Standardized Prevalence Ratios Research Articles

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan

BackgroundWhile it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known.MethodsStandardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area.ResultsThe prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients.ConclusionsThe prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

Cancer Prevalence among Physicians in Korea: A Single Center Study.

BackgroundThere is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population.MethodsWe analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy.ResultsWe collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001).ConclusionThis study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians.

Cancer Prevalence among a Cross-sectional Survey of Female Orthopedic, Urology, and Plastic Surgeons in the United States

BackgroundExposure to ionizing radiation from fluoroscopy performed during surgery, although low and within established limits, remains a health concern among surgeons. Estimates of breast cancer prevalence among women across surgery specialties with different patterns of fluoroscopy use are needed to evaluate this concern. MethodsFemale U.S. surgeons in urology, plastics, and orthopedics were identified using national directories and mailed surveys to collect information on occupational and medical history, including cancer diagnoses. Standardized prevalence ratios (SPRs) and 95% CIs were calculated by dividing the observed number of cancers among female surgeons in each specialty by the expected number, based on the gender-specific, age-specific, and race-specific cancer prevalence statistics in the general U.S. population. ResultsStandard fluoroscopy use more than once per week was common among urologists (54%) and orthopedists (37%); the same frequency of mini fluoroscopy use was only common among orthopedics (31%) and hardly ever used by urologists. Plastic surgeons reported very infrequent use of any fluoroscopy. For orthopedic surgeons, a significantly greater than expected prevalence of any cancer (SPR, 1.85; 95% CI, 1.19–2.76) and breast cancer (SPR, 2.90; 95% CI, 1.66–4.71) were observed. There was no difference between the observed and expected prevalence of any cancer or breast cancer for urology or plastics. ConclusionsUsing the first available cancer prevalence data comparing female surgeons across three specialties, we report that orthopedic surgeons have a greater than expected prevalence of cancer that may or may not be owing to occupational exposure to ionizing radiation.

Standardized binomial models for risk or prevalence ratios and differences.

Epidemiologists often analyse binary outcomes in cohort and cross-sectional studies using multivariable logistic regression models, yielding estimates of adjusted odds ratios. It is widely known that the odds ratio closely approximates the risk or prevalence ratio when the outcome is rare, and it does not do so when the outcome is common. Consequently, investigators may decide to directly estimate the risk or prevalence ratio using a log binomial regression model. We describe the use of a marginal structural binomial regression model to estimate standardized risk or prevalence ratios and differences. We illustrate the proposed approach using data from a cohort study of coronary heart disease status in Evans County, Georgia, USA. The approach reduces problems with model convergence typical of log binomial regression by shifting all explanatory variables except the exposures of primary interest from the linear predictor of the outcome regression model to a model for the standardization weights. The approach also facilitates evaluation of departures from additivity in the joint effects of two exposures. Epidemiologists should consider reporting standardized risk or prevalence ratios and differences in cohort and cross-sectional studies. These are readily-obtained using the SAS, Stata and R statistical software packages. The proposed approach estimates the exposure effect in the total population.

Increased risk of additional cancers among patients with gastrointestinal stromal tumors: A population‐based study

