Standardized Morbidity Research Articles

Association between the COVID-19 pandemic and short-term outcomes after esophagectomy for esophageal cancer in facilities with and without board-certified esophageal surgeons: a nationwide retrospective cohort study.

The COVID-19 pandemic had a profound impact on cancer screening, diagnosis, and treatment procedures. We speculated that during the COVID-19 pandemic, sufficient medical resources were maintained in board-certified hospitals, resulting in favorable short-term outcomes, whereas hospital functions in non-board-certified hospitals declined, leading to mortality increase. The aim of this study is to investigate the impact of COVID-19 pandemic on short-term outcomes after esophagectomy, based on the scale of the facilities. Data of patients who underwent esophagectomy for esophageal cancer between January 2018 and December 2022 were analyzed using the National Clinical Database (NCD) of Japan. We selected the Authorized Institutes for Board-certified Esophageal Surgeons (AIBCESs) certified by the Japan Esophageal Society (JES) at the hospital level for evaluating the difference in outcomes between institutions. Operative mortality rates and other morbidities were evaluated using the standardized mortality and morbidity ratio (SMR, the ratio of the number of observed patients to the expected number of patients). Within the study period, the annual mean operative mortality rate was higher in non-AIBCESs than in AIBCESs. The SMR showed no significant difference after the COVID-19 pandemic in non-AIBCES for mortality, as well as that in AIBCES. In non-AIBCESs, no worsening of results caused by the COVID-19 pandemic was observed despite the shortage of medical resources. Our findings highlighted the high quality of esophageal surgery in Japan during the COVID-19 pandemic, a critical situation with limited medical resources.

Результаты эпидемиологического мониторинга заболеваемости, смертности, распространенности злокачественных новообразований на основе действующего государственного ракового регистра.

Today, the cancer registry is an information and analytical system for collecting, storing and analyzing information about malignant neoplasms throughout the Russian Federation, as well as about the state of specialized oncological care. The value of the cancer registry is that its information can and should be analyzed: the registry allows for a statistical assessment of the disease, to see differences in morbidity, including depending on the region. Purpose of the study is to analyze the morbidity, mortality and prevalence of malignant neoplasms in the Russian Federation for the period 2012–2022. Materials and methods. Calculation and analysis of indicators were carried out in accordance with the recommendations of the International Agency for Research on Cancer for calculating indicators. The calculation of indicators was carried out with a 95% confidence interval. To calculate standardized morbidity and mortality rates, the world standard for the age distribution of the population was used. The calculation of the increase/decrease of indicators over a 10-year period was carried out with preliminary alignment of the time series. Results. Indicators of morbidity, mortality and prevalence of malignant neoplasms in the Russian Federation for the period 2012–2022 were analyzed, general trends in changes in indicators were determined for all cancers and several of the most common localizations that make the greatest contribution to the morbidity and mortality from cancer, the male and female population of the Russian Federation. Findings. Based on the results obtained, it is necessary to expand the implementation of the developed screening measures and strengthen control over existing programs for the early detection of cancer.

Hepatic real-world outcomes with obeticholic acid in primary biliary cholangitis (HEROES): A trial emulation study design.

Primary biliary cholangitis (PBC) is a rare, progressive liver disease. Obeticholic acid (OCA) received accelerated approval for treating patients with PBC in whom ursodeoxycholic acid (UDCA) failed, based on a surrogate endpoint of reduction in alkaline phosphatase. Analysis of the long-term safety extension with 2 external control groups demonstrated a significant increase in event-free survival in OCA-treated patients. This fully real-world evidence study assessed the effect of OCA treatment on the clinical outcomes. This trial emulation used data from the Komodo Healthcare Map™ claims database linked to US national laboratory, transplant, and death databases. Patients with compensated PBC and intolerance/inadequate response to UDCA who initiated OCA therapy were compared with patients who were OCA-eligible but not OCA-treated. The primary endpoint was time to first occurrence of death, liver transplant, or hospitalization for hepatic decompensation, analyzed using a propensity-score weighted Cox proportional hazards model. Baseline prognostic factors were balanced using standardized morbidity ratio weighting. For the primary analysis, 4174 patients contributed 11,246 control index dates; 403 patients contributed OCA indexes. Weighted groups were well balanced. Median (95% CI) follow-up in the OCA and non-OCA arms was 9.3 (8.4-10.6) months and 17.5 (16.2-18.6) months (weighted population; censored at discontinuation). Eight events occurred in the OCA arm, 32 in the weighted control (HR=0.37; 95% CI=0.14-0.75; p<0.001). Effects were consistent for each component of the composite endpoint. We identified a 63% reduced risk of hospitalization for hepatic decompensation, liver transplant, or death in OCA-treated versus non-OCA-treated individuals. HEROES; ClinicalTrials.gov NCT05292872.

