0.979–1.008). In contrast, the incidence rate for all stroke remained nearly stable among people without diabetes (1.003; 0.993–1.013) and for ischaemic stroke (1.002; 0.991–1.013). The relative risk comparing diabetic and non-diabetic population decreased for all stroke (two percent annual reduction) but not for ischaemic stroke. Time trends were similar for both sexes regarding all and ischaemic strokes. We found a reduction in risk of stroke in the diabetic population while this rate did not materially change in the non-diabetic population.

Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease: A Population-Based Inception and Birth Cohort Study

Objectives:To determine the association between inflammatory bowel disease (IBD) and rural/urban household at the time of diagnosis, or within the first 5 years (y) of life.Methods:Population-based cohorts of residents of four Canadian provinces were created using health administrative data. Rural/urban status was derived from postal codes based on population density and distance to metropolitan areas. Validated algorithms identified all incident IBD cases from administrative data (Alberta: 1999–2008, Manitoba and Ontario: 1999–2010, and Nova Scotia: 2000–2008). We determined sex-standardized incidence (per 100,000 patient-years) and incident rate ratios (IRR) using Poisson regression. A birth cohort was created of children in whom full administrative data were available from birth (Alberta 1996–2010, Manitoba 1988–2010, and Ontario 1991–2010). IRR was calculated for residents who lived continuously in rural/urban households during each of the first 5 years of life.Results:There were 6,662 rural residents and 38,905 urban residents with IBD. Incidence of IBD per 100,000 was 33.16 (95% CI 27.24–39.08) in urban residents, and 30.72 (95% CI 23.81–37.64) in rural residents (IRR 0.90, 95% CI 0.81–0.99). The protective association was strongest in children <10 years (IRR 0.58, 95% CI 0.43–0.73) and 10–17.9 years (IRR 0.72, 95% CI 0.64–0.81). In the birth cohort, comprising 331 rural and 2,302 urban residents, rurality in the first 1–5 years of life was associated with lower risk of IBD (IRR 0.75–0.78).Conclusions:People living in rural households had lower risk of developing IBD. This association is strongest in young children and adolescents, and in children exposed to the rural environment early in life.

Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States: A Cohort Study.

Clostridium difficile infection (CDI), the most common health care-associated infection, often recurs. Fecal microbiota transplantation is increasingly used to treat multiply recurrent CDI (mrCDI). To determine whether the incidence of mrCDI is increasing in proportion to CDI and to identify risk factors for mrCDI. Retrospective cohort study. United States. 38911718 commercially insured patients in the OptumInsight Clinformatics Database, of whom 45341 developed CDI. Age- and sex-standardized incidence rates for CDI and mrCDI. From 2001 to 2012, the annual incidence of CDI and mrCDI per 1000 person-years increased by 42.7% (from 0.4408 to 0.6289 case) and 188.8% (from 0.0107 to 0.0309 case), respectively. The increase in mrCDI incidence was independent of known risk factors for CDI. Those who developed mrCDI were older (median age, 56.0 vs. 49.0 years; adjusted odds ratio [aOR] per 10-year increase in age, 1.25 [95% CI, 1.21 to 1.29]) and were more likely to be female (63.8% vs. 58.7%; aOR, 1.24 [CI, 1.11 to 1.38]) and to have used antibiotics (72.3% vs. 58.8%; aOR, 1.79 [CI, 1.59 to 2.01]), proton-pump inhibitors (24.6% vs. 18.2%; aOR, 1.14 [CI, 1.01 to 1.29]), or corticosteroids (18.3% vs. 13.7%; aOR, 1.15 [CI, 1.00 to 1.32]) within 90 days of CDI diagnosis. Chronic kidney disease (10.4% vs. 5.6%; aOR, 1.49 [CI, 1.24 to 1.80]) and diagnosis in a nursing home (2.1% vs. 0.6%; aOR, 1.99 [CI, 1.34 to 2.93]) were also associated with increased risk for mrCDI. The primary analyses included only commercially insured patients in the United States. Relative to CDI, mrCDI incidence has disproportionately increased, indicating a rising demand for mrCDI therapies. National Institute of Diabetes and Digestive and Kidney Diseases and National Institute of Allergy and Infectious Diseases.

Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study

BackgroundTo investigate the risk of first-time acute coronary syndrome (ACS), stroke and venous thromboembolism (VTE) in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated spondyloarthritis (uSpA), compared to each other and to the general population (GP).MethodsThis is a prospective nationwide cohort study. Cohorts with AS (n = 6448), PsA (n = 16,063) and uSpA (n = 5190) patients and a GP (n = 266,435) cohort, were identified 2001–2009 in the Swedish National Patient and Population registers. The follow-up began 1 January 2006, or 6 months after the first registered spondyloarthritis (SpA) diagnosis thereafter, and ended at ACS/stroke/VTE event, death, emigration or 31 December 2012. Crude and age- and sex-standardized incidence rates (SIRs) and hazard ratios (HRs) were calculated for incident ACS, stroke or VTE, respectively.ResultsStandardized to the GP cohort, SIRs for ACS were 4.3, 5.4 and 4.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort, respectively, compared to 3.2 in the GP cohort. SIRs for stroke were 5.4, 5.9 and 5.7 events per 1000 person-years at risk in the AS, PsA and uSpA cohort compared to 4.7 in the GP cohort. Corresponding SIRs for VTE were 3.6, 3.2 and 3.5 events per 1000 person-years at risk compared to 2.2 in the GP cohort. Age-and sex-adjusted HRs (95% CI) for ACS events were significantly increased in AS (1.54 (1.31–1.82)), PsA (1.76 (1.59–1.95)) and uSpA (1.36 (1.05–1.76)) compared to GP. Age-adjusted HRs for ACS was significantly decreased in female AS patients (0.59 (0.37–0.97)) compared to female PsA patients. Age-and sex-adjusted HRs for stroke events were significantly increased in AS (1.25 (1.06–1.48)) and PsA (1.34 (1.22–1.48)), and nonsignificantly increased in uSpA (1.16 (0.91–1.47)) compared to GP. For VTE the age-and sex-adjusted HRs for AS, PsA and uSpA were equally and significantly increased with about 50% compared to GP.ConclusionsPatients with AS, PsA and uSpA are at increased risk for ACS and stroke events, which emphasizes the importance of identification of and intervention against cardiovascular risk factors in SpA patients. Increased alertness for VTE is warranted in patients with SpA.

Prevalence and Incidence of Diagnosed Chronic Rhinosinusitis in Alberta, Canada

Reported prevalence rates of chronic rhinosinusitis (CRS) range from 1% to 12% worldwide. To facilitate appropriate health service delivery and resource allocation, it is important to improve the estimated burden of CRS to the health care system. To assess the prevalence and incidence of diagnosed CRS in Alberta, Canada, from the perspective of the health care system and to evaluate the 10-year temporal trend and geographic variation of diagnosed CRS. From provincial-wide physicians' claim data, a CRS cohort was identified using a validated case definition. The population at the midpoint (2008-2009) of the study period (2 925 930) was used as the reference. The crude as well as age- and sex-standardized incidence and prevalence rates were calculated. The age-specific incidence and prevalence by sex were also assessed in each study year. Small-area variation analysis was conducted using extremal quotient, weighted coefficient of variation, χ2 statistic, systematic component of variation, and empirical Bayes variance estimate. Of the 2 925 930 individuals in the study at midpoint (2008-2009), 1 451 261 (49.6%) were women, and the mean (SD) age was 45 (17) years. From fiscal year 2004-2005 to fiscal year 2013-2014, the mean age- and sex-standardized incidence of diagnosed CRS was 2.5 (range, 2.3-2.7) per 1000 population. The estimated prevalence based on age-specific incidence varied between 18.8 (95% CI, 18.7-18.9) and 23.3 (95% CI, 23.1-23.5) per 1000 population during 2004-2005 to 2013-2014, and no obvious growing trend was found. There was high geographic variation in the diagnosed incidence and prevalence of CRS (mean systematic component of variation, 19.4 and 12.3, respectively). Although the incidence and prevalence rates of diagnosed CRS were lower compared with earlier published estimates obtained from population-based survey analysis, outcomes from this study may more accurately reflect the disease burden of CRS to the health care system. Given that the prevalence of CRS within a single province is expected to be uniformly distributed, the large geographic variation in diagnosed CRS indicates a potential gap in quality of care and justifies further investigation into the reasons for the variation.

