Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations.

BACKGROUND: Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. MATERIALS AND METHODS: This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient's gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission. RESULTS: The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient's age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The "weekend" effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission. CONCLUSION: Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.

Overall Survival in Patients with Hepatocellular Carcinoma Treated with Sorafenib: A Polish Experience.

BACKGROUND The mortality caused by hepatocellular carcinoma is expected to rise in the upcoming decade. Sorafenib has become the preferred systemic treatment option in patients with unresectable HCC. This study aimed to present the median overall survival (OS) in a group of patients with advanced HCC, treated with sorafenib in Poland between 2011 and 2019. MATERIAL AND METHODS The analyzed group of patients was qualified for treatment with sorafenib, financed by the National Health Fund, based on the guidelines of the Polish Drug Program. Kaplan-Meier method was used to plot the OS curves, and the log-rank test was used for testing. Multivariate assessment of factors (sex and age) related to the time to death of the patient was done using Cox regression. RESULTS Of the 2072 treated patients, 75% were men (1556) and 25% were women (516). The minimum age of patients in the trial group was 18 years and the maximum age was 90 years. Among the 1556 analyzed cases in males, 27.44% (427) did not end with death (by the date of completing the analysis). The percentage of one-year survival for this population was 58.16%, and the 2-, 3-, and 5-year survival rates were 34.45%, 21.81%, and 9.72%, respectively. The percentage of censored cases in the 516 females was 25.78% (133). The 1-2-, 3-, and 5-year survival for this population was 59.30%, 36.27%, 22.47%, and 11.34%, respectively. Statistical tests did not reveal a significant difference in the curve profiles by sex. There were no associations between OS and age. CONCLUSIONS Systemic treatment with sorafenib in accordance with the presented criteria allows for very good results, comparable to the results of selected groups of patients presented by other authors.

Trends in psoriatic arthritis epidemiology in Poland.

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis, usually seronegative and associated with psoriasis (Ps). The prevalence and incidence of psoriatic arthritis show strong ethnic and geographic variations. The aim of the study was to assess the epidemiological trends in psoriatic arthritis in Poland. The National Health Fund (NHF) database for the period 2008-2018 was analyzed. PsA was defined as ICD-10 codes L40.5, M07, M07.0, M07.1, M07.2 and M07.3, while psoriasis as ICD-10 codes L40 and L40.X (L40.0 to L40.9). A steady increase in the number of PsA patients (from 16,790 to 32,644) and in PsA recorded prevalence (from 38.47 per 100,000 in 2008 to 73.11 per 100,000 in 2018) was observed between 2008 and 2018. The PsA/Ps ratio increased to a similar extent (from 8.3 to 17.5%). The percentage of PsA patients receiving rehabilitation services remained constant throughout the observation period (mean: 17.35%; range 16.7-18.9%). The study showed a steady and continuous increase in PsA recorded prevalence. A simultaneous increase in the PsA/Ps ratio suggests that the main reason for the observed trend is greater disease detection .

Prevalence of axial spondyloarthritis in Poland.

The prevalence of axial spondyloarthritis (axSpA) in the published data varies significantly. Two types of axSpA can be distinguished depending upon the presence of abnormalities consistent with sacroiliitis on plain radiography: ankylosing spondylitis (AS) and nonradiographic axial SpA (nr-axSpA). The aim of this study is to perform a retrospective analysis of axSpA prevalence in Poland in the years 2008-2017. The National Health Fund (NHF) database for the period 2008-2017 was analysed. Data of all patients with the ICD-10 codes M46 (M46.1, M46.8, M46.9) or M45 (further named other inflammatory spondylopathies-OIS and AS, respectively) as the main or co-existing diagnosis were extracted and analysed. The AS prevalence was stable during the period under examination amounting to approximately 0.083%, while the OIS prevalence increased from 0.036 to 0.059%. For both men and women, the AS prevalence increased with age, reaching a maximum around the age of 70; however, in men, a marked increase in prevalence was observed earlier as compared to women (20-24 vs. 40-44 years, respectively). The OIS prevalence also increased with age; however, the maximum was reached earlier as in case of AS. Moreover, a sharp increase in OIS prevalence occurred earlier than in AS (15-19 years) with no difference between sexes. In Poland, approximately 0.1% of the population suffers from AS-the prevalence remained stable over the last decade. The prevalence of OIS increased markedly over the studied period which presumably reflects an increasing prevalence of nr-axSpA as the effect of the introduction of ASAS classification criteria for axSpA.