Analysis of surgical volume and short‐term outcomes for upper gastrointestinal cancer post‐COVID‐19: Evidence from a nationwide Japanese database

AbstractAimPrevious studies indicated that short‐term outcomes for gastroenterological surgeries did not worsen during the COVID‐19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre‐ and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short‐term outcomes.MethodsData from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD‐established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.ResultsEsophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.ConclusionsThis study analyzed changes in surgical volume and short‐term outcomes for upper gastrointestinal cancer in the post‐COVID‐19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.

Thrombosis with thrombocytopenia syndrome following adenovirus vector-based vaccines to prevent COVID-19: Epidemiology and clinical presentation in Spain

BackgroundWe describe the epidemiological and clinical characteristics of thrombosis with thrombocytopenia syndrome (TTS) cases reported in Spain. MethodsWe included all venous or arterial thrombosis with thrombocytopenia following adenovirus vector-based vaccines (AstraZeneca or Janssen) to prevent COVID-19 disease between February 1st and September 26th, 2021. We describe the crude rate and the standardized morbidity ratio. We assessed the predictors of mortality. ResultsSixty-one cases were reported and 45 fulfilled eligibility criteria, 82% women. The crude TTS rate was 4/1 000 000 doses and 14–15/1 000 000 doses between 30–49 years. The number of observed cases of cerebral venous thrombosis was 6–18 higher than the expected in patients younger than 49 years. Symptoms started 10 (interquartile range (IQR): 7–14) days after vaccination. Eighty percent (95% confidence interval (CI): 65%–90%) had thrombocytopenia at the time of the emergency department visit, and 65% (95% CI: 49%–78%) had D-dimer >2000 ng/mL. Patients had multiple location thrombosis in 36% and fatal outcome in 24% cases. A platelet nadir < 50 000/μL (odds ratio (OR): 7.4; CI 95%: 1.2–47.5) and intracranial hemorrhage (OR: 7.9; IC95%: 1.3–47.0) were associated with fatal outcome. ConclusionTTS must be suspected in patients with symptoms 10 days after vaccination and thrombocytopenia and/or D-dimer increase.

Features of the epidemiology of esophageal cancer among the population of Ukraine for the period from 2016 to 2023

Esophageal cancer is an extremely serious and highly relevant issue with substantial medical and social significance. The significance is primarily due to its aggressive nature, as esophageal cancer progresses rapidly and is often diagnosed in its late stages. Late detection limits treatment options and generally leads to poorer survival outcomes, making it one of the most challenging cancers to manage. A study of data from the National Cancer Registry of Ukraine examined trends in standardized morbidity and mortality rates from 2016 to 2021. Over this period, the standardized morbidity rate decreased by 16.3%, while the standardized mortality rate dropped by 15.6%, suggesting some improvements in early detection and treatment approaches during those years. However, the outbreak of hostilities in Ukraine in 2022 created substantial barriers to healthcare operations, particularly in cancer centers. According to official data, military actions disrupted data collection, making it impossible to calculate standardized morbidity and mortality rates per capita for years 2022–2023. By the end of 2023, only data on the total number of patients registered in cancer care institutions were available. This lack of comprehensive data limits understanding of current trends in esophageal cancer and complicates planning for healthcare resources in the coming years. Wartime conditions pose unique challenges, as access to quality medical care may be restricted or delayed. For conditions like esophageal cancer, where early detection is crucial, limited access can lead to a higher likelihood of advanced-stage diagnoses, ultimately impacting prognosis and survival rates. These circumstances underscore the importance of maintaining continuity in cancer care, even under adverse conditions, through targeted healthcare planning. Keywords: analysis of dynamics, cancer, mortality and morbidity.