Most gastrointestinal stromal tumors (GISTs) are considered nonhereditary or sporadic. However, single-institution studies suggest that GIST patients develop additional malignancies at increased frequencies. It was hypothesized that greater insight could be gained into possible associations between GISTs and other malignancies with a national cancer database inquiry. Patients diagnosed with GISTs (2001-2011) in the Surveillance, Epidemiology, and End Results database were included. Standardized prevalence ratios (SPRs) and standardized incidence ratios (SIRs) were used to quantify cancer risks incurred by GIST patients before and after GIST diagnoses, respectively, in comparison with the general US population. There were 6112 GIST patients, and 1047 (17.1%) had additional cancers. There were significant increases in overall cancer rates: 44% (SPR, 1.44) before the GIST diagnosis and 66% (SIR, 1.66) after the GIST diagnosis. Malignancies with significantly increased occurrence both before and after diagnoses included other sarcomas (SPR, 5.24; SIR, 4.02), neuroendocrine-carcinoid tumors (SPR, 3.56; SIR, 4.79), non-Hodgkin lymphoma (SPR, 1.69; SIR, 1.76), and colorectal adenocarcinoma (SPR, 1.51; SIR, 2.16). Esophageal adenocarcinoma (SPR, 12.0), bladder adenocarcinoma (SPR, 7.51), melanoma (SPR, 1.46), and prostate adenocarcinoma (SPR, 1.20) were significantly more common only before the GIST diagnosis. Ovarian carcinoma (SIR, 8.72), small intestine adenocarcinoma (SIR, 5.89), papillary thyroid cancer (SIR, 5.16), renal cell carcinoma (SIR, 4.46), hepatobiliary adenocarcinoma (SIR, 3.10), gastric adenocarcinoma (SIR, 2.70), pancreatic adenocarcinoma (SIR, 2.03), uterine adenocarcinoma (SIR, 1.96), non-small cell lung cancer (SIR, 1.74), and transitional cell carcinoma of the bladder (SIR, 1.65) were significantly more common only after the GIST diagnosis. This is the first population-based study to characterize the associations and temporal relations between GISTs and other cancers by both site and histological type. These associations may carry important clinical implications for future cancer screening and treatment strategies.

Risk of coronary artery disease in patients with ankylosing spondylitis: a systematic review and meta-analysis.

To investigate the association between coronary artery disease (CAD) and ankylosing spondylitis (AS). We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, standardized prevalence ratio or standardized incidence ratios with 95% confidence comparing CAD risk in patients with AS versus non-AS controls. Pooled risk ratios and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance of DerSimonian and Laird. Out of 229 potentially relevant articles, ten studies (five retrospective cohort studies and five cross-sectional studies) were identified and included in our data analysis. The overall pooled risk ratio of CAD in patients with AS was 1.41 (95% CI: 1.29-1.54). The pooled risk ratios for cross-sectional and cohort studies were 2.08 (95% CI: 1.28-3.40) and 1.36 (95% CI: 1.31-1.41), respectively. The statistical heterogeneity of this meta-analysis was moderate with an I(2) of 56%. Our study demonstrated a statistically significant increased CAD risk among patients with AS with 41% excess risk.

Prevalence of Cancer in Female Plastic Surgeons in the United States

Objective: Several female sub-populations of the healthcare industry, including radiologists, radiology technicians, and orthopedic surgeons, display an increased prevalence of breast cancer. Female plastic surgeons have a similar exposure to possible risk factors such as radiation exposure, late parturition, and overnight shifts. Therefore, this study aimed to evaluate the risk of breast cancer and overall cancer in female plastic surgeons. Methods: A two-page survey designed to collect data on respondent demographics, cancer incidence and exposure to social and occupational risk factors as identified in the current literature was mailed to 612 currently practicing female plastic surgeons identified by the American Society of Plastic Surgeons (ASPS). Prevalence rates for breast cancer and cancer in general were calculated. Only melanoma and internal cancers that were diagnosed within 15 years of the survey date were included, enabling us to compare the results with data from the National Institute’s Surveillance Epidemiology and End Results (SEER 11) Program. Standardized prevalence ratios (SPR), confidence intervals, and exact p-values were calculated. Results: Fourteen of the 352 respondents had been diagnosed with cancer, including three breast cancer cases, within 15 years preceeding the survey. These numbers are not signficantly lower than the expected prediction of 16 cancer and six breast cancer cases, based on the sex and race-specific prevalences in the general U.S. population. SPRs were 0.89 [95%CI: 0.49 to 1.5] for all cancers and 0.54 [95%CI: 0.11, 1.57] for breast cancer. Conclusion: Despite similarities to subpopulations with increased breast and overall cancer prevalence, the subpopulation of female plastic surgeons had no evdience of excess cancers compared to age and race-adjusted women in the general US population.

Lack of exercise of "moderate to vigorous" intensity in people with low levels of physical activity is a major discriminant for sociodemographic factors and morbidity.

