Time Trends In Incidence Research Articles

Incidence and Clinical Presentation of Pheochromocytoma and Sympathetic Paraganglioma: A Population-based Study.

Pheochromocytoma and sympathetic paraganglioma (PPGL) are rare catecholamine-secreting tumors but recent studies suggest increasing incidence. Traditionally, PPGL are described to present with paroxysmal symptoms and hypertension, but existing data on clinical presentation of PPGL come from referral centers. We aimed to describe time trends in clinical presentation and incidence of PPGL in a population-based study. We conducted a nationwide retrospective cohort study of a previously validated cohort of 567 patients diagnosed with PPGL in Denmark 1977-2015. We collected clinical data from medical records of a geographic subcohort of 192 patients. We calculated age-standardized incidence rates (SIRs) and prevalence for the nationwide cohort and descriptive statistics on presentation for the subset with clinical data. SIRs increased from 1.4 (95% CI 0.2-2.5) per million person-years in 1977 to 6.6 (95% CI 4.4-8.7) per million person-years in 2015, corresponding to a 4.8-fold increase. The increase was mainly due to incidentally found tumors that were less than 4 cm and diagnosed in patients older than 50 years with no or limited paroxysmal symptoms of catecholamine excess. On December 31, 2015, prevalence of PPGL was 64.4 (CI 95% 57.7-71.2) per million inhabitants. Of 192 patients with clinical data, 171 (89.1%) had unilateral pheochromocytoma, while unilateral paraganglioma (n = 13, 6.8%) and multifocal PPGL (n = 8, 4.2%) were rare. Incidence of PPGL has increased 4.8-fold from 1977 to 2015 due to a "new" group of older patients presenting with smaller incidentally found PPGL tumors and few or no paroxysmal symptoms.

Stage–specific incidence trends of renal cancers in the East of England, 1999–2016

ObjectivesTo determine stage-specific time-trends in renal cancer incidence. MethodsWe used population-based East Anglia data 1999−2016 (population ∼2 million) on 5,456 primary renal cancer diagnoses, estimating stage-specific annual incidence using Poisson regression, allowing for changing time-trends, and adjusting for sex, age, and socioeconomic deprivation. ResultsRenal cancer incidence increased from 9.8–16.4 cases per 100,000 during 1999−2016. Incidence of Stage I, II, and III cases increased over time, most steeply for Stage I, with annual Incidence Rate Ratio [IRR] for Stage I of 1.09 (95 % CI 1.07–1.12) during 1999−2010; and 1.03 (1.00–1.05) during 2011−2016. In contrast, the annual incidence of Stage IV renal cancer decreased during most years, IRR of 0.99 (0.98–1.00) during 2003−2016. ConclusionThe findings are consistent with both earlier detection of symptomatic renal cancer and increasing identification of asymptomatic lesions. However, the decreasing incidence of late-stage disease suggests genuine shifts towards earlier diagnosis.

Hospitalization for hypoglycaemia in people with diabetes in Denmark, 1997-2017: Time trends in incidence and HbA1c and glucose-lowering drug use before and after hypoglycaemia.

ObjectiveTo assess incidence trends of first hospitalization for hypoglycaemia in Denmark and to examine HbA1c levels and glucose‐lowering drug use before and after hospitalization among individuals with type 1 or type 2 diabetes.Research Design and MethodsWe performed a population‐based study linking diagnosis, prescription and laboratory data. Standardized incidence of first hospitalization for hypoglycaemia in Denmark was assessed for each calendar year 1997–2017. HbA1c and glucose‐lowering drug use was compared with age‐ and sex‐matched diabetes comparisons without hospitalization for hypoglycaemia.ResultsThe annual age‐ and sex‐standardized incidence rate of first hospitalization for hypoglycaemia per 100,000 person‐years increased during 1997–2003 (from 17.7 to 30.3 per 100,000 person‐years), remained stable until 2010 (30.4) and gradually declined until 2017 (22.0). During this period, we identified 3,479 people with type 1 diabetes and 15,329 people with type 2 diabetes experiencing first hospitalization for hypoglycaemia. Both diabetes groups experienced a mean HbA1c decrease of ~12%–15% in the months preceding first hospitalization, followed by a gradually increasing HbA1c afterwards. People with type 1 diabetes and hospitalization used similar insulin therapies as those without hospitalization. People with type 2 diabetes and hospitalization more often received insulin (55%) than comparisons (45%), and 45% discontinued insulin or stopped all glucose‐lowering therapy after first hospitalization.ConclusionsIncidence of hospitalizations for hypoglycaemia has declined by one fourth the last decade in the Danish population. A HbA1c decrease precedes first hospitalization for hypoglycaemia in individuals with diabetes, and profound changes in glucose‐lowering drug therapy for type 2 diabetes occur after hospitalization.