Risk for malignancy in rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs compared to the general population: A nationwide cohort study in Japan

Objectives: To investigate and compare the risk for malignancy in rheumatoid arthritis (RA) patients treated with biologics in Japan to the general population.Methods: Data for 14,440 patients from 335 institutions who were given infliximab, etanercept, adalimumab, golimumab, tocilizumab, or abatacept were retrieved from the SafEty of biologics in Clinical Use in Japanese patients with RhEumatoid arthritis (SECURE) database.Results: We identified 333 incidents of malignancies in 320 patients during 49,320 patient-years (PY). The age- and sex-standardized incidence rate (ASR) (95% confidence interval [CI]) for overall malignancy of the SECURE cohort was 313.9/105 PY (271.4–361.3), and the standardized incidence rate ratio (SIR) (95% CI) was 0.745 (0.667–0.826). The ASR was decreased compared to the estimated incidence rate of malignancies in the Japanese general population (462.4/105 PY). The SIRs for site-specific nonhematopoietic malignancies of the SECURE cohort were not significantly elevated compared to the Japanese general population. A significant increase of SIR for malignant lymphoma (6.183, 95% CI, 4.809–7.643) was found in the SECURE cohort, similar to or slightly higher than the SIR previously reported from Japanese cohorts for RA patients.Conclusions: Continued vigilance with larger numbers of patients, longer observation periods, and inclusion of different biologics are recommended.

Incidence of childhood-onset type 1 diabetes in Biscay, Spain, 1990-2013.

To identify the incidence rate (IR) and epidemiologic trends of childhood type 1 diabetes mellitus (T1DM) in children aged 0 to 14-yr-old from 1990 to 2013, in the north of Spain (Biscay). A prospective-retrospective study was performed. Capture-recapture method was used: primary cases were ascertained from hospital register and a secondary independent data source was obtained from diabetes associations and public health plan database. Age and sex-standardized incidence rates were calculated using direct method, assuming an equal distribution in each age/sex group. In order to identify and analyse trends the period studied was divided into two (1990-2001 and 2002-2013) 11-year periods. The 95% confidence interval (CI) was estimated assuming the Poisson distribution. A total of 399 new cases were identified throughout the study. Mean age at diagnosis was 8.9 ± 3.7 yr. Completeness of ascertainment was 99.1%. Mean annual age-standardized IR was 10.7 (95% CI: 9.6-11.7). The mean incidence for the 0-4, 5-9 and 10-14 age groups was 5.1, 14.6 and 13.2 per 100,000 children/yr, respectively. The incidence rate trend in the whole group was not statistically significant. In the 10-14 age group we found a yearly average increase (2.5% [CI 95% 0.4-4.6]; P < 0.05) and analysing by sex, this statistically significant incidence trend was observed only in boys. We did not find a seasonal onset pattern. The IR did not increase in this population during the period studied unlike the results in other Spanish regions and European Countries.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

ASSOCIATION BETWEEN PRIMARY PREVENTION INDICATORS AND REGIONAL VARIATIONS IN THE INCIDENCE OF MAJOR CARDIOVASCULAR EVENTS: THE CANHEART STUDY