IntroductionThe aim is to examine the differences between participation at low and zero moderate to vigorous physical activity (MVPA) in relation to their trends and associations with known socio-demographic and health factors. We hypothesised that the number of people at zero MVPA level could be rising despite a parallel increase in the population meeting the recommended MVPA level. We also hypothesised that graded associations of sociodemographic and health factors exist across MVPA levels.MethodsTwo independent population-based samples (n = 4320 [2004] and n = 2176 [1997]), were recruited with a stratified and random sampling procedure and interviewed at home by professional interviewers. The MVPA was assessed by validated questionnaire. The participants were classified into three MVPA levels: zero, low and recommended MVPA. The trend of each MVPA level was analysed with the standardized prevalence ratios. Correlates of low and zero MVPA levels were examined using multinomial logistic regression.ResultsThe population at zero and recommended MVPA levels rose between 1997–2004 by 12% (95% CI, 5–20%) and 7% (95% CI,−4–19%) respectively, while the population at low MVPA level decreased. At zero MVPA level, associative patterns were observed with sociodemographic and health factors which were different when compared to the population at low MVPA level.ConclusionsDespite the slight increase of population meeting the recommended MVPA level, a higher trend of increase was observed at zero MVPA level. Both recommended and low MPVA levels increased their participation by absorbing participants from the low MVPA level. The sociodemographic profile of those with low MVPA was more similar to the population at recommended MVPA than at zero MVPA level. Methodological implications about the combination of light and moderate-intensity PA could be derived. The prevention of decline in actual low MVPA could change the trend of increase in the population at zero MVPA level, particularly among young adults.

The association between psychiatric disorders and work-related problems among subway drivers in Korea.

ObjectivesThis study aimed to find the prevalence and occupational risk factors for major psychiatric disorders among subway drivers in South Korea.MethodsOf all 998 current subway drivers, 995 participated in this study. The Korean version of the Composite International Diagnostic Interview (K-CIDI 2.1) was administered by trained interviewers to diagnose psychiatric disorders in all participants. The questions on socio-demographic characteristics and working conditions included some questions related to a person under train (PUT) experience and work-related problems. One-year prevalence and lifetime prevalence of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and panic disorder were diagnosed through the interview. The standardized prevalence ratios (SPRs) of these three disorders were calculated in the sample of subway drivers using the 2011 Korean National Epidemiologic Survey data as a basis. Multiple logistic regressions were performed to determine the association between work-related factors and the prevalence of the psychiatric disorders.ResultsThe standardized prevalence ratios (SPRs) for a 1-year prevalence of MDD and PTSD among subway drivers were 1.1 (95% CI 0.7-1.7) and 5.6 (95% CI 3.1-8.8), respectively. Conflict with passengers was significantly associated with an increased risk for both MDD and PTSD in 1-year and in lifetime prevalence. Experiencing a sudden stop due to an emergency bell increased the risk of the lifetime prevalence of MDD (OR 2.61, 95% CI 1.14-6.97) and PTSD (OR 7.53, 95% CI 1.77-32.02). The risk of PTSD significantly increased among drivers who once experienced a near accident in terms of both the 1-year prevalence (OR 8.81, 95% CI 1.96-39.3) and the lifetime prevalence (OR 6.36, 95% CI 2.40-16.90).ConclusionsPTSD and panic disorder were more prevalent among subway drivers than in the general population. We found that having a conflict with passengers, a near accident, and a breakdown while driving can be risk factors for psychiatric disorders among subway drivers. Therefore, a prompt and sensitive approach should be introduced for these high risk groups within the subway company.

Prevalence of multiple sclerosis among immigrants in Norway

Background: Multiple sclerosis (MS) prevalence is unevenly distributed worldwide. Immigration to Norway from countries with a lower MS prevalence is increasing. The aim of this study was to investigate MS prevalence in different immigrant populations in Norway and evaluate the effect of migrating from low- to high-risk regions of MS. Method: First- and second-generation immigrants from the largest immigrant populations were identified from the 2012 Norwegian prevalence study. Prevalence of MS in different ethnic groups was compared using the standardized prevalence ratio (SPR). Results: European and North-American immigrants had the highest prevalence of MS, whereas African and Asian immigrants had the lowest. The prevalence of first-generation Iranian immigrants was not significantly different from the total Norwegian population (SPR 0.70, 95% CI: 0.46–1.03). Second-generation immigrants from Pakistan (SPR 1.62, 95% CI: 0.88–2.76) had a strong increase in prevalence compared to the first generation (SPR 0.13, 95% CI: 0.05–0.28). Conclusion: MS prevalence among immigrants in Norway in general reflects the uneven distribution worldwide. The sharp increase in prevalence in immigrants seen in one generation suggests strong environmental factors affecting the MS risk in Norway.