Time trends in incidence and survival of small intestinal cancer in Sweden.

BackgroundSmall intestinal cancer is less common than some other gastrointestinal malignancies. Tumours of different histological types and anatomical sites of origin have therefore often been described together. The aim of this study was to investigate the epidemiology for each of the four main subtypes: duodenal adenocarcinoma (D-AC), duodenal neuroendocrine tumour (D-NET), jejunoileal adenocarcinoma (J/I-AC), and jejunoileal neuroendocrine tumour (J/I-NET).MethodsAll patients with small intestinal cancer diagnosed between 1960 and 2015 were identified from the Swedish Cancer Register. The age-adjusted incidence rate with incidence rate ratios, as well as overall (OS) and net (NS) survival, were determined and temporal trends were analysed.ResultsThe incidence rate was highest for J/I-NET, with 9.98 clinical diagnoses per million in 2010–2015. Clinical diagnosis of D-AC increased more than 10-fold and surpassed J/I-AC as the second most common subtype. D-NET was by far the least common subtype. Diagnosis at autopsy became less common over time, whereas clinical diagnoses increased significantly for all four subtypes. All subtypes except J/I-AC affected men more often than women. The age distribution was similar between subtypes, although patients with adenocarcinomas were slightly older. Survival was generally much better for patients with NET than for those with adenocarcinoma. Both OS and NS showed a negative association with advancing age. Survival improved only for J/I-NET from a 5-year NS of 0.69 in the 1960s to 0.81 in 2010–2015.ConclusionThe incidence of small intestinal cancer is increasing, particularly for D-AC and in the elderly. Survival of patients with small intestinal cancer has improved only for J/I-NET over the last decades.

Time trends in colorectal cancer incidence in four regions of Latin America: 1983-2012.

This study aimed to assess time trends in colorectal cancer incidence from 1983 to 2012 in Latin America. This was an ecological time-series study whose population consisted of individuals aged 20 years or older diagnosed with colorectal cancer. Data from population-based cancer registries in Cali (Colombia), Costa Rica, Goiânia (Brazil), and Quito (Ecuador), were used for rates estimation, while time trends estimations were proceeded by the Joinpoint Regression Program. The study showed an increase in colorectal cancer incidence in men and women in Cali (2.8% and 3.2%, respectively), Costa Rica (3.1% and 2.1%, respectively), and Quito (2.6% and 1.2%, respectively), whereas in Goiânia, only women showed an increase in colorectal cancer rates (3.3%). For colon cancer, we observed an increasing trend in incidence rates in men and women in Cali (3.1% and 2.9%, respectively), Costa Rica (3.9% and 2.8%, respectively), and Quito (2.9% and 1.8%). For rectal cancer, we observed an increasing trend in incidence in men and women in Cali (2.5% and 2.6%, respectively), Costa Rica (2.2% and 1%, respectively), and Goiânia (5.5% and 4.6%, respectively), while in Quito only men showed an upward trend (2.8%). The study found increases in colorectal cancer, colon cancer, and rectal cancer in four Latin America regions. This findings reflect lifestyle, such as dietary changes, following the economic opening, and the prevalence variations of colorectal cancer risk factors by sex and between the four studied regions. Finally, the different strategies adopted by regions for colorectal cancer diagnosis and screening seem to influence the observed variation between anatomical sites.

Rising Prostate Cancer Incidence in Sub-Saharan Africa: A Trend Analysis of Data from the African Cancer Registry Network.

