Specific Incidence Rates Research Articles

Cancer and treatment specific incidence rates of immune-related adverse events induced by immune checkpoint inhibitors: a systematic review.

Immune-related adverse events (irAE) induced by immune checkpoint inhibitors (ICI) are a treatment-limiting barrier. There are few large-scale studies that estimate irAE prevalence. This paper presents a systematic review that reports the prevalence of irAE by cancer type and ICI. A systematic review was undertaken in MEDLINE OVID, EMBASE and Web of Science databases from 2017-2021. A total of 293 studies were identified for analysis and, of these, event rate was calculated for 272 studies, which involved 58,291 patients with irAE among 305,879 total patients on ICI. Event rate was calculated by irAE and ICI type. Mean event rate for general irAE occurrence across any grade was 40.0% (37.3-42.7%) and high grade was 19.7% (15.8-23.7%). Mean event rates for six specific types of irAE are reported. Mean event rate for ICI monotherapy was 29.7% (27.7-33.2%), 45.7% (29.6-61.7%) for ICI combination therapy, and 30.3% (27.3-35.0%) for both ICI monotherapy and combination therapy. This systematic review characterises irAE prevalence across current research that examines irAE risk factors across cancers and ICI. The findings confirms that irAE occurrence is very common in the real-world setting, both high grade and irAE across any grade.

Lidocaine pre-treatment for Succinylcholine induced postoperative myalgia and associated factors: Longitudinal study

IntroductionPostoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study. MethodsProspective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value < 0.05 was used to show the difference, direction and strength of association. ResultExposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (p = 0.513) but in non-exposed patients (p = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (p > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia. ConclusionLidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.

Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry.

Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca). A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype. A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states. The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.

Epidemiology of Non-Traumatic Lower Extremities Amputations in West Africa: Nationwide Data from Togo

Non-traumatic lower limb amputation (NT-LLA) has consequences at individual and public health levels. Population based studies in sub-Saharan Africa are scarce and often related to single centre series. This study aimed to estimate the incidence of NT-LLA (minor and major) and to describe epidemiological, clinical, and prognostic aspects in Togo. This was a population based observational study conducted among all patients who underwent NT-LLA. Traumatic amputations were excluded. Sociodemographic, clinical, and work up data were collected from clinical files in any Togolese health centre from 1 January 2016 to 31 December 2021. Incidence rates were adjusted for age. Over the six year period, 352 patients (59% males) underwent NT-LLA (mean ± standard deviation age 60 ± 15.7 years). The average age adjusted incidence rate of NT-LLA was 8.5 per million/year (95% confidence interval [CI] 7.6 - 9.4). Men were 1.7 times more likely to undergo a NT-LLA than women. The relative risk of NT-LLA was 48 times higher in patients with diabetes than in patients without diabetes. Around 61.0% of the NT-LLAs occurred within the 50 - 74 age group and 54.3% had diabetes mellitus. Among amputees, 54.5% had a diagnosis of peripheral artery disease (PAD) and 52.8% had diabetic ulcers, with co-existence of several factors. Less than 5% of participants had a history of smoking tobacco. Average length of hospital stay was 12 days. The in hospital mortality rate was 8.8% (9.0% for major, 6.7% for minor amputations). Only 18.2% had duplex ultrasound performed and 1.7% angiography prior to amputation. No patient underwent vascular intervention prior to amputation. This is the first study to report nationwide and contemporary epidemiological data on NT-LLAs in West Africa, highlighting several specificities. Large scale interventions are needed to ameliorate the care of diabetes and PAD and improve facilities for optimal management of patients at risk of amputation in Africa.

The combined effects of growth and maturity status on injury risk in an elite football academy.

This study aimed to explore the interaction between growth rate on specific injury incidence and burden on pre-, circa- and post-peak height velocity (PHV) periods. Injury and stature data collected during the 2000-2020 seasons in an elite football academy were retrospectively analysed. Only players with height measurements from childhood until the attainment of adult height were included in the study (N = 84). Growth data were smoothed using a cubic spline to calculate daily growth rate and height. Growth rate was categorised into three groups: fast (> 7.2 cm/year), moderate (3.5-7.2 cm/year) and slow (< 3.5 cm/year). Percentage of observed adult height was used to classify players as pre-PHV (< 88%), circa-PHV (88-95%) or post-PHV (> 95%). Overall and specific injury incidence and burden and rate ratios for comparisons between growth rate groups were calculated on pre-, circa- and post-PHV periods, separately. Overall injury incidence and burden were greater in pre-PHV players with quicker growth rates compared to players growing moderately and slowly. All in all, players with more rapid growth-rates were at higher risk for growth-related injuries in all pre-, circa- and post-PHV periods. Post-PHV, the incidence and burden of joint/ligament injuries were 2.4 and 2.6-times greater in players growing slowly compared to players growing moderately. Practitioners should monitor growth rate and maturity status and consider their interaction to facilitate the design of targeted injury risk reduction strategies.