Severe Depressive Episode with Psychotic Symptoms and Type 2 Diabetes: A 2010-2017 Longitudinal Study.

BACKGROUND There have been few studies published on the prevalence of severe depressive episode in people with type 2 diabetes (T2DM) or its role in adherence to dietary recommendations. We examined the Polish National Health Fund (NFZ) database estimates of all medical visits from 2010 to 2017 to determine the trend and the epidemiology of severe depressive episode in T2DM. MATERIAL AND METHODS The NFZ database was used. We defined the T2DM group diagnosed with both T2DM and severe depressive episode according to the ICD-10 codes. The annual prevalence of severe depressive episode was estimated according to the T2DM diagnosis status, and the age groups were stratified into 8 groups. RESULTS Relative risk for depression (regardless of severity of symptoms) in T2DM is 1.347 [95%CI: 1.342-1.353]. The frequency trend of severe depressive episode with or without psychotic symptoms remains relatively stable. In the case of mild and moderate depressive episode, a downward trend was noted, but they are still the most frequent mood disorders diagnosed. Patients with T2DM aged 20 to 40, for whom the peak of coexistence of these illnesses was noted, are the group particularly vulnerable to depression. Depression also remains on a relatively high but stable level for patients over 60 years of age. CONCLUSIONS The coexistence of depressive episodes in T2DM is a key challenge for medicine and public health. Measures aimed at early identification of patients with T2DM prone to depression need to be taken. Creating multidisciplinary care teams in diabetes management is also necessary.

Real-World Evidence of Patient Outcome Following Treatment of Advanced Gastrointestinal Stromal Tumor (GIST) with Imatinib, Sunitinib, and Sorafenib in Publicly Funded Health Care in Poland.

BACKGROUND This study aimed to undertake an analysis of ten years of real-world evidence (RWE) on overall survival (OS) following treatment of advanced gastrointestinal stromal tumor (GIST) with imatinib, sunitinib, and sorafenib using data from the Polish National Health Fund. MATERIAL AND METHODS Data from the Polish National Health Fund, the sole Polish public payer, identified 1,641 patients with advanced GIST who were treated with imatinib (n=1047), sunitinib (n=457), and sorafenib (n=137). The differences in overall survival (OS) were analyzed. RESULTS For patients with advanced GIST, the median follow-up time for patients treated with imatinib was 71 months (95% CI, 64.8-79.2), the median OS was 56.9 months (95% CI, 50.4-61.2), with survival at 12 months (89.5%), 24 months (77.9%), 36 months (66.9%), and 60 months (48.4%). The median follow-up time for patients treated with sunitinib was 41.4 months (95% CI, 34.6-49.3), the median OS was 22.8 months (95% CI, 19.2-26.8), with survival at 12 months (68.2%), 24 months (47.1%), and 36 months (31%). The median follow-up time for patients treated with sorafenib was 17.4 months (95% CI, 14.6-22.9), the median OS was 16.9 months (95% CI, 13.7-24.3), with survival at 12 months (61.9%), at 24 months (36.2%), and at 36 months (16.8%). CONCLUSIONS Real-world data collected in a ten-year period confirmed the effectiveness of the use of imatinib, sunitinib, or sorafenib for the treatment of advanced GIST and was comparable with the findings from clinical trials.

Analysis of the survival of patients receiving systemic treatment for melanoma of the skin: a retrospective population study with patients treated in Poland in 2011-2015.