Prostate cancer is the leading cancer in men in sub-Saharan Africa (SSA) regarding incidence and mortality. Published data from a few registries in SSA suggest that the rates are still rising, but there is little comprehensive information on the time trends of prostate cancer incidence. We analyzed registry data on 13,170 incident prostate cancer cases in men aged 40 years or above, from 12 population-based cancer registries in 11 SSA countries, with at least a 10-year time span of comparable data. We observed an increase in cumulative risks (CR) and age-standardized incidence rates (ASR) over time in all registries (statistically significant in all but one). The highest values of CR were found in Seychelles and Harare (Zimbabwe). The highest annual increase in the ASRs was seen in Seychelles and Eastern Cape (South Africa), whereas the lowest was seen in Mauritius. We mainly found a steady increase in incidence with age and during successive periods. This analysis reveals that prostate cancer incidence rates are rising in many populations in SSA-often very rapidly-which is in contrast to recent observations worldwide. We acknowledge that the reasons are multifactorial and largely remain unclear, but believe that they are primarily associated with improvements in health care systems, for example, a broader use of prostate-specific antigen testing. This study is the first to compare population-level data on time trends of prostate cancer incidence between multiple countries of SSA, presenting the different rates of increase in 11 of them.

37-year incidence and mortality time trends of common cancer types by sex, age, and stage in the canton of Zurich

The Cancer Registry Zurich, Zug, Schaffhausen and Schwyz is one of the oldest cancer registries in Switzerland, first registering tumours in 1980 for the canton of Zurich. The aim of this study was to analyse trends in incidence and mortality for the most common types of cancer in the canton of Zurich from 1981 to 2017. In this analysis of population-based cancer registry data, we included malignant tumours of the breast (ICD10 C50), prostate (C61), colon/rectum (C18–C21), lung (C33–C34), and melanoma (C43), diagnosed between 1981 and 2017. Age-standardised incidence and mortality rates per 100,000 person-years were computed using the 1976 European Standard Population. Incidence and mortality time trends were assessed using joinpoint regression analysis. In men, incidence for prostate cancer and melanoma increased over the study period, while it decreased for colon/rectum and lung cancer. A joinpoint for prostate cancer indicated the start of a decreasing trend in 2002. In women, incidence increased for breast cancer, lung cancer and melanoma; no trend was observed for colon/rectum cancer. Cancer mortality decreased for prostate, colon/rectum and lung cancer in men, with no clear trend for melanoma. In women, mortality decreased for breast cancer, colon/rectum cancer and melanoma, but increased for lung cancer. The overall increasing incidence trends for prostate and breast cancer, as well as for melanoma, are in line with data from other Western countries. While lung cancer incidence is decreasing in men, it is still on the rise in women. Despite increasing incidence rates, mortality rates are decreasing for all localisations except for lung cancer in women. The opposite direction of incidence and mortality curves is probably mostly due to better and more effective treatment options, as well as earlier detection.

Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016.

Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9-1.2 and girls IRR 1.1, 95% CI: 0.9-1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7-1.2) and girls (APC +0.6%, 95% CI: 0.3-0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.

Trends in Micronutrient Laboratory Testing in Switzerland: A 7-Year Retrospective Analysis of Healthcare Claims Data.

BackgroundMicronutrient laboratory tests (MLT) are increasing in many healthcare systems. This study assessed time trends of annual MLT incidence in the Swiss population and examined the frequency of specific MLT, defined as the number of yearly tests performed in individual persons.MethodsFor annual time trends, we used a longitudinal design with a seven-year observation period (2012–2018) and for yearly testing frequency we used a cross-sectional design (2018 only). The database consisted of nationwide insurance claims from adult persons.ResultsPersons with MLT compared to persons without were older (mean age 57.1 years vs 48.6 years) and to a higher proportion female (65.1% vs 45.5%). Between 2012 and 2018, we included 6.7 million person years and found an increase in the proportion of persons receiving any MLT from 24.5% to 35.0%. Tests with strongest absolute increase during the observation period were vitamin D (from 7.4% of persons to 20.4%), vitamin B12 (from 9.0% to 17.6%) and ferritin (from 17.4% to 26.6%). In 2018, vitamin D and vitamin B12 tests were performed more than once in 4.5% and 3.3% of the population, respectively.ConclusionWe found that the Swiss population undergoes MLT with high and increasing frequency. Testing for vitamin D, vitamin B12 and ferritin is very common and of questionable appropriateness.

