True Rise In Incidence Research Articles

Central nervous system abscesses and empyemas in England: epidemiological trends over five decades

To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades. Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019. Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively. The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.

Diagnostics of Celiac disease: comprehensible solutions to a complex problem

The prevalence of the celiac disease (CeD) is increasing worldwide, which is not only due to the modern capabilities of the latest laboratory and instrumental technologies but rather with a true rise in incidence. Despite recent advances in endoscopic imaging and serological tests, the accurate diagnosis of CeD remains challenging. Since the majority of patients are “asymptomatic” from the gastrointestinal aspects they come to medical attention because of other reasons than CeD and a large number of CeD passes undiagnosed. This fact highlights the need for improved strategies in the future for the optimal detection of patients and use of clear algorithms for diagnosing CeD. The review describes the global experience in diagnosing CeD and provides «step-by-step» recommendations to help specialists in medicine not only in cases with the usual classical manifestations of CeD, but also in complex clinical variants of this disease or for patients already following a gluten-free diet. Keywords: diagnostics of celiac disease, CeD, anemia, intestinal biopsy, non-gastrointestinal symptoms, serology for celiac disease, HLA testing, gluten-free diet.

Salivary duct carcinoma.

The review puts new information on geno- and phenotype of salivary duct carcinoma (SDC) in the perspective of the updated 2017 WHO classification. The proportion of SDC is increasing. This may be because of a true rise in incidence, but certainly to better diagnostic tests and changed WHO definitions. In this light, a substantial proportion of carcinoma expleomorphic adenoma is now attributed to the category of SDC. 'Low-grade SDC' and 'SDC in-situ' of the former WHO classification, are now named low-grade and high-grade intraductal carcinoma (IDC), respectively. Recent series quantify biologic aggressiveness: perineural growth, vascular invasion, and extracapsular extension in lymph node metastasis are each observed in two out of three patients with SDC. Most patients die within 3 years, but once 5-year disease-free survival is reached, further disease activity is exceptional. The typical molecular biological profile with high human epidermal growth factor receptor 2 and androgen receptor expression is increasingly successfully exploited in clinical trials for advanced SDC. The aggressive SDC is increasingly diagnosed. Despite intensive combined surgery and radiation therapy, many patients recur, for whom new bullets, targeting the molecular biological mechanisms, are the subject of ongoing clinical trials.

Up in the Air: Does Ground-Level Ozone Trigger Kawasaki Disease?