Ilizarov method and its combined methods in the treatment of long bone defects of the lower extremity: systematic review and meta-analysis

BackgroundIlizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods.MethodsStudies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique.ResultsSixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity.ConclusionOur study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.

Abstract 15469: Projected Heart Failure Incidence in US Adults From 2018-2050

Background Heart failure (HF) currently affects 6.7 million people in the US accounting for $40 billion in annual healthcare costs. Projecting future trends in the clinical burden of HF may guide strategic investments in prevention and treatment as well as workforce planning. This study projects the incidence of heart failure in the US population through 2050. Methods: The Cardiovascular Disease (CVD) Policy Model is an established computer-simulation, state-transition model for the US population ages 35-94 years. Age- and sex- specific HF incidence rates were derived from NHLBI pooled cohort studies; the probability of HF hospitalizations associated with coronary heart disease (CHD) or stroke were derived from the National Inpatient Sample and published literature. We applied age- and sex-specific risk factor distributions, incidence, and event rates from 2018 to population projections through 2050 from the US Census. The model estimated absolute number of incident HF cases in subpopulations with CHD (ischemic HF) and without CHD (non-ischemic HF). Results: In 2018, 11% of the US population without HF was aged &gt;=75 years, which compares with 16% projected in 2050. The estimated HF incidence rate was higher in males. The annual incidence of HF in US adults aged 35 to 94 years is projected to increase by 39% from 836,000 in 2018 to 1.2 million by 2050 (Table 1). Most incident HF is estimated to occur in the population without CHD, accounting for three quarters of HF in women and over half in men. Among those with HF, the proportion of the population aged &gt;=75 years was projected to increase from 42% in 2018 to 54% in 2050. Conclusion A large increase in incident HF is expected in coming years, primarily due to an aging population. Most incident HF is estimated to be non-ischemic. Primary prevention, specifically controlling risk factors associated with non-ischemic HF, may offer the greatest opportunity to reduce HF incidence.

Incidence of Lung Adenocarcinoma by Age, Sex, and Smoking Status in Taiwan.

Knowing whether the effects of smoking and other risk factors with lung adenocarcinoma (ADC) incidence varies by sex would provide information on lung cancer prevention strategies. To evaluate whether women in Taiwan have higher age- and tumor stage-specific lung ADC incidence rates than men irrespective of smoking status (ie, ever smoker or never smoker). This population-based cohort study used data sets synthesized from the Taiwan Cancer Registry (TCR) from 1979 to 2019; the TCR Long Form (TCRLF) from 2011 to 2019, which provides individual-level smoking and tumor stage information; the Taiwan Cause of Death Database (TCOD) from 1985 to 2019; the National Health Insurance Research Database (NHIRD) from 2000 to 2020; the Monthly Bulletin of Interior Statistics (MBIS) from 2011 to 2019; the National Health Interview Survey from 2001, 2005, 2009, 2013, and 2017; and Taiwan Biobank data from 2008 to 2021. Included patients were aged 40 to 84 years and had any invasive lung cancer from January 1, 2011, to December 31, 2019. Smoking status. The main outcomes were age-specific female-to-male incidence rate ratios (IRRs) of lung ADC by smoking status and tumor stage. Linked data from the TCR, TCOD, NHIRD, Taiwan National Health Interview Survey, and MBIS were used to estimate the age- and sex-specific numbers of cancer-free individuals at midyears from 2011 to 2019 by smoking status. Using the TCR and TCRLF, age-, sex-, tumor stage-, and diagnosis year-specific numbers of patients with lung ADC from 2011 to 2019 by smoking status were estimated. A total of 61 285 patients (32 599 women [53.2%]) aged 40 to 84 years (mean [SD] age, 64.66 [10.79] years) in the Taiwanese population of approximately 23 million were diagnosed with invasive lung ADC as their first lifetime cancer between 2011 and 2019. Among smokers, men had higher tobacco use by almost all examined metrics, including nearly twice the mean (SD) number of pack-years smoked (eg, 7.87 [8.30] for men aged 30-34 years vs 4.38 [5.27] for women aged 30-34 years). For 5-year age bands between 40 and 84 years, incidence of lung ADC was significantly higher among females than males for nearly all age groups irrespective of tumor stage and smoking status (eg, for the age group 70-74 years, the female-to-male IRR for late-stage lung ADC among never smokers was 1.38 [95% CI, 1.30-1.50]). In this cohort study, women had higher age- and stage-specific lung ADC incidence rates than men in Taiwan for both never and ever smokers, suggesting the possibility of differential exposures between sexes to risk factors other than smoking and the potential modification of ADC risk factors by sex. Further work is needed to determine whether this pattern replicates in other populations, discover the causes of lung ADC, and put preventive measures in place.