The role of public health versus invasive coronary interventions in the decline of coronary heart disease mortality

Purpose: There has been considerable debate on the extent to which the decline in coronary heart disease (CHD) mortality has been caused by better control of coronary risk factors in the general population or is the result of invasive coronary interventions in symptomatic individuals. MethodsUsing the Myocardial Infarction Data Acquisition System, a statewide database of all cardiovascular hospital admissions in New Jersey, we examined time trends in incidence of death from CHD in the Years 2000–2014 in persons with a history of hospitalization for CHD in the previous 10 years and those without such a history. ResultsOver the 10-year study period, there was a marked decline in CHD-related mortality in both persons with a history of CHD and persons without a history of CHD. The decline occurred across all gender, racial, and age groups and was higher in those without a prior history of CHD. ConclusionsThis adds more evidence that the decline in CHD was not only because of advanced invasive medical and surgical treatments but also equally because of improved lifestyle, pharmacologic treatment of risk factors for CHD, and public health interventions.

Time trends in incidence rates of atrial fibrillation-related strokes in Norway 2001–2014: a nationwide analysis using data from the cardiovascular disease in Norway (CVDNOR) project

Abstract Background Stroke incidence rates declined in Norway during 2001 to 2014. Atrial fibrillation (AF) incidence rates were stable in the same period. Purpose We aimed to study time trends in incidence (first time) of acute stroke hospitalizations and stroke deaths associated with AF in Norway in the period 2001–2014. Methods Nationwide hospital discharge diagnoses in the Cardiovascular Disease in Norway (CVDNOR) database and in the National Patient Registry were linked to the National Cause of Death Registry. All hospitalizations with acute stroke (including ischemic stroke, intracerebral bleeding and unspecified stroke) and out-of-hospital deaths with stroke as underlying cause in individuals 25 years and older were obtained during 1994–2014. Incident stroke was defined as the first hospitalization or out-of-hospital death due to stroke with no hospitalization for acute stroke or stroke sequela the past 7 years. Stroke was defined as AF-related if AF was registered during a hospitalization the past 7 years, or as underlying or contributing cause of death up to 28 days after the stroke hospitalization. Age-standardized incidence rates with 95% confidence intervals (CIs) were calculated using direct standardization to the age-distribution in the Norwegian population per 2001. Age-adjusted average yearly incidence rate ratios (IRR) with 95% CIs were estimated by negative binomial regression analyses. Results From 2001 to 2014 we identified 157 580 incident stroke cases of which 38 317 were AF-related. The proportion of incident strokes that were related to AF increased from 20.6% in 2001 to 26.3% in 2014. Age-standardized incidence rates of AF-related strokes per 100,000 person years were stable at 88 (85, 92) in 2001 and 79 (76, 83) in 2014, corresponding to a 0% average yearly change, IRR 1.00 (0.99, 1.00). The age-standardized incidence rates of non-AF-related strokes per 100,000 person years decreased from 334 (328, 341) in 2001 to 214 (209, 219) in 2014, corresponding to a 3% average yearly decrease, IRR 0.97 (0.97, 0.97). Conclusion The favourable trend in total stroke incidence rates from 2001 to 2014 does not include AF-related strokes. This may suggest that AF has become accountable for a higher proportion of incident strokes or that AF detection improved over this period. Figure 1. Age-standardized incidence rates of stroke hospitalizations or out-of-hospital deaths per 100,000 person years (py) by year, illustrated as all strokes (blue horizontal line) and AF-related strokes (red horizontal line/height of red area). The height of the blue area illustrates the rate for non-AF related strokes. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Vestre Viken Hospital Trust (public hospital research fund)

Haemolymphatic cancer among children in Sardinia, Italy: 1974–2003 incidence

ObjectivesTo explore the time trend and geographical distribution of childhood leukaemia incidence over the territory of the Italian region of Sardinia.SettingAll hospitals departments, diagnostic centres and social security agencies in...

Age-Specific Time Trends in Incidence Rates of Autism Spectrum Disorder Following Adaptation of DSM-5 and Other ASD-Related Regulatory Changes in Israel.