Vol. 125, No. 6 Science SelectionsOpen AccessUp in the Air: Does Ground-Level Ozone Trigger Kawasaki Disease? Lindsey Konkel Lindsey Konkel Search for more papers by this author Published:23 June 2017CID: 064003https://doi.org/10.1289/EHP2092View Article in:中文版AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Kawasaki disease occurs most often in children of East Asian ancestry,1 but the known genetic factors2 cannot explain why more children have been diagnosed with the disease in recent years, according to Bing-Fang Hwang, an environmental epidemiologist at China Medical University in Taiwan. Hwang and colleagues now report an association between exposure to ground-level ozone and increased risk of Kawasaki disease in a group of young Taiwanese children.3Kawasaki disease is a childhood ailment that causes fever, rash, and a red tongue, among other symptoms. It leads to inflammation in blood vessels throughout the child’s body. Most children recover from the disease within a few weeks, but up to one-quarter develop heart problems, including coronary artery aneurysms, arrhythmias, and even heart failure.4The origins of Kawasaki disease are still a mystery, although airborne agents appear likely to play a role. Researchers now report an association between hospitalizations for the disease and summertime exposures to ground-level ozone. © Anurak Pongpatimet/Shutterstock.The incidence of Kawasaki disease in children under age 5 is highest in Japan (264.8 per 100,000 children), followed by Korea (132.4 per 100,000 children) and Taiwan (82.77 per 100,000 children).5 Although many nations around the world, including Taiwan, have reported an increase in the number of Kawasaki disease diagnoses in the past decade, it is not clear whether these reports represent a true rise in incidence or just greater awareness of the disease.6Despite decades of research, the origins of Kawasaki disease are not fully understood. “It follows an immunological pattern that does not look like any other disease we know,” says Jane Burns, director of the Kawasaki Disease Research Center at the University of California, San Diego, School of Medicine, who was not involved with the study. There is evidence that viral infection may play a role,7 and other previous studies have suggested that some windborne environmental factors may trigger the disease in genetically susceptible children.8,9In the new study, Hwang and colleagues used a Taiwanese health insurance database to identify 695 hospitalizations for Kawasaki disease in children under age 5 between 2000 and 2010. The team then estimated daily levels of five air pollutants near the home of each child, accounting for atmospheric variables including temperature, humidity, and wind direction.The researchers found an association between hospitalizations for Kawasaki disease and ozone pollution for the summer months only, possibly because children spend more time outdoors in the summertime. When they divided patients into four groups based on their estimated level of ozone exposure, hospitalization was more likely for children in the three highest quartiles compared with the lowest, although the association was not statistically significant for the third quartile of exposure. They also found no significant associations with other pollutants, including nitrogen dioxide and coarse particulate matter.The study contributes to the growing body of research highlighting the link between Kawasaki disease and the environment, says Xavier Rodó, an atmospheric scientist who studies Kawasaki disease at the Catalan Institute of Climate Sciences in Barcelona, Spain. However, it is not clear from the findings whether ozone causes Kawasaki disease, or whether ozone pollution could be a predictor of some other risk factor that is associated with high-ozone days, says Rodó, who was not involved in the Taiwan study. Ground-level ozone is created when nitrogen oxides and volatile organic compounds—found in vehicle exhaust, industrial emissions, and other sources—react in the presence of sunlight.10The possibility of an airborne trigger is very plausible, says Burns. Children with Kawasaki disease develop enlarged lymph nodes under the jawbone but nowhere else in the body. Those are the lymph nodes that drain the upper airway, she explains.One possible direction for future studies is to compare Kawasaki cases in locations in different parts of the world and incorporate statistical models that can further investigate associations among several environmental factors. “Whether ozone holds up in other analyses in different parts of the world as a trigger or whether it is a marker for the real trigger,” Burns says, “this is a productive avenue of research that deserves more focus.”

Incidence of cutaneous malignant melanoma by socioeconomic status in Canada: 1992-2006.

BackgroundThere are no nationwide studies documenting changes in cutaneous malignant melanoma incidence or association of incidence with socioeconomic status (SES) in Canada. We sought to determine whether melanoma incidence increased from 1992 to 2006 and if there was an association between SES and melanoma incidence. Additionally, we studied whether there was a correlation between province of residence and melanoma incidence.MethodsCases from the Canadian Cancer Registry were reviewed. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. Cases were linked to income quintiles by postal code. A negative binomial regression was performed to identify relationships among these variables.ResultsOverall incidence of melanoma in Canada increased by 67 % from 1992 to 2006 (p < 0.0001). The increase in incidence was greater for melanoma in situ compared with invasive melanoma (136 % versus 52 % [p < 0.0001]). Incidence was positively correlated with higher income quintiles; the incidence rates among patients in the lowest income quintiles were 67 % of that for the highest income quintiles (p < 0.0001).DiscussionA wide variety of explanations have been postulated for an increased incidence in melanoma among persons of higher SES, including access to and awareness of screening, more access to vacations in sunny climates, and increased leisure time. Variations in incidence of melanoma by urban vs. rural location and province may indicate differences in access to dermatologists across Canada.ConclusionsMelanoma incidence is increasing in Canada and is higher among people in high SES groups. This rise is likely due to a combination of factors including a true rise in incidence due to increases in sun exposure, and also an increased detection rate, particularly in those who are more aware of the disease and have access to resources for detection.