The spectrum of idiopathic inflammatory myopathies in Western Australia: epidemiological characteristics and mortality over time

To determine long term overall and subgroup specific incidence rates and associated mortality for idiopathic inflammatory myopathies (IIM) in a population wide study. We included patients hospitalised between 1980 and 2015 with incident IIM as defined by relevant diagnostic codes for dermatomyositis (DM) polymyositis (PM), inclusion body myositis (IBM), other IIM and overlap myositis (OM) in the Western Australia Health Hospital Morbidity Data Collection (n = 846). Trends over time for annual incidence rate per million population (AIR) were analysed by least square regression and Kaplan–Meier survival and mortality rates (MR)/100 person years compared with a matched control group (n = 3681). The averaged AIR for all IIM was 19 (CI 10.4–27.5) and stable over time with point prevalence reaching 205.3 (CI 185.6–226.6) per million in 2015. Over time, the AIR for DM 5.0 (CI 0.6–9.4) and IBM 3.3 (CI 0.7–9.6) was stable, while AIR decreased for PM (p < 0.01) and increased for other IIM (p < 0.01) and OM (p < 0.01). IBM patients were eldest at diagnosis (68 years, CI 59–77) with male preponderance in IBM (53.4%) and other IIM (55.8%) groups. Crude mortality (54.5 vs 41.3%), MR ratio (6.65 vs 5.91) and 5 (65.8% vs 71.6%) and 10-year (52.5% vs 58.7%) survival were all worse for IIM patients (all p < 0.05). IBM patients had highest MR (10.1; CI 8.38–12.14) and lowest 10-year survival (39.2%). While cardiovascular disease and cancer were predominant causes of death, they were proportionally lower in IIM patients, where respiratory and rheumatic disease were more frequent causes of death. While the overall incidence of IIM in WA was stable over 35 years, the spectrum of IIM has changed significantly with increases especially in other IIM and OM. The overall prognosis with IIM remains guarded with 10-year survival just over 50%.

564 Pelvic Fracture Incidence in EU15+ Countries: Trends Over a 30-Year Period

Abstract Aim Pelvic fractures (PF) are relatively uncommon but significant injuries accounting for approximately 3% of all skeletal injuries. We aimed to assess the burden of PFs across high health expenditure countries by describing the trends in PF incidence rates over the last three decades. Method Using the Global Burden of Disease (GBD) Study database, we extracted sex specific PF age-standardised incidence rates (ASIRs) from 1990-2019 for each of the 19 European Union (EU) 15+ countries. We performed Joinpoint regression analysis to further characterise the trends. Results Over the 30-year period of study, 89% of countries experienced a decline in ASIRs for males, with a median percentage change of -11.8%, in comparison to females where 53% of countries experienced an increase in ASIR (median percentage increase of +3.1%). For females, the largest increases in PF incidence were observed in the Netherlands and Belgium; these were also the only two counties with increased overall PF incidence in males over the study period observed. The countries with the greatest decrease in ASIRs were Italy and Denmark for females and Portugal and Spain for males. Joinpoint regression identified that over the time periods covered by the most recent trends, PF incidence rates had increased in 58% of countries for females and 52% of countries for males. Conclusions We found overall decreased incidences of PFs amongst males over the last 3 decades, compared with increased incidence in females. However, joinpoint regression analysis demonstrated a trend towards rising incidence of PFs amongst both males and females in recent years.

Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population

Proximal femoral fractures are a serious complication, especially for elderly patients. Detailed epidemiological analyzes provide a valuable resource for stakeholders in the health care system in order to foresee future development possibly influenceable by adaption of therapeutic procedures and prevention strategies. This work aimed at answering the following research questions: (1) What are the incidence rates of proximal femoral fractures in the elderly U.S. population? (2) What is the preferred treatment procedure for these fractures? Proximal femoral fractures occurred between January 1, 2009 and December 31, 2019 in patients ≥ 65 years were identified from the Medicare Physician Service Records Data Base. The 5% sample of Medicare beneficiaries, equivalent to the records from approximately 2.5 million enrollees formed the basis of this study. Fractures were grouped into head/neck, intertrochanteric, and subtrochanteric fractures. The overall incidence rate, age and sex specific incidence rates as well as incidence rate ratios were calculated. Common Procedural Terminology (CPT) codes were used to identify procedures and operations. In 2019, a total number of 7982 femoral head/neck fractures was recorded. In comparison to 9588 cases in 2009, the incidence substantially decreased by 26.6% from 666.7/100,000 inhabitants to 489.3/100,000 inhabitants (z = − 5.197, p < 0.001). Also, in intertrochanteric fractures, a significant decline in the incidence by 17.3% was evident over the years from 367.7/100,000 inhabitants in 2009 to 304.0 cases per 100,000 inhabitants in 2019 (z = − 2.454, p = 0.014). A similar picture was observable for subtrochanteric fractures, which decreased by 29.6% (51.0 cases per 100,000 to 35.9 cases per 100,000) over the time period (z = − 1.612, p = 0.107). Head/neck fractures were mainly treated with an arthroplasty (n = 36,301, 40.0%). The majority of intertrochanteric fractures and subtrochanteric fractures received treatment with an intramedullary device (n = 34,630, 65.5% and n = 5870, 77.1%, respectively). The analysis indicated that the incidence of all types of proximal femoral neck fractures decreased for the population of elderly patients in the U.S. within the last decade. Treatment of head and neck fractures was mainly conducted through arthroplasty, while intertrochanteric and subtrochanteric fractures predominantly received an intramedullary nailing.

Significantly reduced rates of interpersonal violence in an urban Danish population 2003–2021

This study aimed to describe changes in annual incidence rates and the severity of deliberate interpersonal violence based on hospital and forensic data in a Danish urban population 2003–2021. Included in the study were local victims of violence admitted to Odense University Hospital and/or subjected to medico-legal autopsy at the Institute of Forensic Medicine, University of Southern Denmark from 2003 to 2021. Based on population counts, we estimated overall and gender specific annual incidence rates in different age groups. For the 14,788 victims included in the study, the gender-specific incidence rates were 5.7 for males and 2.4 for females per 1000 population/year. The incidence rates decreased almost fourfold for both genders in all age groups. In both gender, the incidence rate of violence involving mild injuries decreased significantly, whereas incidence rate of violence involving severe injuries remained unchanged over the study period. The proportion of superficial lesions decreased and the proportion of wounds, bone fractures, and deep lesions increased. The proportion of victims with injuries from knifes increased from 3.0 to 5.4% in the study period. Overall, 0.3% died from their injuries. The present study showed a significant decreased in the incidence rate of violence based on hospital and forensic data. The decrease involved solely victims with less severe injuries. We recommend studies combining hospital, forensic, and police data.

Risk of gastric carcinoma will be low in generations born at turn of the 20th and 21st centuries in Finland. Modelling NORDCAN data of the age group specific incidence rates of gastric cancer with PLS-regression and with attention to age (‘age effect’) and year of the birth (‘cohort effect’)