INTRODUCTION: In Poland, it is uniquely possible to assess real effects of the introduction of new oncological therapies on the overall survival in patients as such therapies are funded by one payer only - the National Health Fund (NHF). Data collected by the NHF make it possible to analyse the survival of all patients who were diagnosed with melanoma. AIM: The paper presents findings of a retrospective analysis of the efficacy of systemic treatment in patients with malignant melanoma of the skin in Poland with regard to the overall survival. MATERIAL AND METHODS: The analysis of the overall survival was performed with the Kaplan-Meier method in the population receiving systemic treatment. Three groups of patients were analysed. Group 1 included all patients who had started systemic treatment between 1 March 2011 and 1 March 2015: 1,258 patients. The median overall survival was 8.4 months. Group 2 included 444 patients who had started systemic treatment between 1 March 2011 and 28 February 2013. The median overall survival was 6.6 months in this group. Group 3 included 814 patients who had started systemic treatment between 1 March 2013 and 1 March 2015 and included 546 patients who were also treated in drug programmes with ipilimumab and vemurafenib (approx. 67%). The median overall survival was 9.4 months. RESULTS: A difference in the overall survival between group 3 and 2 was statistically significant (p < 0.05). CONCLUSIONS: The introduction of vemurafenib and ipilimumab into systemic treatment in Poland using public funds had a significant effect on the prolongation of the overall survival in patients with malignant melanoma of the skin.

Epidemiology and direct costs of atopic dermatitis in Poland based on the National Health Fund register (2008-2017).

INTRODUCTION: Epidemiological data indicate significant differences in atopic dermatitis (AD) prevalence between countries. AIM: The purpose of this study is to (i) analyse the recorded prevalence of atopic dermatitis (diagnoses of AD reported to the Polish National Health Fund (NHF)) and to (ii) estimate direct costs of medical care for AD incurred by the NHF. MATERIAL AND METHODS: The analysis was based on data reported to the database of the public payer (NHF). The prevalence rates were calculated using the NHF data and population estimates were obtained from the Central Statistical Office of Poland (GUS). RESULTS: In 2017, the annual prevalence rate of AD in the Polish population was 32.5 per 10,000 inhabitants (34.7/10,000 for women and 30.1/10,000 for men). The highest prevalence was observed in the youngest age groups (300/10,000 in children up to 4 years of age and 141/10,000 in 5-9-year-olds). The prevalence rate decreased with age and AD was the least prevalent in patients over 85 years of age (4/10,000). In 2008-2017, NHF expenditure on AD treatment varied between PLN 19.9 million (EUR 5.6 million) in 2008 and PLN 28.4 million (EUR 6.5 million) in 2016. CONCLUSIONS: The prevalence rates of AD in Poland estimated on the basis of NHF data are significantly lower than those reported in previous epidemiological studies conducted in Poland and worldwide. This may indicate that the prevalence of AD in the Polish population is underestimated or that there are no adequate disease control measures in patients with a confirmed diagnosis.

Syphilis in Poland is on the rise and underreported.

INTRODUCTION: Despite the availability of diagnostic tests and effective treatment, there has been a problem with vigilance and reporting of that infectious disease in many countries including Poland. AIM: To compare the incidence of syphilis in Poland in years 2010-2016 according to the mandatory epidemiological surveillance system with the data of the National Health Fund (NHF). MATERIAL AND METHODS: Data of the NHF in Poland were collected. The total number of patients with syphilis (all forms) was estimated on the basis of their unique identifying numbers (PESEL). RESULTS: The steady increase in the incidence of syphilis in Poland throughout 2010-2016 was found, apart from the congenital form of the disease, which decreased since 2010. The higher prevalence of syphilis was noted in men. The number of hospitalized patients remained constant. According to the data of the NHF, the number of cases of syphilis in Poland was twofold higher as compared to the statistics of the mandatory epidemiological surveillance system (National Institute of Public Health - National Institute of Hygiene, NIPH-NIH), which was the basis of reports published up to date. CONCLUSIONS: Our work shows that there is a remarkable underreporting of syphilis in the mandatory epidemiological surveillance system in Poland, involving also hospitalized patients. The use of the data of NHF in the surveillance of syphilis in Poland is proposed.

A Ten-Year Longitudinal Study of Prevalence of Eating Disorders in the General Polish Type 2 Diabetes Population.