The burden of cardiovascular disease varies across Canada but it is unknown whether variations in health system performance are associated with these differences. As part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) ‘big data’ initiative, we studied the association between several modifiable primary prevention indicators and the incidence of major cardiovascular events across Ontario, Canada. We constructed a population-based cohort of 5.9 million primary prevention patients aged 40 to 105 in Ontario as of January 1, 2008, by linking together information from multiple population-based databases (health survey, physician billing, hospital discharge, electronic medical record, laboratory, and vital statistics; see www.canheart.ca). A set of primary prevention indicators (family doctor visits, risk factor screening, prevalence, management, and control) and the 3-year age and sex-standardized incidence rate of major cardiovascular disease events (i.e. myocardial infarction, stroke, cardiovascular death) were measured between January 1, 2008 and December 31, 2010 across Ontario’s 14 health service regions, known as Local Health Integration Networks (LHINs). Pearson correlation coefficients and p-values were calculated for the association of each indicator with the incidence of CVD events. The age and sex-standardized incidence rate of major cardiovascular events varied nearly 2-fold from a low of 4.3 (95% CI 4.2 to 4.4) events per 1000-person years in the Central LHIN to a high of 7.5 events per 1000 person-years in the North East (95% CI 7.3 to 7.7) and North West LHINs (95% CI 7.2 to 7.8).(Table and Figure) Residents living in lower CVD risk regions had a higher mean number of family doctor visits/year (p=0.004), a greater likelihood of receiving lipid and diabetes screening as recommended in Canadian practice guidelines (p<0.001), and higher blood pressure control rates among hypertensive patients (p=0.005). Higher smoking rates were found in regions with higher CVD event rates (p<0.001) but rates of formal smoking cessation counselling provided by family doctors were not associated with CVD event rates (p=0.261). The proportion of patients aged 65 and over prescribed statins (p=0.341) and glycemic control rates (HbA1c ≤7%) among diabetics (p=0.348) were not associated with regional variations in CVD event rates. Residents of Ontario’s health regions with the lowest incidence of CVD events had more family doctors visits each year, were more likely to be screened for dyslipidemia and diabetes, and had more hypertensive patients with controlled blood pressures. Opportunities exist across Ontario to further improve the prevention of CVD events.View Large Image Figure ViewerDownload (PPT)

Gastric cancer incidence in the Romagna Region of Italy: A spatial and temporal analysis

BackgroundThe worldwide decrease in gastric cancer incidence is due to a birth-cohort-dependent decrease in exposure to major risk factors. MethodsIn an area of northern Italy with a historically strong internal geographical gradient in gastric cancer incidence, variations in rates by municipality and age group between 1987 and 2008 were evaluated. The study period was divided into three nonadjacent periods. End points included: age- and sex-standardised incidence rates; incidence rate ratio between age- and sex-standardised incidence rates; smoothed relative risks of gastric cancer incidence, and posterior probabilities of the relative risk being >1. ResultsIn 1987–1990, the estimate of posterior probabilities of relative risk being >1 showed a higher incidence in hilly/mountainous areas. Between 1987–1990 and 2005–2008, a uniform decrease of more than 50% was observed (incidence rate ratio: plain, 0.45 (95% confidence interval 0.40–0.51); hill, 0.44 (0.34–0.58); mountain, 0.48 (0.22–1.02)). The decrease in the mountainous area was weak in the middle time period, with an incidence rate ratio of 0.92 (0.46–1.84), and intensified afterwards. The decrease occurred earlier and was more pronounced among younger people. In 2005–2008, gastric cancer risk was uniform across ages and municipalities. ConclusionsThe observed changes in gastric cancer incidence is the epilogue of a birth-cohort-dependent decrease in exposure to major risk factors.

Estimating the Burden of Osteoarthritis to Plan for the Future.