Background and methods We examined in NORDCAN database how the annual age group-specific incidence rates (IR) of gastric cancer (GCA), and correspondingly the GCA risk, have declined in Finland during the twentieth century, and whether this decline corresponds to a decrease in the cohort-specific prevalence rate of Helicobacter pylori (Hp) gastritis that is considered an important precancerous risk condition for GCA. Results In modelling with partial least squares regression (PLSR), the logarithmically transformed IRs (ln(IR) of GCA were well explained with age and birth cohort as explanatory model variables. By considering the observed (actual) and the PLSR-modelled IRs, the IR of GCA (and the risk of GCA) has decreased gradually in Finland from 1900 onward, cohort by cohort. By prediction of the future with PLSR, the IRs of GCA will be markedly lower in all cohorts during the twenty-first century than in the twentieth century. By PLSR modelling, less than 10 GCA cases per 100,000 people are predicted to appear annually in cohorts (generations) born at the turn of the 20th and 21st centuries, even when these people will be 60–80 years old in the years 2060–2070. Conclusions The IR of GCA and GCA risk progressively declined by cohort in Finland during the whole twentieth century. This decline corresponds in extent and time window to earlier observations in the decline of the prevalence rate of Hp gastritis in the same birth cohorts and supports the hypothesis of the role of Hp gastritis as an important risk condition of GCA.

O109 Pelvic fracture incidence in EU15+ countries: trends over a 30-year period

Abstract Introduction Pelvic fractures (PF) are relatively uncommon but account for approximately 3% of all skeletal injuries. We aimed to assess the burden of PFs across high health expenditure countries by describing the trends in PF incidence rates over the last three decades. Methods Using the Global Burden of Disease (GBD) Study database, we extracted sex specific PF age-standardised incidence rates (ASIRs) from 1990-2019 for each of the 19 European Union (EU) 15+ countries. We performed Joinpoint regression analysis to characterise the trends. Results Over the 30-year period of study, 89% of countries experienced a decline in ASIRs for males, with a median percentage change of -11.8%, in comparison to females where 53% of countries experienced an increase in ASIR (median percentage increase of +3.1%). For females, the largest increases in PF incidence were observed in the Netherlands and Belgium; these were also the only two counties with increased overall PF incidence in males over the study period observed. The countries with the greatest decrease in ASIRs were Italy and Denmark for females and Portugal and Spain for males. Joinpoint regression identified that over the time periods covered by the most recent trends, PF incidence rates had increased in 58% of countries for females and 52% of countries for males. Conclusion We found overall decreased incidences of PFs amongst males over the last 3 decades, compared with increased incidence in females. However, joinpoint regression analysis demonstrated a trend towards rising incidence of PFs amongst both males and females in recent years.

National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan

BackgroundCervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation.ObjectiveTo estimate the burden of cervical cancer in Pakistan using available data sources.MethodsWe performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan.ResultsA total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995–1997 ASIR = 6.81, 1998–2002 ASIR = 7.47, and 2017–2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015–2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year.ConclusionThe estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.

The Spatial Variability of the Sex and Age- Specific 10-Year Incidence of Cardiovascular Diseases and its Clinical Risk Factors in Athens Metropolitan Area: a Local Statistical Modelling Approach in the Context of the ATTICA Epidemiological Study

According to the published European public health policies, emphasis should be given on the identification of high-risk areas, in terms of both Cardiovascular Diseases (CVDs) incidence, as well as of its main clinical risk factors. Thus, we aimed to investigate: (a) the geographical variability of the sex and age-specific 10-year incidence of CVDs and its clinical risk factors in the Athens metropolitan area, the most urbanised city in Greece accounting for about 35% of the total Greek population, and (b) the spatial heterogeneity of the association between the main clinical risk factors and the 10-year CVD incidence at an aggregated level. Data regarding the 10-year CVD incidence (% of population in each municipality with any CVD after the 10-year period), as well as the prevalence of the risk factors (obesity, hypertension, diabetes mellitus, hypercholesterolaemia; expressed as % of population in each municipality) were provided by the ATTICA epidemiological study for 2020 individuals found during the 10-year follow-up with complete data for locality geocoding. Socio-economic, demographic, and environmental characteristics for each municipality of the Attica region, were obtained from official national and international databases. A local statistical modelling approach, namely the Geographically Weighted Regression, was implemented in order to investigate the associations at a local level and therefore give emphasis on the design of more effective public health programs, taking into account the special characteristics of each area. Hypercholesterolaemia was found to be the most prevalent clinical risk factor in the study area, while higher prevalence for all the risk factors were presented in areas of lower socioeconomic status (SES), where a significantly higher number of new CVD cases in the decade were detected as well. 10-year CVD incidence was also found to be significantly elevated in areas characterized by worse health status in terms of the risk factors’ prevalence, while the sex and age- specific CVD incidence rates were found to be differently affected by these factors. Interestingly, despite the fact that CVDs are acknowledged as a man’s disease, areas of higher (South & North) and moderate (East) SES were found to be characterized by higher CVD incidence rates in females, while in areas of lower SES (West), higher CVD incidence rates were found in males. In line with the current European policy, the identification of areas where the intensity of the studied associations is stronger, can be considered a crucial methodological aspect for the design and implementation of more effective CVD prevention programs at the community level.