BACKGROUND Little has been reported regarding the epidemiology of eating disorders (EDs) in type 2 diabetes (T2DM). We examined the Polish National Health Fund-NFZ database estimates of all medical visits from 2008 to 2017 to determine the trend and the epidemiology of EDs in T2DM patients. MATERIAL AND METHODS The NFZ database were used. We defined the T2DM group diagnosed with both T2DM and EDs according to the ICD-10 codes. Demographic data were collected from the webpage of Statistics Poland (GUS). The annual prevalence of EDs was estimated according to the T2DM diagnosis status, and the age groups were stratified into 8 groups. RESULTS The prevalence of EDs in T2DM patients in the whole patient population with diagnosed T2DM ranged from 0.059% (in 2017) to 0.086% patients (in 2010). Differences in subcategories of EDs were noted. In the case of anorexia nervosa, a decreasing trend of coexistence with T2DM was noted. However, in the case of atypical anorexia nervosa, an increasing trend was observed. Both in the case of bulimia nervosa and atypical bulimia nervosa, an increasing trend of coexistence with T2DM was noted. As patients with T2DM age, the prevalence of EDs in T2DM decreased. CONCLUSIONS A relatively stable trend of prevalence of EDs in T2DM patients benefiting from state medical care indicated the need to develop effective screening methods and adequate procedures for therapeutic interventions with this group of patients using a multidisciplinary therapeutic team.

The assessment of overall survival (OS) after adjuvant chemotherapy for patients with malignant endometrial cancer in Poland.

OBJECTIVES: In 2013 malignant endometrial cancers have amounted to 7.3% of all cancers diagnosed among women in the report by the Polish National Cancer Registry Raw prevalence rate amounted to 28.7, whereas standardised prevalence rate 15.6 per 100 000 population. Among the causes of death, these cancers amounted to 3% and were ranked ninth on the list of the most common causes of oncologic mortality of women. In the year 2013 a total of 1243 women died of malignant endometrial cancers. A stable increase of malignant endometrial cancer incidence has been observed for 2 decades. Despite that fact, the increase of the mortality incidence is at a much lower level, which demonstrates the much higher effectiveness of the treatment of such cancers. The recording rate of the malignant endometrial cancer mortality amounts to 95%, so the presented absolute numbers are reliable. Examining the clinical stages of malignant endometrial cancers, we can establish that approx. 85% of them are diagnosed at stage I or II according to the FIGO classification. Patients with advanced stages of cancer represent less than 15%. MATERIAL AND METHODS: retrospective analysis of endometrial body cancer prevalence data for the entire population of Poland, assessment of malignant endometrial cancer prevalence in the years 2008-2015 and overall survival probability in the population of patients undergoing adjuvant chemotherapy. RESULTS: The number of patients with a diagnosed malignant endometrial cancer within the studied period in Poland remains on a stable level (2008 - 30.6 thousand patients, 2015 - 40.2 thousand patients). Among all listed patients with the indica-tion of C54 each year approx. 20% enters hospital treatment. System therapy with chemotherapy drugs was used in approx. 1-2% of patients treated in hospitals. The average age of the patients was 64.9 years, and the median age 65 years. The num-ber of observations was 2085, including 1088 censored observations. The average survival for the sample under study was 30.67 month (SD = ± 0.6); median survival time was 23.93 month. The number of censored observations was 1088 (52.16%). Probable survival of 1 year is achieved by 67.57% of patients, 2 years by 49.73%, 3 years by 40.68%, above 5 years 30.77%. CONCLUSIONS: The incidence of endometrial cancer in Poland in the years 2008-2015 continues to grow at 5% upward trend (in Europe 3.4-5.9). In Poland in 2012, crude incidence rate for cancer of the uterus was 29.8 and did not differ significantly from the results in countries such as Finland, Slovakia, Sweden, Belgium and Bulgaria. The overall survival after adjuvant chemotherapy for patients with malignant endometrial cancer in Poland shows considerable differences depending on the region of the country.

Prevalence of psoriatic arthritis and costs generated by treatment of psoriatic arthritis patients in the public health system - the case of Poland.