Incidence and survival in patients with cutaneous melanoma by morphology, anatomical site and TNM stage: A Danish Population-based Register Study 1989–2011

IntroductionThe incidence of melanoma of the skin has risen in Denmark in recent decades, the increase being steeper from 2004. It is unclear whether this represents a true rise in incidence or whether it is caused by an increased awareness of the condition. MethodsTo assess whether the increase was characterised by early-stage melanomas and a higher proportion of melanomas with superficial spreading morphology, we studied all skin melanoma patients registered in the Danish Cancer Register 1989–2011 (n=27,010) and followed up for death through 2013. Trends in age-standardised incidence by sex, subsite and morphology, relative survival, TNM stage distribution and stage-specific relative survival from 2004 were analysed. ResultsThe incidence of melanoma more than doubled over 23 years. A steeper increase from 2004 was driven mainly by superficial spreading tumours, but the proportion of nodular melanomas in patients 50 years of age and over also increased significantly. The largest increase occurred for stage I tumours and for tumours on the trunk. From 1989–1993 to 2009–2011 the 5-year relative survival increased at 12% and 6% points for male and female patients, respectively. InterpretationGreater awareness, and thus lower stage at diagnosis (mediated by a large skin cancer prevention campaign from 2007), might explain part of the increase, but the increase in nodular melanoma also points to a genuine increase in the risk of melanoma.

The increasing incidence of foetal echogenic congenital lung malformations: an observational study.

The aim of this study was to investigate the incidence of congenital lung malformations over the past 19 years. Congenital lung malformations (CLM) are a heterogeneous group of lung abnormalities. The antenatal diagnosis is important for foetal and neonatal management but there have been no studies examining whether the reported incidence of this abnormality is constant. A retrospective cross-sectional study of cases identified from the Wessex Antenatally Detected Anomalies (WANDA) register 1994-2012. One hundred and thirty-three cases of CLM in 524 372 live and stillbirths were identified. All but seven were identified on antenatal ultrasound. During the early registry (1994-1998) the average incidence of CLM was 1.27 per 10,000 births. By the last 4 years (2008-2012) this had risen to 4.15 per 10,000 births, with a progressive increase during the intervening years. There was over a three-fold increase in the antenatally detected CLM in the Wessex region 1994-2012. Comparison with the antenatal detection of diaphragmatic hernia suggests that this is a true rise in incidence rather than an artefactual increase due to increased antenatal recognition secondary to improved ultrasound resolution and operator experience. These results have clinical and cost implications for practitioners of foetal medicine, neonatology and paediatric surgery services.

P3.121 Are We Seeing a True Rise in Neisseria Gonorrhoeae and Chlamydia Trachomatis in England in Men Who Have Sex with Men?

BackgroundThe Health Protection Agency (HPA) in England have reported the number of sexually transmitted infections (STIs) diagnosed in men who have sex with men (MSM) continues to rise. Of note,...