With aging and obesity trends, the incidence and prevalence of osteoarthritis (OA) is expected to rise in Canada, increasing the demand for health resources. Resource planning to meet this increasing need requires estimates of the anticipated number of OA patients. Using administrative data from Alberta, we estimated OA incidence and prevalence rates and examined their sensitivity to alternative case definitions. We identified cases in a linked data set spanning 1993 to 2010 (population registry, Discharge Abstract Database, physician claims, Ambulatory Care Classification System, and prescription drug data) using diagnostic codes and drug identification numbers. In the base case, incident cases were captured for patients with an OA diagnostic code for at least 2 physician visits within 2 years or any hospital admission. Seven alternative case definitions were applied and compared. Age- and sex-standardized incidence and prevalence rates were estimated to be 8.6 and 80.3 cases per 1,000 population, respectively, in the base case. Physician claims data alone captured 88% of OA cases. Prevalence rate estimates required 15 years of longitudinal data to plateau. Compared to the base case, estimates are sensitive to alternative case definitions. Administrative databases are a key source for estimating the burden and epidemiologic trends of chronic diseases such as OA in Canada. Despite their limitations, these data provide valuable information for estimating disease burden and planning health services. Estimates of OA are mostly defined through physician claims data and require a long period of longitudinal data.

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons.

Heart failure (HF) continues to be a leading cause of morbidity and mortality in industrialized countries. Data on the epidemiology of HF are largely lacking for Germany. The aims of this study were to estimate the incidence and prevalence of HF in Germany, to estimate 1-year all-cause mortality in patients who received their first diagnosis of HF in hospital and to assess related risk factors. The study was based on data for the years 2004-2006 from three German statutory health insurance providers, comprising data of more than six million people. The study sample was not restricted to a specific age group. The incidence rate of HF in 2006 was assessed in patients who did not have a diagnosis of HF or had not received medications for HF in the previous 2 years. One-year all-cause mortality in patients who received their first diagnosis of HF in hospital was analysed using Kaplan-Meier method and Cox proportional hazard model. Case identification was based on confirmed outpatient diagnoses, main and secondary hospital discharge diagnoses as well as medications for HF. The age- and sex-standardized incidence rate of HF was 2.7 per 1000 person years. Age- and sex-standardized prevalence of HF was 1.7% in 2004, 1.9% in 2005 and 1.7% in 2006. The 1-year all-cause mortality was 23% among patients who received their first HF diagnosis during a hospitalization in 2006. Our study revealed an incidence and prevalence of HF in Germany which were largely comparable to those from other countries. Due to the poor prognosis of HF, high readmission rates and an aging society, HF remains highly relevant in the context of health care planning.

Validation of a coding algorithm to identify bladder cancer and distinguish stage in an electronic medical records database.

Studies on outcomes in bladder cancer rely on accurate methods to identify patients with bladder cancer and differentiate bladder cancer stage. Medical record and administrative databases are increasingly used to study cancer incidence, but few have distinguished cancer stage, and none have focused on bladder cancer. In this study, we used data from The UK Health Improvement Network (THIN) to identify patients with bladder cancer using at least one diagnostic code for bladder cancer, and distinguish muscle-invasive from non-invasive disease using a subsequent code for cystectomy. Algorithms were validated against a gold standard of physician-completed questionnaires, pathology reports, and consultant letters. Algorithm performance was evaluated by measuring positive predictive value (PPV) and corresponding 95% confidence interval (CI). Among all patients coded with bladder cancer (n = 194), PPV for any bladder cancer was 99.5% (95% CI, 97.2-99.9). PPV for incident bladder cancer was 93.8% (95% CI, 89.4-96.7). PPV for muscle-invasive bladder cancer was 70.1% (95% CI, 59.4-79.5) in patients with cystectomy (n = 95) and 83.9% (95% CI, 66.3-94.5) in those with cystectomy plus additional codes for metastases and death (n = 31). Using our codes for bladder cancer, the age- and sex-standardized incidence rate (SIR) of bladder cancer in THIN approximated that measured by cancer registries (SIR within 20%), suggesting that sensitivity was high as well. THIN is a valid and novel database for the study of bladder cancer. Our algorithm can be used to examine the epidemiology of muscle-invasive bladder cancer or outcomes following cystectomy for patients with muscle invasion.