Is the development of arrhythmia predictable in rheumatoid arthritis?

This study aimed to determine whether there is a difference in the electrocardiography (ECG) measurements of healthy controls and rheumatoid arthritis (RA) patients and to predict whether they can be used to determine the risk of arrhythmia in patients. The prospective study included 50 cardiac asymptomatic RA patients (38 males, 12 females; mean age: 46.8±9.1 years; range, 18 to 60 years) who met the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology RA criteria and 50 healthy volunteers (34 males, 16 females; mean age: 43.4±10.4 years; range, 18 to 60 years) as a control group between June 1, 2022, and August 31, 2022. Disease activity of the patients was calculated with the Disase Activity Score (DAS28). Heart rate, minimum and maximum QT intervals, QT dispersion, minimum and maximum P waves, P wave dispersion (Pd), minimum and maximum Tp-e intervals, Tp-e dispersion, minimum and maximum corrected QT (QTc) intervals, QTc dispersion, and the Tp-e/QTc ratio in ECGs were calculated. The mean disease duration of the RA group was 9.09±5.74 years. The mean C-reactive protein level was 9.83±8.29, the mean erythrocyte sedimentation rate was 26.12±16.28 mm/h, and the mean DAS28 was 3.03±0.37. There was a statistically significant increase in the maximum P wave, Pd, maximum QT, QT dispersion, maximum QTc, QTc dispersion, maximum Tp-e, Tp-e dispersion, and Tp-e/QTc dispersion parameters in the RA group compared to the control group, while there was a significant decrease in the minimum P wave, minimum QT, and minimum QTc parameters. In our study, the Pd, QTc dispersion, Tp-e dispersion, and Tp-e/QTc dispersion values of our patients, which indicate the risk of atrial and ventricular arrhythmia, were found to be significantly higher. This finding suggests that our patients had an increased risk of cardiac morbidity and mortality. Arrhythmias are the likely source of the increase in sudden cardiac death in RA, and these new indicators measured on ECG can be used as standardized cardiovascular morbidity and mortality indicators in the future.

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

ObjectiveTo analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000–2019.MethodThis is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.ResultsThere were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC − 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.ConclusionHospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Features of the incidence of breast cancer in the Republic of Kazakhstan

Aim of the study. Analysis of breast cancer incidence in Kazakhstan for the period 2020 – 2022.Materials and methods. The study included all registered cases of breast cancer morbidity and mortality in the Republic of Kazakhstan for the period 2020-2022. Data for analysis were taken from the official statistical source: Statistical collection «Health of the population of the Republic of Kazakhstan and the activities of healthcare organizations in 2020»; Statistical collection “Health of the population of the Republic of Kazakhstan and the activities of healthcare organizations in 2021-2022.” The search depth was 3 years, from 2020 to 2022. A direct standardization method using a global population standard was used to calculate standardized morbidity and mortality rates.Results and discussion. As a result of studying statistical data for 2020-2022, it was found that cancer incidence rates per 100 thousand population in 2022, compared with 2021, increased by 5.2%, and compared to 2020 increased by 13.5%. In the structure of incidence, both in 2020 and 2021, and in 2022, breast cancer occupied 1st place, with an increase in dynamics from 2020 to 2022 from 8.76 to 9.73 per 100 thousand population.An analysis of the incidence of breast cancer by stages of the disease in the context of regions of Kazakhstan showed that high rates of stages I and II of breast cancer were established in the Kyzylorda, Pavlodar, and Atyrau regions. The lowest incidence rates of stage I and II breast cancer were observed in Akmola, Mangistau and Turkestan regions.Conclusions. According to the results of our review, many studies indicate that this disease continues to be the most frequently diagnosed malignant neoplasm and the leading cause of death among women in various countries of the world, including Kazakhstan. The conclusion of this article is that the incidence and mortality from breast cancer continues to be an urgent epidemiological problem in Kazakhstan, requiring further scientific research to identify risk factors.