High diabetes risk among asylum seekers in The Netherlands.

To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardized prevalence ratios were found for asylum seekers from Somalia, Sudan and Sri Lanka. The standardized prevalence ratio was higher in asylum seekers aged ≥ 30 years. Incidence rates were higher compared with the reference population for all length-of-stay intervals. Asylum seekers from the majority of countries of origin were at higher risk of diabetes compared with the general population in the Netherlands. Asylum seekers from Somalia were particularly at risk. This emerging public health issue requires attention from policy-makers and care providers.

AB0133 Blood Transfusion (BT) is Associated with the Risk of Developing Rheumatoid Arthritis (RA) and with Disease Severity: Data from ESPOIR Cohort

BackgroundBoth environmental or lifestyle factors, including smoking, overweight and periodontal disease, were found to be associated with an increased risk for developing rheumatoid arthritis (RA). Few studies suggested that blood...

THU0094 Incidence and Predictors of Morphometric Vertebral Fractures in Patients with Ankylosing Spondylitis

BackgroundAnkylosing spondylitis (AS) is associated with an increased incidence of vertebral fractures (VFs). Previous studies report the prevalence of morphometric VFs; however, the actual incidence and predictors of morphometric VFs...

Excess Burden of Depression among HIV-Infected Persons Receiving Medical Care in the United States: Data from the Medical Monitoring Project and the Behavioral Risk Factor Surveillance System

BackgroundWith increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.Methods and FindingsWe used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.ConclusionsDepression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden.

The self-reported health of U.S. flight attendants compared to the general population

BackgroundFew studies have examined the broad health effects of occupational exposures in flight attendants apart from disease-specific morbidity and mortality studies. We describe the health status of flight attendants and compare it to the U.S. population. In addition, we explore whether the prevalence of major health conditions in flight attendants is associated with length of exposure to the aircraft environment using job tenure as a proxy.MethodsWe surveyed flight attendants from two domestic U.S. airlines in 2007 and compared the prevalence of their health conditions to contemporaneous cohorts in the National Health and Nutrition Survey (NHANES), 2005-2006 and 2007-2008. We weighted the prevalence of flight attendant conditions to match the age distribution in the NHANES and compared the two populations stratified by gender using the Standardized Prevalence Ratio (SPR). For leading health conditions in flight attendants, we analyzed the association between job tenure and health outcomes in logistic regression models.ResultsCompared to the NHANES population (n =5,713), flight attendants (n = 4,011) had about a 3-fold increase in the age-adjusted prevalence of chronic bronchitis despite considerably lower levels of smoking. In addition, the prevalence of cardiac disease in female flight attendants was 3.5 times greater than the general population while their prevalence of hypertension and being overweight was significantly lower. Flight attendants reported 2 to 5.7 times more sleep disorders, depression, and fatigue, than the general population. Female flight attendants reported 34% more reproductive cancers. Health conditions that increased with longer job tenure as a flight attendant were chronic bronchitis, heart disease in females, skin cancer, hearing loss, depression and anxiety, even after adjusting for age, gender, body mass index (BMI), education, and smoking.ConclusionsThis study found higher rates of specific diseases in flight attendants than the general population. Longer tenure appears to explain some of the higher disease prevalence. Conclusions are limited by the cross-sectional design and recall bias. Further study is needed to determine the source of risk and to elucidate specific exposure-disease relationships over time.