Kretanje obolevanja i umiranja od kolorektalnog karcinoma kod muškaraca i žena Centralne Srbije za period 1999-2020. godine

Introduction/Aim: Colorectal cancer is the third leading cancer in terms of morbidity in the world, right after breast and lung cancer, and the second leading malignant tumor according to the number of deaths, after lung cancer. This descriptive study aimed to analyze the trends in incidence and mortality from colorectal cancer in men and women in Central Serbia from 1999 to 2020. Methods: Data on patients and deaths from colorectal cancer (codes C18-C20, according to the International Classification of Diseases), as well as on the number of inhabitants, by sex and age, for the period from 1999 to 2020, were taken from cancer registries in Central Serbia and at the request of the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut". Crude, age-specific and standardized incidence and mortality rates for colorectal cancer were calculated. In order to analyze trends in incidence and mortality rates, joinpoint regression analysis was used. Results: In the period from 1999 to 2020 in Central Serbia, an average of 1696 men and 1112 women were diagnosed with colorectal cancer, and 990 men and 676 women died. In the mentioned period, the average standardized incidence rate (per 100,000) was 34.4 for men and 19.5 for women, and the average standardized mortality rate (per 100,000) was 18.4 for men and 10.1 for women. Average age specific incidence and mortality rates from colorectal cancer increase with age in both sexes. In the period 1999-2020, the standardized incidence rates of colorectal cancer are increasing significantly by 0.7% per year for women and 1% per year for men. In women, a significant increase in the mortality rate from colorectal cancer of 2.6% per year is observed in the period 1999-2006 year, and then a decline of 1.2% per year for the period 2006-2020. However, in men, a significant increase is observed in the period 1999-2010, followed by a decrease of 1.2% per year, but without statistical significance. Conclusion: It is necessary to work on improving the implementation of organized screening for colorectal cancer, as well as on educating the population about the risk factors for the occurrence of this malignancy and the possibilities for prevention.

Obolevanje i umiranje od raka dojke u muškoj i ženskoj populaciji Centralne Srbije u periodu 2009-2020. godine

Introduction/Aim: In 2020, breast cancer is the leading cause of morbidity globally when considering both sexes together, followed by prostate cancer and lung cancer. However, breast cancer is very rare in men. In this descriptive study, incidence and mortality from breast cancer was analyzed in the population of men and women in Central Serbia for the period from 2009 to 2020. Methods: Data on patients and deaths from breast cancer, as well as the number of inhabitants, by gender and age, were taken from published and unpublished material of the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut". General, specific and standardized incidence and mortality rates were used in the analysis. Joinpoint regression analysis was used to analyze trends in morbidity and mortality. Results: In the period 2009-2020. In 2010, the average standardized incidence rate (per 100,000) for breast cancer was 1.3 for men and 65.3 for women, and the average mortality rate (per 100,000) was 0.4 for men and 19.8 for women. During the observed period, the standardized incidence rate for men increased by 1.9% per year and the mortality rate by 2.4%, but without significance. In women, the standardized incidence rate increases significantly by 3.5% per year in the period 2013-2020, and the standardized mortality rate significantly decreases by -0.5% per year in the period 2009-2020. years. In both sexes, mortality and incidence rates increased with age, except that in women the incidence rate for the age of 70 and over was lower compared to the incidence rate for the age of 60-69. Conclusion: It is necessary to further improve the implementation of organized screening for breast cancer in women in the territory of Central Serbia, to work on the reduction and/or elimination of risk factors, as well as on raising the awareness of men that there is a possibility that they can also get breast cancer.