Increased Incidence of Critical Illness Among Patients With Inflammatory Bowel Disease: A Population-Based Study

Little is known about how often, and for what reasons, patients with inflammatory bowel diseases (IBD) are admitted to the intensive care unit (ICU). We compared incidences of ICU admission, characteristics of critical illness, and mortality after ICU admission between patients with IBD and the general population. We identified all persons with IBD in the province of Manitoba using a validated administrative definition of IBD for the period from 1984 to 2010. Cases were considered incident for IBD if their first health system contact for IBD was in 1989 or later. We identified a population-based control group, matched by age, sex, and geography (based on postal code). Case and control cohorts were linked to the Manitoba ICU database. We compared outcomes between groups using age- and sex-standardized rates, Cox proportional hazards models, and logistic regression models, adjusting for age, sex, comorbidity, and socioeconomic status. There were 8224 prevalent and 4580 incident cases of IBD. After adjustment, the risk for ICU admission was higher for patients with IBD than controls (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.58-2.02). The risk of ICU admission was higher for patients with Crohn's disease (HR, 2.31; 95% CI, 1.95-2.75) than ulcerative colitis (HR, 1.37; 95% CI, 1.13-1.65). From 2000 through 2010, age- and sex-standardized annual incidence rates for ICU admission in the prevalent IBD cohort ranged from 0.55% to 1.12%. Compared with controls admitted to ICUs, 1 year after ICU admission, mortality was 32% among patients with IBD. Patients with IBD have a higher risk for admission to the ICU than the general population, and increased mortality 1 year after admission. These findings underscore the potential severity of IBD.

The epidemiology of rheumatoid arthritis in Ontario, Canada.

Epidemiologic assessments of sufficiently large populations are required in order to obtain robust estimates of disease prevalence and incidence, particularly when exploring the influence of various factors (age, sex, calendar time). We undertook this study to describe the epidemiology of rheumatoid arthritis (RA) over the past 15 years. We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based research database of all Ontarians with RA. The ORAD records were linked with census data to calculate crude and age and sex-standardized prevalence and incidence rates from 1996 to 2010. Vital statistics were used to estimate annual all-cause mortality during the study period. As of 2010, there were 97,499 Ontarians with RA, corresponding to a cumulative prevalence of 0.9%. Age and sex-standardized RA prevalence increased steadily over time from 473 (95% confidence interval [95% CI] 469-478) per 100,000 population (0.49%) in 1996 to 784 (95% CI 779-789) per 100,000 population (0.9%) in 2010. Age and sex-standardized incidence per 100,000 population ranged from 62 (95% CI 60-63) in 1996 to 54 (95% CI 52-55) in 2010. All-cause mortality decreased by a relative 21.4% since 1996. Over a 15-year period, we observed an increase in RA prevalence over time. This rise may be attributed to the increasing time to ascertain cases (which may have been latent in the population during earlier years of the study), increasing survival, and/or an increase in the aging background population. Incidence appears to be stable.