Prevalence and Correlates of Cigarette Smoking among Chinese Schizophrenia Inpatients Receiving Antipsychotic Mono-Therapy

ObjectiveTo investigate the prevalence rate of cigarette smoking and its socio-demographic and clinical correlates in Chinese schizophrenia inpatients receiving antipsychotic mono-therapy.MethodsThis study was a cross-sectional, two-site, hospital-based survey. Four hundred and twenty-nine schizophrenia patients (male/female: 66.9% vs. 33.1%) were consecutively recruited from psychosis inpatient wards of two large specialty psychiatric hospitals in mainland China. Patients were assessed using a cigarette smoking questionnaire, the Positive and Negative Symptom Scale, the Simpson Angus Scale, the Barnes Akathisia Rating Scale, and the Abnormal Involuntary Movement Scale. Socio-demographic and other clinical data were also collected. We calculated the prevalence of current smoking in our sample as well as its indirectly standardized prevalence ratio (ISPR) using data from the 2010 Global Adult Tobacco Survey in China.ResultsThe prevalence rate of current smoking was 40.6% in our sample, and 57.5% in males and 6.3% in females. The ISPRs of all patients, men and women were 1.11(95%CI: 0.95∼1.29), 1.07(95%CI = 0.91∼1.24) and 4.64(95%CI = 2.12∼8.82), respectively. The overall and male-specific prevalence of current smoking did not differ significantly between patients and the general population. In multiple logistic regression analysis, male sex, older age, poor marital status, alcohol use, use of first-generation antipsychotics, longer duration of illness, more frequent hospitalizations, and more severe negative symptoms were independently associated with current smoking.ConclusionMale Chinese inpatients with schizophrenia who received a mono-therapy of antipsychotics were not more likely to smoke than the general population. Cigarette smoking is more common in schizophrenia patients with more severe illness.

Incidence and predictors of morphometric vertebral fractures in patients with ankylosing spondylitis.

IntroductionAnkylosing spondylitis (AS) is associated with an increased incidence of vertebral fractures (VFs); however the actual incidence and predictors of morphometric VFs are unknown. The present study examined the incidence and predictors of new VFs in a large AS cohort.MethodsIn total, 298 AS patients who fulfilled the modified New York criteria were enrolled and spinal radiographs were evaluated biennially. Clinical and laboratory data and radiographic progression were assessed according to the Bath AS Disease Activity Index, erythrocyte sedimentation rate, C-reactive protein (CRP), and the Stoke AS spine score (SASSS). VF was defined according to the Genant criteria. The incidence of VFs at 2 and 4 years was evaluated using the Kaplan-Meier method. The age-specific standardized prevalence ratio (SPR) for AS patients in comparison with the general population was calculated.ResultsOf 298 patients, 31 (10.8%) had previous VFs at baseline. A total of 30 new VFs occurred in 26 patients over 4 years. The incidence of morphometric VFs was 4.7% at 2 years and 13.6% at 4 years. Multivariate logistic regression analysis showed that previous VFs at baseline and increased CRP levels at 2 years were predictors of new VFs (odds ratio (OR) =12.8, 95% confidence interval (CI) = 3.6-45.3 and OR = 5.4, 95% CI = 1.4–15.9). The age-specific specific standardized prevalence ratio of morphometric VFs in AS was 3.3 (95% CI 2.1–4.5).ConclusionsThe incidence of morphometric VFs increased in AS. Previous VFs and increased CRP levels predicted future VFs. Further studies are needed to identify the effects of treatment interventions on the prevention of new VFs.

Does Attrition during Follow-Up of a Population Cohort Study Inevitably Lead to Biased Estimates of Health Status?