We analyzed data on 879,029 children born in 1999-2017 from a large Israeli health fund to evaluate time-trends in incidence of autism spectrum disorder (ASD). This included examining possible effects associated with the adaptation of the DSM-5 criteria for ASD, and the implementation of regulatory changes affecting eligibility for ASD-related stipends and services. ASD cases were ascertained based on electronic medical records review, with complete verification of ASD case status. Results indicated a substantial increase in ASD incidence rate (IR) over time that was overall not appreciably affected by the above changes. Cumulative incidence through age 8 rose from 0.46% (boys: 0.73; girls: 0.18) in 2007 to 1.30% (boys: 2.12; girls: 0.45) in 2018. Age-specific analyzes indicated that the largest increase in IR occurred in toddlers and preschool children, with a more modest increase at older age groups. Results suggest that the rise in early diagnosed ASD does not stem from a downward shift in the distribution of ages at first diagnosis, but rather from early detection of cases not previously diagnosed. Findings highlight the need to expand research aimed at identifying exogenous factors that may underlie the rise in incidence, and to evaluate factors that may contribute to late diagnosis of some cases. Autism Res 2020, 13: 1893-1901. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In an analysis of nearly 900,000 Israeli children born in 1999-2017, we found that the incidence of autism spectrum disorder (ASD) increased significantly over time, especially among toddlers and preschool children but also at older age groups. We additionally observed that changes affecting diagnostic criteria for ASD and eligibility for ASD-related services did not appreciably affect these trends. Results highlight the need to continue research aimed at identifying factors causing this increase and reasons contributing to late diagnosis of some cases.

Borderline ovarian tumors in Denmark 1997-2018: Time trends in incidence by histology, age and educational level.

After some decades with an increasing incidence of borderline ovarian tumors, more recent studies have observed that the incidence rate seems to be leveling off or declining. In this study, we describe the incidence of borderline ovarian tumors in Denmark 1997-2018 by histology, age at diagnosis and educational level. All borderline ovarian tumors registered in the Danish Pathology Registry during 1997-2018 were identified and individual-level educational information was retrieved from nationwide registers. Age-standardized incidence rates were estimated according to histology, age at diagnosis and educational level. To investigate incidence trends over time, the average annual percentage change and corresponding 95% confidence intervals (CIs) were estimated using Poisson regression. We identified 3927 women with borderline ovarian tumors during the study period, of which 1997 (50.9%) were serous and 1743 (44.4%) were mucinous. The age-standardized incidence rate of serous borderline ovarian tumors did not change significantly over calendar time (average annual percentage change=-0.13, 95% confidence interval [CI] -1.13 to 0.88). For mucinous tumors, the age-standardized incidence rate was also relatively stable during the first half of the study period, followed by a decrease from 2.56 to 1.25 per 100000 person-years between 2007-2011 and 2017-2018. Over the entire study period, the incidence rate of mucinous borderline tumors declined on average by 2.91% (95% CI -4.24 to -1.51) per year. The incidence of both types of borderline ovarian tumors seemed to be highest among women with a low educational level. Over calendar time, the incidence of mucinous tumors decreased in all educational groups, whereas the incidence of serous tumors decreased exclusively in women with a high educational level. Time trends did not differ markedly by age at diagnosis. In Denmark, the incidence of serous borderline ovarian tumors was stable during 1997-2018, whereas the incidence of mucinous borderline ovarian tumors decreased. The incidence rates of both types of borderline ovarian tumors tended to be highest among women with a low educational level throughout the study period.

Infective endocarditis at a tertiary care hospital in South Korea

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends,...

Time trends and predictors of laboratory-confirmed recurrent and severe Clostridioides difficile infections in Manitoba: a population-based study.

Many previous studies of Clostridioides difficile infection (CDI) epidemiology have used hospital discharge data codes, which can have limited accuracy. We used a data set of laboratory-confirmed cases of CDI in the province of Manitoba, Canada, to describe the epidemiology of CDI over a decade. We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included (n = 8471) and followed up from CDI diagnosis. We assessed time trends of CDI, incidence and predictors of recurrence and severe outcomes, and health care encounters after CDI diagnosis. CDI episodes were stratified by community versus hospital site of acquiring CDI. Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital. Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.