Adherence to consensus-based diagnosis and treatment guidelines in adult soft-tissue sarcoma patients: a French prospective population-based study

Soft-tissue sarcomas (STSs) are rare tumors with varied histological presentations. Management and treatment are thus complex, but crucial for patient outcomes. We assess adherence to adult STS management guidelines across two French regions (10% of the French population). We also report standardized incidence. STS patients diagnosed from 1 November 2006 to 31 December 2007 were identified from pathology reports, medical hospital records, and cancer registries. Guideline adherence was assessed by 23 criteria (validated by Delphi consensus method), and age and sex-standardized incidence rates estimated. Associations between patient, treatment, and institutional factors and adherence with three major composite criteria relating to diagnostic imaging and biopsy as well as multidisciplinary team (MDT) case-review are reported. Two hundred and seventy-four patients were included (57.7% male, mean age 60.8 years). Practices were relatively compliant overall, with over 70% adherence for 10 criteria. Three criteria with perfect Delphi consensus had low adherence: receiving histological diagnosis before surgery, adequacy of histological diagnosis (adherence around 50% for both), and MDT discussion before surgery (adherence <30%). Treatment outside of specialized centers was associated with lower adherence for all three composite criteria, and specific tumor sites and/or features were associated with lower adherence for diagnostic imaging, methods, and MDT meetings. STS standardized incidence rates were 4.09 (European population) and 3.33 (World) /100 000 inhabitants. Initial STS diagnosis and treatment across all stages (imaging, biopsy, and MDT meetings) need improving, particularly outside specialized centers. Educational interventions to increase surgeon's sarcoma awareness and knowledge and to raise patients' awareness of the importance of seeking expert care are necessary.

Risk of AIDS-Defining Cancers Among HIV-1–Infected Patients in France Between 1992 and 2009: Results From the FHDH-ANRS CO4 Cohort

We examined trends in the incidence of the 3 AIDS-defining cancers (ADCs; Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], and cervical cancer) among human immunodeficiency virus (HIV)-infected patients relative to the general population between 1992 and 2009 in France, focusing on age at ADC diagnosis and on patients with controlled viral load and restored immunity on combination antiretroviral therapy (cART). Age- and sex-standardized incidence rates were estimated in patients enrolled in the French hospital database on HIV, and in the general population in France during 4 calendar periods (1992-1996, 1997-2000, 2001-2004, and 2005-2009). Standardized incidence ratios (SIRs) were calculated for all periods and separately for patients on cART, with CD4 counts ≥500 cells/µL for at least 2 years and viral load ≤500 copies/mL. Although the incidence of ADCs fell significantly across the calendar periods, the risk remained constantly higher in HIV-infected patients than in the general population. In patients with restored immunity, the relative risk remained significantly elevated for KS (SIR = 35.4; 95% confidence interval [CI], 18.3-61.9), and was similar to that of the general population for NHL (SIR = 1.0; 95% CI, .4-1.8). ADCs were diagnosed at a younger age in HIV-infected patients, with a particularly marked difference for NHL (-11.3 years, P < .0001). The incidence of all ADCs continued to fall, including cervical cancer, in the cART period, but the risk remained higher than in the general population in 2005-2009. In patients with stably restored immunity, KS remained significantly more frequent than in the general population.

Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009

Few studies based in well-defined North American populations have examined the occurrence of juvenile idiopathic arthritis (JIA), and none has been based in an ethnically diverse population. We used computerized healthcare information from the Kaiser Permanente Northern California membership to validate JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population. We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases, 9th edition, diagnosis code of 696.0, 714, or 720 in computerized clinical encounter data during 1996-2009. In a random sample, we then reviewed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms. Finally, we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA. A diagnosis of JIA was confirmed in 69% of individuals with at least 1 relevant code. Forty-five percent were newly diagnosed during the study period. The age- and sex-standardized incidence rate of JIA per 100,000 person-years was 11.9 (95% CI 10.9-12.9). It was 16.4 (95% CI 14.6-18.1) in girls and 7.7 (95% CI 6.5-8.9) in boys. The peak incidence rate occurred in children aged 11-15 years. The prevalence of JIA per 100,000 persons was 44.7 (95% CI 39.1-50.2) on December 31, 2009. The incidence rate of JIA observed in the Kaiser Permanente population, 1996-2009, was similar to that reported in Rochester, Minnesota, USA, but 2 to 3 times higher than Canadian estimates.