Attrition is a potential source of bias in cohort studies. Although attrition may be inevitable in cohort studies of older people, there is little empirical evidence as to whether bias due to such attrition is also inevitable. Anonymised primary care data, routinely collected in clinical practice and independent of any cohort research study, represents an ideal unselected comparison dataset with which to compare primary care data from consenting responders to a cohort study. Our objective was to use this method as a novel means to assess if (i) responders at follow-up stages in a cohort study remain representative of responders at baseline and (ii) attrition biases estimates of longitudinal associations. We compared primary care consultation morbidities and prescription prevalences among circa 32,000 patients aged 50+ who contribute to an anonymised general practice database (Consultations in Primary Care Archive (CiPCA)) with those from patients aged 50+ in the North Staffordshire Osteoarthritis Project (NorStOP) cohort, United Kingdom (2002–2008; n = 16,159). 8,197 (51%) persons responded to the NorStOP baseline survey and consented to medical record review. 5,121 and 3,311 responded at 3- and 6-year follow-ups. Differences in consulting prevalence of non-musculoskeletal morbidities between NorStOP responders and CiPCA comparison population did not increase over the two follow-up points except for ischaemic heart disease. Differences observed at baseline for osteoarthritis-related consultations were generally unchanged at the two follow-ups (standardised prevalence ratios for osteoarthritis (1.09–1.13) and joint pain (1.12–1.23)). Age and gender adjusted associations between baseline consultation for chronic morbidity and future new osteoarthritis and related consultations were similar in CiPCA (adjusted Hazard Ratio: 1.40; 95% Confidence Interval: 1.34,1.47) and NorStOP 6-year responders (1.32; 1.15,1.51). There was little evidence that responders at follow-ups represented any further selection bias to that present at baseline. Attrition in cohort studies of older people does not inevitably indicate bias.

Antibiotic and anti-asthmatic drug prescriptions in Italy: geographic patterns and socio-economic determinants at the district level

To analyse the prevalence rate of antibiotics and anti-asthmatics in children and adolescents at the healthcare district level. Data sources were three regional prescription databases. A total of 175 healthcare districts (3.3 million children/adolescents) participated in the study, providing data for the year 2008. Prevalence rate was standardised by age. The ANOVA test was used to compare prevalence rates of districts in the three regions. The standardised prevalence ratio (SPR) was calculated for each district and a map of the index was elaborated. The correlation among latitude, average annual income per inhabitant, hospitalisation rate, number of paediatricians per 1,000 resident children and prevalence rate was evaluated by district (Spearman's test). The antibiotic prevalence rate was, on average, 47.9% (34.0 to 67.9% between districts), while the anti-asthmatic prevalence was 21.4% (11.7-35.6%). The prevalence was higher in districts from the southern regions (antibiotics F = 92.1, anti-asthmatics F = 107.5; p < 0.001). There was a significant correlation between the prevalence of antibiotics and anti-asthmatics (rS = 0.77 p < 0.001), and the prevalence of both was inversely related to latitude (respectively rS = -0.71, -0.72; p < 0.001) and average income (rS = -0.77, -0.73; p < 0.001). Children/adolescents living in districts in the lower quintile of average income were more exposed to antibiotic (OR = 1.75; 1.74-1.77) and anti-asthmatic (OR 1.56, 1.55-1.57) prescriptions. A lower income at the district level is related to higher antibiotic and anti-asthmatic drug prescription rates. Local socio-economic inequities can concur in prescribing distribution and must be considered when planning educational interventions to reduce over-prescription.

Implementation of the Connective Tissue Screening Questionnaire in Northeast Pennsylvania to Identify Comorbidities of Connective Tissue Diseases in Subjects With Systemic Lupus Erythematosus

Previous studies have described an increased risk of developing an additional connective tissue disease (CTD) when one such ailment is present. We examine here the likelihood that individuals with systemic lupus erythematosus (SLE) screen positive for one or more of the following five autoimmune CTDs: Sjögren's syndrome, scleroderma, rheumatoid arthritis, dermatomyositis/polymyositis, and mixed connective tissue disorder. Five hundred SLE-diagnosed subjects were asked to complete a CTD screening questionnaire (CSQ). The results were analyzed according to the set of diagnostic criteria given by the American College of Rheumatology to identify probable cases of each CTD. Significant standardized prevalence ratios and comorbidities indicate an increased risk for the other autoimmune CTDs. In all, 96% of the subjects screened positive for at least one additional CTD, and 13% screened positive for at least two additional CTDs. We see that the SLE-diagnosed population may benefit from further attention regarding the presence of additional CTDs, which may further inform treatment strategies. We also see the application of the CSQ as a potentially important tool for clinical practice, and we describe the present study's limitations along with possible ways that these can be addressed.