Characteristics of COVID-19 cases with breakthrough infection in the governorate of Sousse, Tunisia

Abstract Introduction In early 2021, Tunisia implemented a national COVID-19 strategy of vaccination aimed at disease elimination. In this study, we aimed to investigate the characteristics of the breakthrough COVID-19 infection in the governorate of Sousse, Tunisia. Methodology We conducted a cross-sectional study including all post-vaccination COVID-19 cases from March 2021 to August 2021. We collected data via 15-minute telephonic call interviews. We estimated the specific incidence rates (SIR) of confirmed cases by vaccine type and expressed them as cases per 100 000 inhabitants. Statistical analyzes were carried out using anonymous and codified Excel tables and SPSS 20. Results Overall, we included 618 cases of breakthrough COVID-19 infection. The majority were female (sex-ratio=0.8), and the average age of the overall cases was 55.7±14.5 years (range:19-91). Nearly half (49%) of participants had comorbidities, 19.6% were healthcare workers, and 17.9% were smokers. The majority of cases (70%) received at least one dose of Pfizer vaccine followed by CORONAVAC (15.6%; n = 96). Nevertheless, we found a higher incidence rate of COVID-19 among those vaccinated with SPUTNIK V (SIR=1551.2) followed by SINOPHARM (SIR=823.7). Fifty-eight percent of patients reported a poor adhesion to preventive measures, whereas 38.6% reported high respect for the preventive measures. COVID-19 infection led to hospitalization in 8.1% of cases, hospitalization in intensive care units in 2.1% of cases, and death in 1.8% of cases. Conclusions The findings of our study highlight the low rate of severe cases of COVID-19 among the vaccinated population. Furthermore, we found a discrepancy in the effectiveness of vaccines in the prevention of transmission potential. Yet, many factors could influence the transmission and the severity of COVID-19 breakthrough infection from one region to another. Key messages • low rate of severe cases of COVID-19 among the vaccinated population. • discrepancy in the effectiveness of vaccines in the prevention of transmission potential.

Sex differences among patients with tachyarrhythmias and bradyarrhythmias following acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is commonly complicated by ventricular, supraventricular tachycardias and high-grade atrioventricular block (HAVB) which may result in increased morbidity and mortality. Purpose To evaluate the sex differences in tachyarrhythmias and HAVB, and their associated outcomes following AMI. Methods Using the Acute Coronary Syndrome Israeli Survey (ACSIS) survey database from 2000–2018, we analyzed the specific incidence rates for arrhythmias including: sustained ventricular tachycardia (VT), ventricular fibrillation (VF), new-onset atrial fibrillation (AF) and HAVB in men and women after AMI. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the sex differences of in-hospital arrhythmias after AMI. Multivariate cox proportional hazard models were performed to assess the impact of arrhythmias on 1-year mortality. Results In this cohort study of 14280 patients with 3159 (22.1%) women and 11121 (77.9%) men, 316 (2.2%) experienced ventricular arrhythmias (VAs) (sustained VT or secondary VF) with similar rates among men and women (2.3% and 2.2%, respectively, p=0.62). Compared to men, women were less likely to experience primary VF (1.6% vs 2.3%, p=0.034), but more likely to experience AF (8.6% and 5.0%, p&amp;lt;0.001). 372 (2.6%) patients experienced HAVB with higher rates of HAVB in women than men (3.7% and 2.3%, respectively, p&amp;lt;0.001). After multivariate analyses, the association with primary VF was attenuated (adjusted Odds Ratio (OR) = 0.80, p=0.15) but women remained more likely to experience AF (adjusted OR =1.24, p=0.01) and HAVB (adjusted OR =1.28, p=0.04). The occurrence of VAs was found to be associated with increased mortality in both men (adjusted Hazard Ratio (HR) =3.68, p&amp;lt;0.01) and women (adjusted HR=3.87, p&amp;lt;0.01) without a significant difference between the groups (p for interaction=0.203). The occurrence of AF was found to be associated with increased mortality in both men (adjusted HR=1.64, p&amp;lt;0.001) and women (adjusted HR=1.34, p&amp;lt;0.001) with a significant difference between the groups (p for interaction&amp;lt;0.001). HAVB was found to be associated with increased mortality in both men (adjusted HR=2.31, p&amp;lt;0.001) and women (adjusted HR=2.26, p&amp;lt;0.001) without a significant difference between the groups (p of interaction=0.21). Conclusions The incidence rates of VAs after AMI were similar in men and women, except for primary VF, which was more common among men. Women experienced more AF and HAVB than men. VAs, AF and HAVB were found to be associated with increased mortality. Funding Acknowledgement Type of funding sources: None.