Risk of second primary thyroid cancer in cancer survivors

A risk factor for thyroid cancer (TC) may be a history of former cancer and cancer therapy. The precise risk of a second primary thyroid carcinoma has not yet been revealed. In this study, we evaluated standardized incidence ratios (SIRs) of second primary thyroid cancer (SPTC) with consideration of different conditions and further analyzed the clinicopathological characteristics and survival of these patients. The cohort was selected from the US Surveillance, Epidemiology, and End Results (SEER) Program between 1975 and 2019. The standardized incidence ratios, morbidity risk, clinicopathological features, and survival of second primary thyroid carcinoma were analyzed. Propensity score matching (PSM) was used to balance covariates. Kaplan–Meier method was performed to assess the survival outcomes. Overall, 7066 patients with SPTC and 83,113 patients with primary TC were identified. The SIR of TC in tumor patients was 1.51/10,000, statistically higher than the natural population (0.94/10,000, P < 0.05). The most significant tumors contributing to the increased SIRs of SPTC were acute lymphocytic leukemia (3.49/10,000), Hodgkin’s lymphoma-nodal (3.29/10,000), salivary gland cancer (3.23/10,000), and kidney and renal pelvis cancer (3.05/10,000). The incidence of TC increased significantly in tumor patients who received radiotherapy/chemotherapy before age 35. The age at diagnosis of the SPTC was much older than the primary TC (64.01 vs. 49.55 years, p < 0.001). The SPTC had a higher percentage of histological grades 3/4 (23.14% vs. 15.19%, p < 0.001). Survival analyses demonstrated a worse prognosis for the SPTC group compared to the primary TC group. But after PSM, the survival outcomes of the two groups tended to be equivalent (P = 0.584). The SIRs of TC are higher in tumor patients. The most significant factors contributing to the increased risk of SPTC were some specific former tumors and acceptance of radiotherapy/ chemotherapy before age 35. There was no significant difference in survival between SPTC and primary TC.

A Retrospective Review on the Effects of Nasoalveolar Molding on Infant Weight Gain and Time to Primary Lip Repair in Unilateral and Bilateral Cleft Lip and Palate.

In patients with severe cleft deformities, nasoalveolar molding (NAM) can improve long-term lip and nasal symmetry by reducing the size of the cleft, better aligning the alveolus, lip, and nose, and making the primary lip repair more predictable. Despite the increasing number of published studies on modified NAM techniques, the effects of NAM on weight gain and time to primary lip repair remain less studied. This study aims to evaluate the effect of NAM on feeding, weight gain, growth velocity, and time to primary lip repair in patients with complete unilateral and bilateral cleft lip and palate (BCLP). A retrospective, single-institution review was conducted to identify patients with complete unilateral and BCLP treated between January 2005 and June 2020. The following outcomes were measured: age at the time of lip and palate repairs; weight, height, and BMI on the date of lip repair; and growth velocity. Crude and standardized morbidity ratio-weighted differences in outcome means and 95% confidence intervals were estimated using t tests. Seventy-one patients were included in the study, 30 of whom underwent NAM. On average, patients treated with preoperative NAM underwent lip repair later than patients who were not treated with NAM. They also had a greater growth velocity and BMI when compared to their non-NAM counterparts. These differences, however, were not statistically significant. This study explores the relationships between the use of NAM and preoperative weight gain, as well as time to lip repair in patients with complete unilateral and BCLP. Additional studies may be needed to better elucidate the effect of NAM on weight gain and the time required for surgical repair of the cleft lip and palate.