Commentary: Fact and artefact in the secular increase in the rate of autism

King and Bearman sought to determine whether the increased prevalence of an autism diagnosis in California was due to diagnostic substitution of autism in place of mental retardation (MR). They make good use of systematic administrative data from the California Department of Developmental Services between 1992 and 2005 for this purpose, with the conclusion that changes in diagnostic practices accounted for a quarter of the observed increase in diagnosed autism over this time period. They discuss this finding as reflecting diagnostic substitution or accretion, but it is clear that there was almost no substitution. Thus, in 95% of the cases the change was from ‘pure’ MR to MR plus autism. Figure 3 in King & Bearman indicates a substantial increase in MR between 1992 and 2005, although the proportional increase for autism was greater. Most of the rise applied to ‘pure’ autism, about a quarter to ‘pure’ MR being changed to MR and autism, and very little to MR being replaced by autism. In other words, the main change in diagnostic practice concerned an increased willingness to note co-morbidity. Given that the increase in ‘pure’ autism between 1992 and 2005 was huge (from 4446 to 28 046 cases)—a much greater rise than for co-morbidity (3210–10 410), it is dubious whether the latter increase does much to help in resolving the key basic issue of whether there has been a true increase over time in the incidence of autism. That is particularly so when the available evidence suggests that the main rise has not predominantly involved autism associated with intellectual disability; rather, it seems to have particularly involved autism in individuals with non-verbal IQ in the normal range. King and Bearman quite properly pointed out that they could not examine that suggestion in their dataset. Nevertheless, the consequence is that their main focus was off-target with respect to the observed rise. Almost all reviews have concluded that a substantial part of the rise in the rate of diagnosed autism has been due to a combination of better ascertainment and a broadening of the diagnostic concept, but has there been, in addition, a true rise in incidence? In my view, we simply do not know. The rise has been seen in Europe, the USA and Japan, but there is a geographic variability in whether the main rise began in the 1970s and 80s, or rather in the 1990s. The claims that the so-called ‘epidemic’ of autism was due to either the measles–mumps–rubella (MMR) vaccine or mercury-containing preservative thimerosal that used to be present in many vaccines are not supported by the evidence. Most crucially, in Japan, where MMR was discontinued at a time when it remained in wide use in other countries, the removal of MMR was not followed by any fall in the rate of autism, or even by a reduction in the rate of rise. Similarly, the discontinuation of use of thimerosal in Scandanavia was not followed by any change in the rising rate of autism. Nevertheless, these findings do not rule out a risk effect from other prenatal or postnatal toxins or other hazards. Large-scale prospective epidemiological/longitudinal studies with good biological measures and good diagnostic procedures are needed to test that possibility. The ongoing MoBa study of mothers and babies in Norway constitutes one good example of what is needed in that connection. It should be added that the factor responsible for a real rise in autism (if that truly has occurred) need not necessarily be a specific environmental hazard. The trigger could be a rising age of parenthood, given the evidence that high paternal age is associated with an increased rate of autism in the offspring. How might that operate? One possibility is that it increases the rate of developmental perturbations such as copy number variation (i.e. submicroscopic substitutions or deletion) or minor congenital anomalies or chromosomal anomalies, all of which have been found to be more common in autism. Whilst there is value in considering the role of changing concepts and better ascertainment in the observed rise in the rate of diagnosed autism, and there is still uncertainty on whether or not there has been a true rise in incidence, the greater the need is for hypothesis-testing focused research on possible causal mechanisms that could lead to changes in incidence. MRC SGDP Centre, PO 80, Institute of Psychiatry, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail: camilla.azis@kcl.ac.uk Published by Oxford University Press on behalf of the International Epidemiological Association

Commentary: Diagnostic change and the increased prevalence of autism

Commentary: Diagnostic change and the increased prevalence of autism

Kirk Arden Hoppe. Lords of the Fly: Sleeping Sickness Control in British East Africa, 1900–1960. Westport, Conn: Praeger, 2003. xii + 203 pp. Photographs. Maps. Bibliography. Index. $67.00. Cloth.

Kirk Arden Hoppe. Lords of the Fly: Sleeping Sickness Control in British East Africa, 1900–1960. Westport, Conn: Praeger, 2003. xii + 203 pp. Photographs. Maps. Bibliography. Index. $67.00. Cloth. - Volume 48 Issue 1

Incidence of Diagnosed Carpal Tunnel Syndrome in a General Population

We sought to determine the incidence rate of carpal tunnel syndrome in the general population. Using three different case definitions, we conducted a prospective study to ascertain by medical record review all cases of incident disease in a defined population during a 2-year period. Newly diagnosed probable or definite carpal tunnel syndrome (N = 309) occurred at a rate of 3.46 cases per 1,000 person-years (95% confidence interval = 3.07-3.84). The incidence rate in our study was 3.5 times higher than the rate 20 years ago in a Minnesota city. The rate difference probably results from a combination of reasons, including a true rise in incidence.

The treatment of viral warts.

Warts have been regarded with disfavour throughout the ages and folklore related to their cause and cure is world wide. The demands made on the medical profession for the treatment of warts is 6 times greater than it was 30 years ago (Rook et aI., 1972). Whether this represents a true rise in incidence of warts or is the result of the availability of improved treatments is not clear, but the demand has to be met.

Oxygen administration and retrolental fibroplasia.

The high incidence of retrolental fibroplasia (RLF) in premature infants of low birth weight has led to an intensive search for factors contributing to its pathogenesis. Although it probably is not a new disease,1it has been recognized with increasing frequency since 1942, when Terry2first described the condition, until now it has become one of the two leading causes in the United States of blindness in children.* The currently high occurrence rate cannot be explained either by the higher survival rate in the low-birth-weight group3or by the more concerted search for the condition. It undoubtedly indicates a true rise in incidence of the disease. The development of efficient incubators in the last 15 years has led to the liberal use of oxygen in the care of premature infants. In many nurseries all small premature infants, regardless of respiratory pattern, are routinely placed in incubators supplied