OBJECTIVE: The objective of the study was to analyse the prevalence of psoriatic arthritis (PsA) in Poland and to assess the costs generated by treatment of PsA patients in the system of public healthcare. MATERIAL AND METHODS: The analysis was based on the database of the public payer, the National Health Fund (NFZ). PsA was defined by the diagnostic ICD-10 codes M07 (Enteropathic arthropathies) and L40.5 (Psoriatic arthropathies). The estimate of the costs was based on the reports submitted to the NFZ by health service providers. The prevalence rates were calculated using the NFZ data and the population estimates from the Central Statistical Office of Poland (GUS). RESULTS: In 2015, the prevalence of PsA (ICD-10: L40.5 and M07) in Poland was 3.2 per 10 000 population (3.7 in women and 2.6 in men). In 2015, nearly 7.3 thousand patients with the diagnosis of M07 and 6.3 thousand patients with the diagnosis of L40.5 received healthcare benefits. Women accounted for 60.6% of those patients. Nearly three fourths of PsA patients were aged 40 to 69 years with the median age of 54 years (56 years in women and 50 years in men). Between 2008 and 2015 the NFZ expenditure on the treatment of PsA increased from 6.6 million Polish zloty (PLN) (1.9 million EUR) to PLN 50.8 million (12.1 million EUR). In the same period, the number of PsA patients increased from 3.4 thousand to 11.9 thousand. In 2015, the mean cost of treatment per PsA patient was PLN 3.8 thousand. CONCLUSIONS: The PsA prevalence rates estimated by the authors from the NFZ database are clearly lower than those derived from studies in other European countries, which may suggest that the actual number of PsA patients in Poland may be underestimated. Still the number of patients treated for PsA increased nearly 3.5-fold during 2008-2015, when the cost of PsA treatment rose more than 7 times.

Epidemiology of asthma in Poland in urban and rural areas, based on provided health care services.

INTRODUCTION: Asthma is a serious health and social problem, also in Poland. The epidemiological data indicate that the problem of asthma concerns approximately 4 million people in Poland, whereas almost approximately 70% of them have no diagnosis and are not aware of their illness, and on the other hand in 39% of persons who declared the diagnosis of asthma in a survey the diagnosis was negatively verified (overdiagnosis of asthma). So far, no detailed comparative studies for asthma incidence rate in urban and rural areas were conducted in Poland. The aim of the study was to analyze patients with asthma in Poland in the years 2008-2012, with regard to province and type of commune (rural/urban). MATERIAL AND METHODS: The study used data from National Health Fund (NFZ) - reported by health care providers regarding the patients diagnosed with asthma. Using structured query language (SQL) a set of patients was selected and created, for whom at the same time ICD-10 code: J45.X-bronchial asthma was reported. In order to estimate the number of patients with asthma we used the PESEL social security number as a unique identifier of the patient. Code of the patient's commune of residence in conjunction with the Central Statistical Office data formed the basis for the division of municipalities into urban and rural areas. The analysis of asthma incidence trends in Poland was performed on the basis of health services provided to patients. The analysis was performed by using the Statistica 10 software using a negative binomial regression model. RESULTS: In 2009 a significant increase in the number of patients with asthma was observed compared with the previous year, whereas after 2009 the number of patients diagnosed with asthma remained relatively constant. A significant increase of predominance of women among asthma patients in recent years can be noticed: from 107% in 2008 to almost 115% in 2012 (F:M ratio). Regardless of the analyzed year and the diagnosis the incidence rate remained constant: approximately 55-57% for urban areas and about 43-45% in rural areas. CONCLUSIONS: The average prevalence rate for rural areas is significantly lower than for urban areas. The use of adjusted incidence rate leads to the conclusion that the number of sufferers in urban areas is higher (about 10%) of the number of sufferers in the rural areas. The results of the analysis are consistent with information from previous studies in Poland and in the world.

Changes in the morbidity and costs of systemic lupus erythematosus in Poland in the years 2008-2012.

OBJECTIVES: The goal of the article is to present the changes in morbidity and costs of systemic lupus erythematosus (SLE) in Poland in the 2008-2012 period, depending on the province of residence of the patients based on data reported to the public payer - the National Health Fund. MATERIAL AND METHODS: Based on the ICD-10 code and the patient's personal identity number, the number of patients and medical costs (cost of hospitalization, pharmaceutical, medical procedures, dialysis and specialist consultations) were calculated by province (voivodeship) and urban or rural residence. RESULTS: Annually on average in the assessed period in Poland approximately 20 000 patients were diagnosed with SLE. The studied group was dominated by women (they were 5.2 times more numerous). The morbidity rate was 52.183 patients per 100 thousand inhabitants. Most patients were in the age range of 48-56 years. Average annual expenses for this group of patients over the examined period were USD 16,327 million. Two times more was expended on patients inhabiting cities, approximately 4 times more on women. Calculated per patient, the average cost of therapy was USD 810.63. CONCLUSIONS: The population of SLE patients in Poland is highly stable. The results of analysis indicate 1.64 times more frequent occurrence in urban areas, which may be connected with availability of doctors. The SLE treatment costs in Poland are much lower than in other countries, which is related mainly to the fact that therapy with biological drugs is not financed.