Spatial analysis of cholangiocarcinoma in relation to diabetes mellitus and Opisthorchis viverrini infection in Northeast Thailand

Cholangiocarcinoma (CCA) exhibits a heightened incidence in regions with a high prevalence of Opisthorchis viverrini infection, with previous studies suggesting an association with diabetes mellitus (DM). Our study aimed to investigate the spatial distribution of CCA in relation to O. viverrini infection and DM within high-risk populations in Northeast Thailand. Participants from 20 provinces underwent CCA screening through the Cholangiocarcinoma Screening and Care Program between 2013 and 2019. Health questionnaires collected data on O. viverrini infection and DM, while ultrasonography confirmed CCA diagnoses through histopathology. Multiple zero-inflated Poisson regression, accounting for covariates like age and gender, assessed associations of O. viverrini infection and DM with CCA. Bayesian spatial analysis methods explored spatial relationships. Among 263,588 participants, O. viverrini infection, DM, and CCA prevalence were 32.37%, 8.22%, and 0.36%, respectively. The raw standardized morbidity ratios for CCA was notably elevated in the Northeast’s lower and upper regions. Coexistence of O. viverrini infection and DM correlated with CCA, particularly in males and those aged over 60 years, with a distribution along the Chi, Mun, and Songkhram Rivers. Our findings emphasize the association of the spatial distribution of O. viverrini infection and DM with high-risk CCA areas in Northeast Thailand. Thus, prioritizing CCA screening in regions with elevated O. viverrini infection and DM prevalence is recommended.

Increasing tree cover and high-albedo surfaces reduces heat-related ER visits in Los Angeles, CA

There is an urgent need for strategies to reduce the negative impacts of a warming climate on human health. Cooling urban neighborhoods by planting trees and vegetation and increasing albedo of roofs, pavements, and walls can mitigate urban heat. We used synoptic climatology to examine how different tree cover and albedo scenarios would affect heat-related morbidity in Los Angeles, CA, USA, as measured by emergency room (ER) visits. We classified daily meteorological data for historical summer heat events into discrete air mass types. We analyzed those classifications against historical ER visit data to determine both heat-related and excess morbidity. We used the Weather Research and Forecasting model to examine the impacts of varied tree cover and albedo scenarios on meteorological outcomes and used these results with standardized morbidity data algorithms to estimate potential reductions in ER visits. We tested three urban modification scenarios of low, medium, and high increases of tree cover and albedo and compared these against baseline conditions. We found that avoiding 25% to 50% of ER visits during heat events would be a common outcome if the urban environment had more tree cover and higher albedo, with the greatest benefits occurring under heat events that are moderate and those that are particularly hot and dry. We conducted these analyses at the county level and compared results to a heat-vulnerable, working-class Los Angeles community with a high concentration of people of color, and found that reductions in the rate of ER visits would be even greater at the community level compared to the county.

Public exposure in the Orenburg region due to natural sources of ionizing radiation. Part 3: Approaches to radon survey planning

A comprehensive radiation survey of settlements in six districts of the eastern part of the Orenburg region in terms of exposure to natural sources of ionizing radiation, carried out in 2019, revealed numerous exceedances of the hygienic norm (action level) for indoor radon concentration in residential and public buildings. It was found that among other studied factors, exhalation of radon from the ground under the buildings is the main source of high levels of public exposure. Due to the lack of funding for the continuation of the survey in 2020, specialists of St. Petersburg Research Institute of Radiation Hygiene after Professor P.V. Ramzaev, Directorate of Rospotrebnadzor in the Orenburg region and the Center of Hygiene and Epidemiology in the Orenburg region needed to develop new approaches to survey planning. These new approaches should provide maximum amount of measurement information necessary to ensure radiation safety of the region’s population, with minimal financial investments and labor costs. Indoor radon concentration in residential and public buildings was undoubtedly chosen as the studied factor, and the integrated measurement method using SSNTDs was chosen as the most suitable method for the objectives of the survey due to its scalability and ease of detectors deployment. Since exposure to radon and its progeny is the second leading cause of lung cancer after smoking, the selection of priority districts of the region for the radon survey was based on average standardized trachea, bronchi, and lung cancer morbidity rates in the districts of the Orenburg region for 2009-2018. The survey conducted in 2020-2023 revealed exceedances of the hygienic norm (action level) for indoor radon concentration in five of seven surveyed districts. By 2025 it is planned to conduct radon surveys in three more districts of the Orenburg region with increased respiratory systems cancer morbidity rates.