Is the rise in Crohn's disease in India accompanied by a fall in intestinal tuberculosis? A single-center experience

IntroductionThe relationship between the incidence of intestinal tuberculosis (TB) and Crohn's disease (CD) is interesting, especially considering the striking similarity between the two conditions. Some studies from Asian populations suggested that the incidence of intestinal TB decreases when there is an increase in CD. AimTo compare the incidence trend between intestinal TB and CD over 15 years. MethodsMedical records of patients seen in the Division of Gastroenterology over 15 years (2005–2019) were reviewed. CD was diagnosed according to the Copenhagen criteria. Intestinal TB was diagnosed in the appropriate clinical situation if any one or more of the following was present: (1) positive TB MGIT culture; (2) positive Gene Xpert for TB; (3) suggestive histologic findings, with positive tissue acid-fast bacillus (AFB) on smear or with sustained response to anti-TB therapy. The incidence time trend of patients with CD and intestinal TB diagnosis was then studied year-wise. Results632 medical case records were accessed; 60 patients were excluded due to inadequate data or not fulfilling diagnostic criteria. The 572 patients included 224 with intestinal TB (median age 37 years, IQR 22; 125 [56%] females) and 348 with CD (median age 40 years, IQR 25; 159 [46%] females [p < 0.02 as compared to TB]). Thus, more patients with CD were seen during the study period, but there was no correlation between the incidence of the two conditions (r = 0.318; p = 0.25). ConclusionIn Indian patients in a single private-sector center, there was no inverse correlation between the incidence of intestinal TB and CD over 15 years.

Prevalence and incidence rates of atrial fibrillation in Norway 2004–2014

ObjectiveTo study time trends in incidence of atrial fibrillation (AF) in the entire Norwegian population from 2004 to 2014, by age and sex, and to estimate the prevalence of AF...

Children and adolescents cancer incidence, mortality and survival a population-based study in Midwest of Brazil

ObjectiveTo identify time trends in incidence, mortality and 5-year relative survival in children and adolescents with cancer in Goiania-Goias, Brazil, during the years of 1996–2012. MethodsIncidence and mortality age-standardized rates (ASR) were calculated, and trends were identified by determining the Average Annual Percentage Change (AAPC). Five-year relative survival were estimated. ResultsThe overall incidence ASR (1996–2012) was 164.2/1,000,000 in both genders. In boys was 176.6/1,000,000, in girls it was 151.8/1,000,000. Overall mortality ASR for both gender were 69.3/1,000,000. Incidence rates (AAPC: -0.5; 95 %CI: -2.4;1.4) and mortality rates (AAPC: 0.0; 95 %CI: -2.6;2;7) were stable in the period. Five-year relative survival for all cancers were 63.9 %, with the highest survival rates for retinobastoma (83.5 %), germ cell tumors (79.8 %), and lymphomas (72.7 %). It was observed an increase in survival in the period from de 62.8 % (1996 a 2003) to 65.0 % from 2004 to 2012. ConclusionsChildren and adolescent cancer incidence and mortality rates were higher in Goiania, but both are stable overall. The relative survival slighly improved in the period but remained lower mainly for leukemias.

Time trends in incidence, comorbidity, and mortality of ischemic stroke in Denmark (1996-2016).

To examine whether the incidence, comorbidity, and mortality of first-time ischemic stroke changed in Denmark between 1996 and 2016 overall and according to age and sex using a nationwide cohort design. In this cohort study, 224,617 individuals ≥18 years of age admitted with first-time ischemic stroke between 1996 and 2016 were identified through Danish nationwide registries. We calculated annual age-standardized incidence rates and absolute 30-day and 1-year mortality risks. Furthermore, we calculated annual incidence rate ratios using Poisson regression, odds ratios for 30-day mortality using logistic regression, and hazard ratios for 1-year mortality using Cox regression. The overall age-standardized incidence rates of ischemic stroke per 1,000 person-years increased from 1996 (2.70 [95% confidence interval [CI] 2.65-2.76]) to 2002 (3.25 [95% CI 3.20-3.31]) and then gradually decreased to below the initial level until 2016 (1.99 [95% CI 1.95-2.02]). Men had higher incidence rates than women in all age groups except 18 to 34 and ≥85 years. Absolute mortality risk decreased between 1996 and 2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women between 55 and 64 and ≥85 years of age had higher mortality than men. Similar trends were observed for all analyses after multivariable adjustment. The prevalence of atrial fibrillation, hypertension, diabetes mellitus, and use of lipid-lowering medication increased during the study period. The age-standardized incidence of first-time hospitalization for ischemic stroke increased from 1996 to 2002 and then gradually decreased to below the initial level until 2016. Absolute 30-day and 1-year mortality risks decreased between 1996 and 2016. These findings correspond to increased stroke prevention awareness and introduction of new treatments during the study period.