Costs of plasmocytic myeloma therapy in the drug programme at a Regional Oncology Centre in Poland.

INTRODUCTION: The rapidly growing market for drugs, including oncology and haemato-oncology drugs, is generating enormous financial expenditure for healthcare systems. In Poland, access to high-cost treatments is possible mainly within drug programmes, funded by public healthcare systems. The path of proceeding adopted in Polish regulations is similar to the solutions adopted in other countries. OBJECTIVE: The aim of this study was to demonstrate the actual costs incurred by the treatment entity in the process of treating patients under the drug programme at the Regional Oncology Centre in Olsztyn, north-east Poland. MATERIAL AND METHODS: The oncology drug programme B.54 'Treatment of patients with refractory or malignant plasmocytic myeloma' implemented at the Regional Oncology Centre in Poland between 2018-2021, was selected for the analysis. The choice of the B.54 programme was based on the small population of patients meeting the inclusion criteria for this programme, and the large number of diagnostic procedures stipulated in the drug programme description. On average, 25 patients were treated per year. The financial analysis used the financial categories related to hospital billing information. The costs were presented based on the purchasing power parity of money in 2021, i.e. 1 USD-inter is equivalent to 1.837 PLN. RESULTS: The flat rate form of financing medical services does not cover the actual costs of treatment. Providing patients with necessary medical services without their full coverage by the public payer, burdens the budget of the centre and may lead to indebtedness of the treatment entity. CONCLUSIONS: Without an increase in the valuation of benefits under drug programmes, corresponding to the actual costs of treatment, the expected increase in access to innovative therapies will be difficult to accomplish.

Epidemiology of multiple myeloma in Poland in the years 2008-2017.

Introduction: Multiple myeloma is the third most common blood cancer in Europe and accounts for approx. 10-15% of these cancers. The objective of this study was to determine the incidence, prevalence, mortality and survival in multiple myeloma (ICD code: C90.0) patients in Poland in the years 2008-2017. Material and methods: The analysis used the data on healthcare services provided to patients with multiple myeloma defined with the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) code C90.0 and reported by healthcare entities to the National Health Fund (NFZ). Results: In 2009, the C90.0 incidence per 100,000 inhabitants was 6.4, while in 2017 it was 8.3. The prevalence in the same period increased by 76%, from 13.6/100,000 to 23.9/100,000. The mortality to prevalence ratio gradually decreased from 78% in 2008 to 22.8% in 2017. The 1-year, 3-year and 5-year survival rates in patients with this diagnosis made in the years 2009 and 2013 were 70.5%, 51.5% and 40.2% versus 78.4%, 60.3% and 48.3%, respectively. Conclusions: The incidence and prevalence of multiple myeloma and survival rates in Poland were continuously increasing in the studied period. These trends may result from the aging of Polish society, better recognisability of multiple myeloma and/or improved access to increasingly more effective therapies in Poland. The impact of these factors on the epidemiology of multiple myeloma requires further studies.

Schizophrenic patients with type 2 diabetes: An 8-year population-based observational study.

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010-2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010-2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010-2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23-8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.

The problem of Lyme borreliosis infections in urban and rural residents in Poland, based on National Health Fund data.