Colombian Ocular Diseases Epidemiology Study (CODES): Prevalence Incidence, and Sociodemographic Characterization of Vision Impairment (2015–2019), A Nationwide Study

ABSTRACT Purpose To describe the prevalence, incidence, and sociodemographic characterization of moderate to severe vision impairment (MSVI) and blindness in Colombia based on the National Health Registry Integrated Social Protection Information System (SISPRO) Database. Methods We performed a nationwide population-based study using SISPRO and the International Classification of Diseases. Total and new cases were identified to calculate the prevalence and incidence per 100,000 inhabitants of MSVI and blindness between 2015 and 2019. Blindness was defined as a best-corrected visual acuity (BCVA) of less than 20/400 in the better-seeing eye. Meanwhile, MSVI is a BCVA from 20/70 to equal or better than 20/400 in the better-seeing eye. An ANOVA test was performed to identify age differences. A conditional autoregressive model was also employed to depict standardized morbidity rate maps. Results From the 50 million inhabitants, the average prevalence and incidence of MSVI were 13.94 and 13.34 between 2015 and 2019, respectively, while for blindness, they were 4.03 and 3.53. Females accounted for most reported cases, and there was a notable shift towards individuals over 50 years (p < 0.001). Valle del Cauca was the region with the most cases reported and the greatest disease burden. Conclusion This is the first nationwide population-based study describing the prevalence, incidence, and sociodemographic characterization of blindness and MSVI in Colombia. In recent years, there has been an increased number of cases, prevalence, and incidence, with females over 50 particularly affected. This research provides insight into the country’s vision impairment epidemiology landscape and contributes to formulating public health policies to improve eye health care.

Clarifying the causal contrast: An empirical example applying the prevalent new user study design.

The prevalent new user design extends the active comparator new user design to include patients switching to a treatment of interest from a comparator. We examined the impact of adding "switchers" to incident new users on the estimated hazard ratio (HR) of hospitalized heart failure. Using MarketScan claims data (2000-2014), we estimated HRs of hospitalized heart failure between patients initiating GLP-1 receptor agonists (GLP-1 RA) and sulfonylureas (SU). We considered three estimands: (1) the effect of incident new use; (2) the effect of switching; and (3) the effect of incident new use or switching, combining the two population. We used time-conditional propensity scores (TCPS) and time-stratified standardized morbidity ratio (SMR) weighting to adjust for confounding. We identified 76 179 GLP-1 RA new users, of which 12% were direct switchers (within 30 days) from SU. Among incident new users, GLP-1 RA was protective against heart failure (adjHRSMR = 0.74 [0.69, 0.80]). Among switchers, GLP-1 RA was not protective (adjHRSMR = 0.99 [0.83, 1.18]). Results in the combined population were largely driven by the incident new users, with GLP-1 RA having a protective effect (adjHRSMR = 0.77 [0.72, 0.83]). Results using TCPS were consistent with those estimated using SMR weighting. When analyses were conducted only among incident new users, GLP-1 RA had a protective effect. However, among switchers from SU to GLP-1 RA, the effect estimates substantially shifted toward the null. Combining patients with varying treatment histories can result in poor confounding control and camouflage important heterogeneity.

EPIDEMIOLOGICAL SITUATION OF SKIN CANCER AND MELANOMIA&#x0D; IN THE REPUBLIC OF KAZAKHSTAN IN 2012-2022

Relevance: Skin cancer, including melanoma, is a major health problem and one of the most common cancers in the world.&#x0D; The study aimed to obtain a complete epidemiological picture of skin cancer and melanoma in the Republic of Kazakhstan for 11 years,&#x0D; including analysis of data for 2022, considering various parameters such as age, sex, ethnicity, region, and tumor type.&#x0D; Methods: The study used data from patients registered in the national cancer registry of the Republic of Kazakhstan from 2012 to 2022,&#x0D; diagnosed with skin carcinoma and skin melanoma (ICD-10 code: C44-C43). The number of skin carcinomas and melanoma cases is presented as absolute and crude rates per 100,000 population. Absolute standardized morbidity and mortality rates were calculated using the world&#x0D; standard (World).&#x0D; Results: At the end of 2022, 19,714 and 2,689 patients were diagnosed with “Skin Cancer” or “Skin Melanoma” in the Republic of Kazakhstan, respectively. From 2012 to 2022, the incidence of skin cancer increased by 24% and melanoma by 15%. In 2022, the incidence of skin&#x0D; cancer and melanoma was higher among women by 24% and 26%, respectively. Mortality from skin cancer is in 23rd place, from melanoma in&#x0D; 21st place. Mortality rates from skin cancer and melanoma were 0.5 and 0.7 per 100 thousand population, respectively. The peak incidence of skin cancer in 2022 was observed in the age group 65-74 years (36%), and mortality in the age groups 65-74 and 75-84 years (17% each). The&#x0D; peak incidence of skin melanoma in 2022 was observed in the age groups 55-64 years and 65-74 years (24% and 25%), and mortality in the&#x0D; groups 45-54 years and 35-44 years (14% and 10%).&#x0D; Conclusion: There has been a steady increase in the incidence of skin cancer and melanoma, which indicates the seriousness of this problem in the country and underlines the need for further measures to prevent, diagnose and treat skin cancer and melanoma in the Republic of&#x0D; Kazakhstan. It should be remembered that many cases of skin cancer can be prevented with simple precautions.

Colombian Ocular Diseases Epidemiology Study (CODES): Prevalence and Sociodemographic Characterization of Refractive Errors in Colombian Eye Care Consultations

ABSTRACT Purpose To estimate the prevalence and demographic characteristics of uncorrected refractive errors (URE) in people who attended eye care consultations in Colombia between 2015 and 2019, using the National Health Registry data. Methods We identified ICD codes for myopia (H-52.1), degenerative myopia (H-44.2), hyperopia (H-52.0), and astigmatism (H-52.2) from the Integrated Social Protection Information System. Crude prevalence rates by age and sex were calculated for the population attending eye care services during these years. Additionally, we developed a standardized morbidity map across county departments. Results In Colombia, the prevalence of URE among eye care consultations was 30.26%, increasing from 30.39% in 2015 to 35.14% in 2019. Of the 1,579,778 cases analyzed, 60.9% were females. Astigmatism emerged as the most prevalent URE, predominantly seen in individuals under 40 years old. Myopia showed the highest prevalence in the 10–30 age group, whereas hyperopia was most prevalent in the first decade of life. Geographically, the Andean region recorded most of URE cases, while more remote areas have seen a rising morbidity risk in recent years. Conclusions The rising trend of URE in Colombia and its demographic and geographical variations underscores the urgent need for health professionals and government authorities to acknowledge and address this issue. This study provides crucial insights into the refractive error landscape across the country, highlighting the necessity for prevention programs specifically designed to cater to the country’s unique needs.

Impact of the COVID-19 pandemic on short-term outcomes after pancreaticoduodenectomy for pancreatic cancer: A retrospective study from the Japanese National Clinical Database, 2018-2021.