INTRODUCTION AND OBJECTIVE: Some fragmentary studies show that the incidence of Lyme borreliosis in Poland is increasing. It has been generally accepted that the most affected are forestry workers and farmers. The aim of the study is to compare the incidence of borreliosis in urban and rural residents in 2008-2016. MATERIAL AND METHODS: Databases on Lyme borreliosis from the National Health Fund and Central Statistical Office in Poland were analyzed. For each patient, ambulatory or discharged from every hospital, the diagnosis was compulsorily reported as encoded following the International Classification of Diseases. RESULTS: A steadily increasing number of patients with borreliosis in Poland was found, which doubled in 2008 - 2016. The incidence was similar in urban and rural residents. In all the provinces in Poland, an increase in incidence of borreliosis was observed, although there were big differences between them. The highest frequency of borreliosis was in Podlasie and Warmia-Masuria provinces. The lowest incidence of borreliosis was noticed in Wielkopolska province. In the most provinces the increase in the incidence of borreliosis was steady, except Warmia-Masuria, where it was very low in 2008, and soaring since 2011. The number of cases per year between 2008 - 2016 increased in both in males and females. CONCLUSIONS: The results suggest the need for higher awareness of the risk of Lyme borreliosis in urban residents, because the incidence of Lyme borreliosis is growing independently of the place of residence. Prompt measures to prevent tick bites and appropriate education are urgently needed.

Overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib under drug programmes in Poland - real-world data.

INTRODUCTION: The aim of the study was to estimate the overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib. MATERIAL AND METHODS: Real-world patients who received afatinib, erlotinib or gefitinib between 1 July 2012 and 30 October 2017 were analysed in five subgroups. RESULTS: Among 267 patients treated with afatinib financed as the first line of treatment, 76 (28.46%) deaths occurred. Median observation time was 12.8 months (95% CI: 11.2-13.9). Median OS was 22.8 months (95% CI: 19.2-27.1). Among 83 patients who received erlotinib financed exclusively as the second line of treatment the number of deaths was 74 (89.16%). Median observation time was 64.3 months (95% CI: 60.4-64.6). Median OS was 16 months (95% CI: 13.2-22.9). Among 622 patients who received erlotinib financed both as first and second line treatment, there were 400 (64.3%) deaths. Median observation time was 33.3 months (95% CI: 31.2-37.6). Median OS was 17.8 months (95% CI: 16.4-19.7). Among 137 patients who received gefitinib financed only as the first line of treatment, there were 128 (93.4%) deaths. Median observation time was 58.3 months (95% CI: 49.4-62.5). Median OS was 16 months (95% CI: 13.8-19.7). Among 348 patients who received gefitinib financed both as the first and second line of treatment the number of deaths was 208 (59.8%). Median observation time was 23.7 months (95% CI: 20.7-28.7). Median OS was 15.5 months (95% CI: 12.9-17.5). CONCLUSIONS: Our real-world data regarding OS confirm the benefits found in clinical trials from the use of afatinib, erlotinib or gefitinib. However, the lower overall survival rate of Polish patients compared to similar studies from other research centres suggests the need for deeper investigation of this issue.

Relationship between age and in-hospital mortality during 15,345,025 non-surgical hospitalizations.

INTRODUCTION: Mortality, whether in or out of hospital, increases with age. However, studies evaluating in-hospital mortality in large populations did not distinguish between surgical and non-surgical causes of death, either in young or in elderly patients. The aim of the study was to assess in-hospital non-surgical mortality in a large group of patients, with a special focus on the elderly. MATERIAL AND METHODS: Data from the database of the Polish National Health Fund (NHF) regarding hospitalizations of adult (≥ 18 years) patients not related to surgical procedures in the years 2009-2013 were used to assess in-hospital mortality. RESULTS: 15,345,025 hospitalizations were assessed. The mean in-hospital non-surgery-related mortality rate was 3.96 ±0.17%, and increased from 3.79% to 4.2% between 2009 and 2013. The mean odds ratio for in-hospital death increased with the age of patients, reaching a 229-fold higher rate in the ≥ 95 years age group as compared to the 18-24 age group. The highest mean mortality was associated with respiratory diseases (6.91 ±0.20%), followed by heart and vascular diseases, nervous system diseases, as well as combined gastrointestinal tract, liver, biliary tract, pancreas and spleen diseases (5.65 ±0.27%, 5.46 ±0.05% and 4.01 ±0.13%, respectively). CONCLUSIONS: The in-hospital non-surgery-related mortality rate was approximately 4%. It significantly increased with age and, regardless of age, was highest in patients suffering from respiratory diseases.