The coronavirus disease 2019 (COVID-19) pandemic greatly impacted medical resources such as cancer screening, diagnosis, and treatment given to people for various diseases. We surveyed the impacts of the pandemic on the incidence of complications and mortality following pancreaticoduodenectomy for pancreatic cancer in Japan. Data on patients who underwent pancreaticoduodenectomy for pancreatic cancer were extracted from the Japanese National Clinical Database (NCD) between 2018 and 2021. The number of the pancreaticoduodenectomy for pancreatic cancer were obtained and then the morbidity and mortality rates were evaluated using a standardized morbidity/mortality ratio (SMR), which is the ratio of the observed number of incidences to the expected number of incidences calculated by the risk calculator previously developed by the NCD. This study included 22 255 cases. The number of pancreaticoduodenectomies exhibited an increasing trend even during the COVID-19 pandemic. The mean observed incidence rates of Grade C pancreatic fistula and Clavien-Dindo grade ≥4 complications, and the 30-day mortality and surgical mortality rates were 0.8%, 1.8%, 0.8% and 0.9%, respectively. The standardized morbidity ratios did not increase during the COVID-19 pandemic. The standardized mortality ratios remained within the range of variations observed before the COVID-19 pandemic. The increasing trend in the number of pancreaticoduodenectomies and favorable short-term outcomes even in the COVID-19 pandemic suggest the medical care for pancreatic cancer in Japan functioned well during the pandemic.

Sex Differences in Psychopathology Following Potentially Traumatic Experiences

Various psychopathology may follow trauma; however, sex differences in these ranging manifestations of posttraumatic psychopathology remain understudied. To investigate sex-specific incidence of posttraumatic psychopathology. This population-based cohort study of Danish national health registries included a cohort of individuals who experienced a potentially traumatic event (PTE) from 1994 to 2016. Individuals were further categorized by presence of any pretrauma psychopathology. A comparison group of individuals who experienced a nontraumatic stressor (nonsuicide death of a first-degree relative) was examined as a reference cohort. At least 1 of 8 PTEs (eg, physical assault, transportation accident) derived through health registry International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, with additional qualifiers to improve classification accuracy. Incidence of 9 categories of ICD-10 psychiatric disorders recorded in registries within 5 years of PTEs. The standardized morbidity ratios (SMRs) for psychopathology outcomes were also calculated to compare individuals experiencing PTEs with those experiencing a nontraumatic stressor. This study included 1 398 026 individuals who had been exposed to trauma (475 280 males [34.0%]; 922 750 females [66.0%]). The group of males who had been exposed to trauma were evenly distributed across age, while most females in the trauma-exposed group were aged 16 to 39 years (592 385 [64.2%]). Males and females were equally distributed across income quartiles and predominantly single. Following PTEs, the most common diagnosis was substance use disorders for males (35 160 [7.4%]) and depressive disorders for females (29 255 [3.2%]); incidence proportions for these and other disorders were higher among males and females with any pretrauma psychopathology. Certain PTEs had elevated onset of various psychiatric disorders and some sex differences emerged. Following physical assault, associations were found with schizophrenia or psychotic disorders for males (SMR, 17.5; 95% CI, 15.9-19.3) and adult personality disorders for females (SMR, 16.3; 95% CI, 14.6-18.3). For noninterpersonal PTEs, males had larger SMRs for substance use, schizophrenia or psychotic disorders, and adult personality disorders (SMR, 43.4; 95% CI, 41.9-45.0), and females had larger SMRs for depressive disorders (SMR, 19.0; 95% CI, 18.6-19.4). Sex differences were also observed, particularly when considering pretrauma psychopathology. For example, among interpersonal PTEs, males were most likely to develop substance use disorders after physical assault, whereas females were more likely to develop various disorders, with stronger associations seen for females without pretrauma psychiatric diagnoses. Among noninterpersonal PTEs, exposure to toxic substance showed robust associations with psychopathology, particularly in those without pretrauma psychopathology, with sex-specific differences across psychiatric categories. Mental disorders after trauma were wide-ranging for males and females, and sex differences in patterns of posttraumatic psychopathology were more pronounced when accounting for pretrauma psychopathology. Findings provide new insights for sex-relevant PTEs and their mental health consequences. It also outlines future directions for advancing understanding of a constellation of posttraumatic psychopathology in males and females.